Active Case Finding for Tuberculosis among Health Care Workers in a Teaching Hospital, Puducherry, India.

Background: Health care workers (HCWs) are at risk of acquiring tuberculosis (TB) infection and disease due to occupational exposure. But there are no national guidelines on routine screening for TB (active case finding (ACF)) among HCWs and understand its implementation and feasibility. Methods: This study was conducted among HCWs in a teaching hospital in India. We used symptom screening to identify those with presumptive TB and were further evaluated for diagnosis of TB. Results: A total of 1,001 HCWs were screened over a period of 18 months. In our study, 51 (5.1%) HCWs were found to have presumptive TB and on further evaluation, 5 (0.5%) of these patients were diagnosed with active TB. The number needed to screen (NNS) for one active TB among the HCWs was 200. Alcohol use was significantly associated with both presumptive TB (P = 0.037) and active TB (P = 0.035) among HCWs, and exposure to active TB patients (P = 0.014) in the family and workplace and increased frequency of exposures (P = <0.001) were associated with presumptive TB. Conclusion: ACF for TB among HCWs had a good yield in our study. ACF utilizing routine national TB program guidelines is feasible to be implemented among HCWs to aid in the early diagnosis and treatment of TB in this high-risk group.

A tale of three in symbiosis: TB-COVID-19-Bordetella coinfection.

Coinfections/mixed infections are common in the respiratory tract. Many times existing organisms have similar risk factors and clinical features that make the diagnosis difficult. Coronavirus diagnosed in 2019 (COVID-19) and tuberculosis (TB) are two such diseases. Patients with TB have lower cellular immunity and impaired pulmonary function. In such environment, atypical organisms, can infect and make the outcome unfavorable. A 21-year-old malnourished (body mass index- 15 kg/m2) girl presented with fever and cough for 10 days. Sputum for Cartridge Based Nucleic Acid Amplification Test demonstrated Mycobacterium tuberculosis with no rifampin resistance. Fever persisted (100-101°F) and saturation was dropping even after 10 days of antitubercular treatment. A repeat reverse transcription-polymerase chain reaction was done and was positive. In view of persistent symptoms after 20 days, bronchoscopy was done, and cultures showed Bordetella bronchiseptica. Fever and symptoms resolved completely after initiation of the sensitive drug. Diagnostic delay in coinfections can lead to increased morbidity and mortality.

Coexistence of human immunodeficiency virus, active pulmonary tuberculosis, and aspergilloma: A rare entity.

Tuberculosis (TB) constitutes a significant burden of infectious diseases worldwide. TB and human immunodeficiency virus (HIV) coinfection potentiate each other, which has a negative impact on the disease progression. Aspergillus colonizing a preexisting parenchymal tubercular cavity is referred to as aspergilloma. Aspergilloma occurring in a patient with active TB is unusual. We report the case of a 50-year-old male who presented to us with complaints of cough and recurrent hemoptysis for 3 months. Clinical and radiological examination revealed right upper lobe aspergilloma. A right upper lobectomy was done and a histopathological examination showed evidence of active TB. The patient was started on antitubercular therapy (ATT) followed by antiretroviral therapy (ART). The presence of active TB should not be overlooked in a patient with aspergilloma, especially in immune-compromised individuals such as people living with HIV, as definitive treatment with surgical resection, and ATT along with ART has better outcomes.

Pyopneumothorax of unusual aetiology.

A 50-year old diabetic male presented with cough, breathlessness, fever, and chest pain. Clinical and radiological evaluation revealed a right-sided pyopneumothorax. Surgical drainage with tube thoracostomy was performed. Pleural fluid cultures grew Enterococcus fecium as a sole organism. Our patient was treated with vancomycin and amikacin with an excellent clinical response. Enterococci are rarely implicated in the lower respiratory tract and pleural infections and are not usually considered if initiating empirical treatment. Their intrinsic resistance to empirically used antibiotics may complicate the course of the disease. Hence initial Gram staining and expeditious microbiological isolation with susceptibility testing is warranted in all cases. Gram-positive aerobes, notably staphylococcus followed by streptococcus and pneumococcus, are the commonly encountered organisms in pleural infections.

Simple micro-drainage system for palliation of severe subcutaneous emphysema.

Subcutaneous emphysema (SE) occurs when air enters the tissues under the skin and passes into the soft tissues. We demonstrated a simple, minimally invasive technique for treating extensive SE, using a readily available infant nasogastric tube, in a mechanically ventilated patient.