A cross-sectional study of etiological and sensitivity profiling of meningitis in under-five children.

Objectives: The study aimed to understand the organism spectrum and antibiotic sensitivity profile of acute bacterial meningitis in pediatric population. Methods: A cross-sectional study was conducted at the department of microbiology of a tertiary care center for a period of 18 months. Suspected cases of meningitis between 1 and 60 months of age were considered for the study. All cases underwent cerebrospinal fluid tap for direct microscopy (DM), Gram staining, and culture sensitivity. Results: The mean age of the study patients was 10.42 months, with 61.7% of males and 38.3% of females. DM and culture were positive in 22.90% and 28.00% of the patients, respectively. On Gram stain, there were 29 (59.18%) cases of Gram positivity and 20 (40.82%) cases of Gram negativity. The culture growth showed that Acinetobacter spp. was isolated in 15 (30.6%) of the cases. Enterococcus spp. was isolated in 9 (18.4%) of the cases. Klebsiella pneumoniae was isolated in 8 (16.3%) of the cases. Staphylococcus aureus was isolated in 8 (16.3%) of the cases. Enterobacter spp. was isolated in 3 (6.12%) of the cases. Pseudomonas aeruginosa was isolated in 3 (6.12%) of the cases. Streptococcus pneumoniae was isolated in 3 (6.1%) of the cases. The antibiogram of different agents showed wide variation, with colistin being 100% sensitive for Acinetobacter, Enterobacter, K. pneumoniae, and P. aeruginosa. Conclusion: The present study revealed that Acinetobacter, Enterococcus, K. pneumoniae, and S. aureus were the most common bacterial etiologic agents of ABM. The 100% antibiotic sensitivity of the organisms to some antibiotics may suggest the use of such antibiotics while awaiting for culture sensitivity reports.

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy.

CONTEXT: The diagnosis of mediastinal lymphadenopathy is always a challenge. There always a need of a technique that is highly accurate as well as safe for diagnosis the same. AIMS: The aim of the study is to assess the clinical usefulness and safety profile of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing the patients with mediastinal lymphadenopathy. SETTINGS AND DESIGN: This was an observational prospective study. SUBJECTS AND METHODS: One hundred adult patients with mediastinal lymphadenopathy who underwent EBUS-TBNA with aspirate obtained from the most hypoechoic lymph node (with a 22 gauge needle) and its cytopathological analysis were included in the study. Patients were observed for postprocedure complications. RESULTS: Out of 100, 92 cases were reported as adequate (diagnostic yield = 92%). Among these 92, there were 71 granulomatous lymphadenitis (tuberculosis [TB] = 41 [44.5%], sarcoid-like granuloma = 30 [32.2%]). Malignancy was reported in 16 (17.3%) patients, and 5 (5.43%) were reported to have reactive lymphadenopathy. There was one case each of Mycobacterium avium complex and Mycobacterium abscessus. Out of 16 cases of malignancy, six cases were adenocarcinoma, four cases of squamous cell carcinoma, and two cases of small cell carcinoma. There were three cases of Hodgkin's lymphoma and one case of non-Hodgkin's lymphoma. No major complications were noted, except fever (26), nausea (20), mild bleeding (4), bronchospasm (3), and transient intraprocedural hypoxia (2). CONCLUSIONS: EBUS-TBNA is highly accurate (diagnostic yield 92%) and safe procedure for diagnosing mediastinal lymphadenopathy. In our experience, granulomatous lymphadenitis was most common with TB as the main etiology.

Asbestos-induced lung disease in small-scale clutch manufacturing workers.

BACKGROUND: The crocidolite variety of asbestos is banned. However, chrysotile, which is not prohibited, is still used in developing countries in making products such as clutch plate. Fourteen workers from a small-scale clutch plate-manufacturing factory were analyzed for asbestos-induced lung disease as one of their colleagues had expired due to asbestosis. AIMS: This study was conducted to evaluate the awareness of workers, the prevalence and type of asbestos-induced lung disease, and the sensitivity and specificity of diffusion test. MATERIALS AND METHODS: History, examination, chest radiograph, spirometry with diffusion, and high resolution computed tomography (HRCT) thorax was performed in all the workers. The diagnosis of asbestos-induced lung disease was suspected on the basis of HRCT. This was subsequently confirmed on transbronchial lung biopsy (TBLB). RESULTS: None of the workers had detailed information about asbestos and its ill effects. Eleven out of 14 (71.42%) workers had asbestos-induced lung disease. All 11 had small airway disease (SAD). Three had SAD alone, 6 had additional interstitial lung disease (ILD), and 2 patients had additional ILD and chronic obstructive pulmonary disease. Sensitivity and specificity of residual volume (RV) or total lung capacity (TLC) for detecting SAD was 90% and 100%, respectively, and that of diffusion capacity of lung for carbon monoxide (DLCO) for detecting ILD was 100%. CONCLUSION: The awareness about asbestos in small-scale clutch-plate manufacturing industry is poor. The usage of chrysotile should be strictly regulated as morbidity and mortality is high. DLCO and RV/TLC are sensitive and specific in detecting nonmalignant asbestos induced lung disease.