OMICRON (B.1.1.529) SARS-CoV-2 variant-Latest addition in the battle ground!!!

Background: Fungal colonisation of airways in Post TB patients, can lead to a spectrum of diseases based on the immune response of the host. This study was aimed at studying the different entities of this spectrum. Methods: A cross sectional observational study was conducted over 100 patients of post TB patients to make an observation of the diseases of the spectrum of Aspergillus infections. Results: Of the 100 patients who were studied, IPA was found in 24 (48%), ABPA in 13 (26%), CPA in 5 (10%) patients out of the 50 diabetics. ABPA in 23 (46%) patients, Simple colonization, CPA in 11 (22%) and 4 (8%) patients showed IPA out of the 50 non-diabetics. Conclusion: Chronic pulmonary Aspergillosis was the most common disease from Aspergillus among Post TB patients. Diabetes was associated with invasive forms of Aspergillosis, Invasive Pulmonary Aspergillosis (IPA) and subacute invasive pulmonary aspergillosis (SAIA).

Spectrum of Aspergillus infections in post TB patients

Background: Fungal colonisation of airways in Post TB patients, can lead to a spectrum of diseases based on the immune response of the host. This study was aimed at studying the different entities of this spectrum. Methods: A cross sectional observational study was conducted over 100 patients of post TB patients to make an observation of the diseases of the spectrum of Aspergillus infections. Results: Of the 100 patients who were studied, IPA was found in 24 (48%), ABPA in 13(26%), CPA in 5(10%) patients out of the 50 diabetics. ABPA in 23 (46%) patients, Simple colonization, CPA in 11(22%) and 4 (8%) patients showed IPA out of the 50 non-diabetics. Conclusion: Chronic pulmonary Aspergillosis was the most common disease from Aspergillus among Post TB patients. Diabetes was associated to invasive forms of Aspergillosis, Invasive Pulmonary aspergillosis (IPA) and subacute invasive pulmonary aspergillosis (SAIA).

Rapid detection of drug-resistant Mycobacterium tuberculosis directly from clinical specimens using allele-specific polymerase chain reaction assay

Background & objectives: Rapid detection of drug resistance in Mycobacterium tuberculosis (MTB) is essential for the efficient control of tuberculosis. Hence, in this study a nested-allele-specific (NAS) PCR, nested multiple allele-specific PCR (NMAS-PCR) and multiple allele-specific (MAS) PCR assays were evaluated that enabled detection of the most common mutations responsible for isoniazid (INH) and rifampicin (RIF) resistance in MTB isolates directly from clinical specimens. Methods: Six pairs of primers, mutated and wild type, were used for the six targets such as codon 516, 526 and 531 of rpoB, codon 315 of katG and C15-T substitution in the promoter region of mabA-inhA using allele-specific (AS) PCR assays (NAS-PCR, NMAS-PCR and MAS-PCR). The performance of AS PCR method was compared with phenotypic drug susceptibility testing (DST). Results: The usefulness of AS PCR assays was evaluated with 391 clinical specimens (251 Acid fast bacilli smear positive and MTB culture positive; 93 smear negative and MTB culture positive; 47 smear positive and MTB culture negative) and 344 MTB culture positive isolates. With culture-based phenotypic DST as a reference standard, the sensitivity and specificity of the NAS-PCR, NMAS-PCR and MAS-PCR assay for drug resistance-related genetic mutation detection were 98.6 and 97.8 per cent for INH, 97.5 and 97.9 per cent for RIF and 98.9 and 100 per cent for multidrug resistance (MDR). Interpretation & conclusions: The performance of AS PCR assays showed that those could be less expensive and technically executable methods for rapid detection of MDR-TB directly from clinical specimens.

Clinicohistological disparity in leprosy.

A healthy elderly man presented with localized isolated erythematous tender, anesthetic, oval plaque with little scaling near the medial angle of right eye, of 3 years' duration without any obvious nerve thickening, treated irregularly with WHO MDT for 3 months, clinically simulating BT leprosy with downgrading reversal reaction. Histology showed a BL granuloma with plenty of solid staining AFB within the foamy macrophages. Lepromin test was very weakly positive. The case is discussed in the light of clinicohistological disparity in leprosy cases with review of relevant literatures. A stress is laid on the importance of newer MDT in such cases to prevent drug-resistance, relapse and recurrence.

Adrenocortical insufficiency in smear positive pulmonary tuberculosis.

We studied 40 patients with pulmonary tuberculosis. All were positive for acid-fast bacilli (AFB) in the sputum. Their mean age was 30 yrs (range 10-50 yrs) and the duration of illness was 26.3 +/- 2.3 months. Radiologically minimal, moderately advanced and far advanced lesions were present in 7 (17.5%), 9 (22.5%) and 23 (57.5%) patients respectively. One patient with endobronchial lesion had no radiological evidence of pulmonary tuberculosis. Clinically, 14 patients (35%) had one or the other features of adrenocortical insufficiency. Postural hypotension was the commonest feature and was present in 11 patients (27.5%), followed by nausea and vomiting (20%), loss of axillary hair and libido (10%), skin and mucosal pigmentation in 7.5% of the cases. ACTH stimulation revealed incomplete adrenocortical insufficiency (partially responsive adrenal) in 5 patients (12.5%) and complete adrenocortical insufficiency (non-responsive adrenal) in 2 patients (5%). Patients with features of adrenal insufficiency had significantly longer duration of illness (p < 0.001) but there was no correlation with extent or type of lesion.

Primary drug resistance to both rifampicin and dapsone in a paucibacillary leprosy patient.

A thirty-one year old male patient was diagnosed and treated for a pure or better primary neuritic case of leprosy with dapsone (100 mg daily for 2 years) and rifampicin (600 mg daily for 6 months). From the very outset, the patient did not show any improvement; on the top of it, he subsequently, developed a cutaneous patch, which on histopathological examination, revealed classical features of BT leprosy. Acid-fast bacilli were absent both in skin slit smear and histologic section. A primary resistance to both dapsone and rifampicin, even in paucibacillary patient, is speculated.

Lipomeningocoele masquerading as leprous trophic ulcers.

Trophic ulcers over both feet in a 24 years old male were initially diagnosed as of leprous etiology. However detailed investigations revealed spina bifida and lipomeningocoele over sacral region. Importance of thorough neurological investigations in such cases is stressed to avoid mis-diagnosis of leprosy.

Erythema nodosum leprosum (ENL) in histoid leprosy.

The morphological features of ENL, occurring in histoid leprosy are described. Its infrequent occurrence has been emphasised. The possible immunopathogenesis of its occurrence in histoid leprosy is briefly outlined.