Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study / Medidas de confinamento específicas de cada país em resposta à pandemia de COVID-19 e seu impacto no controle da tuberculose: um estudo global

ABSTRACT The objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.

RESUMO O objetivo deste estudo foi descrever as medidas de confinamento específicas de cada país e os indicadores de tuberculose coletados durante o primeiro ano da pandemia de COVID-19. Dados referentes a confinamento/restrições sociais (uso obrigatório de máscaras faciais e higiene obrigatória das mãos; restrições a viagens internacionais e locais; restrições a visitas familiares e fechamento das escolas) foram coletados de 24 países em cinco continentes. A maioria dos países implantou múltiplos confinamentos, com reabertura parcial ou total. Houve uma redução geral dos casos de tuberculose ativa, tuberculose resistente e tuberculose latente. Embora os confinamentos nacionais tenham sido eficazes na contenção dos casos de COVID-19, vários indicadores de tuberculose foram afetados durante a pandemia.

Poncet's Arthritis in a Patient with Multidrug-Resistant Tuberculosis.

A 17-year-old female diagnosed to have multidrug-resistant pulmonary tuberculosis (MDR-TB), presented with Poncet's arthritis which responded to second-line anti-TB treatment. Poncet's disease is more commonly present in association with extra-pulmonary TB and involves large and small joints. However, our patient had pulmonary MDR-TB and small joint involvement.

Eosinophilic Granulomatosis with Polyangitis Presenting as Cardiac Tamponade.

Eosinophilic granulomatosis with polyangitis (EGPA; earlier called Churg-Strauss syndrome) is a small-vessel necrotising vasculitis typically characterised by asthma, lung infiltrates, extra-vascular necrotising granulomas and hyper-eosinophilia. Cardiac disease is a major contributor to disease-related deaths in EGPA. We describe the case of a 39-year-old woman with late onset asthma, allergic rhinosinusitis, and high extra-vascular and peripheral blood eosinophilia, presenting with peripheral neuropathy and pericardial effusion. Early therapy with intravenous corticosteroids led to resolution of the pericardial effusion and significant clinical improvement. The present case also highlights the importance of being vigilant about potentially fatal cardiac complications in patients with EGPA.

Tropical pulmonary eosinophilia - A review.

Tropical pulmonary eosinophilia (TPE) is a syndrome of wheezing, fever and eosiniphilia seen predominantly in the Indian subcontinent and other tropical areas. Its etiological link with Wuchereria bancrofti and Brugia malayi has been well established. The pathogenesis is due to an exaggerated immune response to the filarial antigens which includes type I, type III and type IV reactions with eosinophils playing a pivotal role. Peripheral blood eosinophilia is usually striking with levels over 3000/μl being common. High serum levels of IgE and filarial-specific IgE and IgG are also found. The pathology may vary from an acute eosinophilic alveolitis to histiocytic infiltration depending on the stage of the disease. While earlier studies had suggested that the disease runs a benign course, more recent work has shown that untreated TPE could result in a fair degree of respiratory morbidity. Pulmonary function tests may show a mixed restrictive and obstructive abnormality with a reduction in diffusion capacity. The bronchoalveolar lavage (BAL) eosinophil count has a negative correlation with the diffusion capacity. Treatment consists of diethylcarbamazine (DEC) for at least three weeks. Despite treatment with DEC, about 20 per cent of patients may relapse. Steroids have shown to have a beneficial effect but the exact dose and duration is yet to be confirmed by randomized controlled trials. A specific and easily available marker is required for TPE in order to distinguish it from other parasitic and non-parasitic causes of pulmonary eosinophilia.

Exacerbations of chronic obstructive pulmonary disease: An Indian perspective.

Background. Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death by 2020. Recent studies reveal that pulmonary embolism (PE) may be a trigger of acute deterioration in patients with COPD. Patients with COPD have approximately twice the risk of PE than those without COPD. Objective. The primary objective was to assess the prevalence of venous thromboembolism (VTE) in patients with acute exacerbation of COPD (AE-COPD) in India. Methods. We conducted this prospective study on patients admitted for AE-COPD in a tertiary care hospital in Mumbai, India. We considered the prevalence of deep venous thrombosis (DVT) to reflect the occurrence of VTE. The screening tool used was a colour Doppler of the bilateral lower limbs. Results. One hundred patients enrolled, were in stage II to stage IV COPD; 9% had DVT. Eight of these nine patients had unilateral DVT. Two patients had developed PE and died. Conclusions. Our results show a lower prevalence of unsuspected DVT in Indian patients admitted for AE-COPD. Future prospective, randomised studies are needed to confirm the findings of the present study and to determine whether a systematic evaluation for VTE is justified in these patients, and hence, be recommended.

Pulmonary manifestations in inflammatory bowel disease: a prospective study.

Background Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known. Aim To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD. Methods Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status. Results Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p<0.0001). Small airway obstruction was seen in 18 patients, restrictive defect in six and mixed defect in three. Twenty-one (22%) patients had abnormal HRCT findings – bronchiectasis and nodules (nine patients each, including one with nodules who later developed active tuberculosis after infliximab therapy), parenchymal bands (8), mediastinal lymphadenopathy (five, including two with tuberculosis on histology and culture), emphysema (5), brochiolitis (2), pleural effusion or thickening (2), pericardial effusion (2), patchy consolidation (1), ground-glass opacities (1) and lung metastasis (1). Three patients had symptoms (one asthma, two cough). Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.

Retrospective study of interstitial lung disease in a tertiary care centre in India.

Background. There has been a recent surge in the recognition of interstitial lung disease (ILD) in India. Methods. We conducted a retrospective study based on the available medical records of 274 patients with biopsy proven ILD seen during the period 1994-2001 at our tertiary care referral hospital. Results. Idiopathic pulmonary fibrosis (43%), sarcoidosis (22%), ILDs secondary to collagen vascular disease (19%) and extrinsic allergic alveolitis, among others, were the most common aetiological causes of ILD. The diagnostic yield from transbronchial lung biopsy (TBLB) was high (96%). Conclusions. Interstitial lung diseases (ILDs) appear to be under-reported from India. Lack of recognition and inadequate availability of diagnostic facilities, like high resolution computed tomography (HRCT) of the chest may be some of the reasons for this. The diagnostic yield from TBLB in our study was high at 96 percent. The TBLB may be used as the initial, cost-effective and safe tool for confirmation of aetiological diagnosis in most patients with diffuse parenchymal lung diseases.

A 12-year-old girl with hodgkin’s disease presenting as a non-resolving pneumonia and an endobronchial nodule.

The presence of a non-resolving pneumonia warrants the suspicion of a possible malignancy. While pulmonary involvement in Hodgkin’s disease can present as a non-resolving pneumonia, the clinical clues of dyspnoea, stridor and wheeze point to a possible endobronchial involvement. A bronchoscopy in such a situation can be valuable for diagnosis, and can aid in staging of the disease. The true incidence of endobronchial involvement in Hodgkin’s disease is not known, but when diagnosed early and treated appropriately, the prognosis is usually good, and a complete cure is possible.

Resection of a endobronchial hamartoma by electrocautery and argon plasma ablation via fiberoptic bronchoscopy.

Endobronchial hamartoma is a rare benign tumour of the lung that may present with bronchial obstruction. We present a case of endobronchial hamartoma that was resected and ablated with electrocautery and argon plasma coagulation by fiberoptic bronchoscopy.