An interesting case of pulmonary infiltrates with eosinophilia: out of sight out of mind.

Tropical pulmonary eosinophilia should be considered in patients presenting with respiratory symptoms and hypereosinophilia, even in areas not endemic for filariasis. This awareness may prevent morbidity associated with its late or wrong diagnosis. https://bit.ly/3t8hHVc.

An uncommon cause of pleural effusion.

Pleural effusions are associated with various aetiologies: systematic evaluation is needed to reach a correct diagnosis. In 20% of cases the aetiology of exudative pleural effusion is elusive and pleural biopsy is required to reach a diagnosis. http://bit.ly/2HyZGVZ.

Pleural effusion in acute pulmonary embolism in Bahrain: Radiological and pleural fluid characteristics.

BACKGROUND AND OBJECTIVES: Pleural effusion is seen in around half of the cases of pulmonary embolism (PE). There are no data on the incidence of pleural effusion in cases of PE in the Kingdom of Bahrain. This study was done to determine the frequency and radiological features of pleural effusion in cases of acute PE and also to characterize the pleural fluid biochemistry and cell type in patients subjected to diagnostic thoracentesis. METHODS: This was a retrospective, observational single-center study. All the data of patients subjected to computed tomography pulmonary angiography (CTPA) in suspected cases of acute PE over a 4-year period were analyzed. RESULTS: A total of 1756 patients were subjected to CTPA from January 2013 to December 2016. A diagnosis of acute PE was made in 200 patients (11.4%). Pleural effusion was identified in 70 cases (35%). Majority of the effusions were small to moderate in size, bilateral, and associated with peripheral emboli. Consolidation, atelectasis, and ground glass attenuation were common associated findings on CTPA in these patients. Consolidation was more common in patients of PE associated with pleural effusion as compared to those with PE alone (62.85% and 33.8%, respectively, odds rato: 3.279 and 95% confidence interval: 1.798-6.091, P < 0.001). Diagnostic thoracentesis was done in 6 (8.6%) of the cases. All the patients had an exudative effusion with normal glucose values and neutrophil predominance. CONCLUSION: PE was associated with pleural effusion in around one-third of the patients in Bahrain. The effusions were mainly small and bilateral. The emboli in cases associated with pleural effusion were mostly peripheral. Consolidation was the parenchymal abnormality detected on CTPA which was significantly associated with the presence of pleural effusion. Most of the pleural effusions were not suitable for thoracentesis. In patients subjected to fluid analysis, the effusions were exudative, neutrophilic predominant, and associated with normal glucose levels.

Allergic aspergillosis in asthmatic patients in a tertiary hospital in the Kingdom of Bahrain.

BACKGROUND INFORMATION: Aspergillosis is an alarming complication in asthma, leading to worsening symptoms and irreversible lung damage. It is underdiagnosed among asthmatics worldwide, especially in our geographical region. AIM: This research was aimed to shed some light on the prevalence of Aspergillus sensitization and allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients in the Kingdom of Bahrain. IMPORTANCE: This project has never been conducted in the region and hopefully will lead to a better care for asthmatics. METHODOLOGY: Our study population consisted of adult outpatients visiting the pulmonary and chest diseases clinic at Al-Salmaniya Medical Complex (SMC); the main inclusion condition was manifesting respiratory distress symptoms related to one or more respiratory tract diseases. 152 individuals were selected; the study group consisted of 119 asthmatic patients manifesting respiratory distress. The control group consisted of 33 nonasthmatic patients that manifested pulmonary distress symptoms due to respiratory tract diseases other than asthma like chronic obstructive pulmonary disease, bronchitis, among others. Sera samples were collected in SMC and analyzed via Phadia-250 fluoro-enzyme-immunoassay to determine the levels of Aspergillus fumigatus-specific IgE. The rAsp f1 antigen was used against IgE. RESULTS: Our results indicated a 16% prevalence of A. fumigatus sensitization in asthmatics; also, 75.6% of asthmatics were sensitized to pollen grains, and 22.3% reported one or many food allergies. Furthermore, details of patients with significant levels of A. fumigatus- specific IgE were analyzed, and ABPA prevalence was estimated to be 10.1% in asthmatics. CONCLUSION: Increasing awareness toward these indolent diseases is required, as well as, more efforts in determining the burden of aspergillosis in other parts of the region.

An interesting case of undiagnosed pleural effusion.

Pulmonary embolism is an important cause of undiagnosed pleural effusion http://ow.ly/HDLx30bVVa7.

A 43-year-old patient presenting with marked eosinophilia and multisystem disease.

A middle-aged male presenting with marked eosinophilia and multisystem disease http://ow.ly/Z7JX301ABjF.

Acute Q Fever Pneumonia.

Q fever is a zoonotic disease caused by Coxiella burnetii which has a worldwide distribution. Pneumonia occurs in almost half of the patients who have an acute C. burnetii infection. Less than 5-6% of community acquired pneumonia (CAP) is found to be caused by this organism. Endemicity of C. burnetii infection has been recorded in various studies carried out in our country. However there is no mention about Q fever as a cause of CAP in the various studies done to identify the aetiological agent. We report a case of acute Q fever related pneumonia and this appears to be the first reported case of pneumonia due to C. burnetii infection in India.