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.

Primary pulmonary T-cell lymphoma.

Primary pulmonary lymphoma (PPL) is a rare clonal proliferation of lymphoid tissue involving one or both lungs. It is of two types, B-cell and T-cell lymphomas among which T-cell lymphoma is a rare entity and it is sparsely considered as a differential diagnosis in neoplastic lesions of the lung. Here, we are reporting a case of primary pulmonary T-cell lymphoma. PPL is a rare disease and can present with nonspecific symptoms. Radiologically, it can easily be confused with more common malignancies such as bronchogenic carcinoma with or without metastases. PPL carries different therapeutic and prognostic implications. Therefore, physicians should make every effort to achieve histopathological diagnosis before prognosticating a patient presenting with lung cancer.

Pulmonary melioidosis complicating foreign body aspiration in a young adult.

Melioidosis is caused by an environmental Gram-negative bacilli Burkholderia pseudomallei. Diabetes mellitus, occupational exposure to soil and water, pre-existing renal diseases and thalassemia are significant independent risk factors for melioidosis. A 30-year-old male carpenter and smoker had a history of accidental aspiration of foreign body 2 months prior. On presentation, he had cough with expectoration and low-grade intermittent fever for 1 month. His chest x-ray displayed left lower zone consolidation with cavitation and presence of foreign body in the left lower lobe bronchus. Bronchoalveolar lavage inoculated onto 5% sheep blood agar and MacConkey agar grew B. pseudomallei. Melioidosis due to foreign body aspiration is rare. To the best of our knowledge, there have not been reports of melioidosis infection associated with foreign body inhalation. Hence, pulmonary melioidosis can be considered as a differential diagnosis in cases of foreign body with secondary infection even in immunocompetent host.

Varied foci of primary benign schwannoma of the thorax: a case series.

Schwannomas are the most common tumor of peripheral nerves. It comprises 1 to 2% of total thoracic tumor. Posterior mediastinum is the most common site in thorax. Hereby we are reporting two cases of schwannoma with different sites of origin. The classical presentation of schwannoma is an asymptomatic mass found on chest radiograph. This tumor is usually benign and slow growing. Imaging followed by histopathological examination is key to the diagnosis of this neoplasm. Resection of tumor cures the disease.

Streptomyces pneumonia in an immunocompetent adult - a rare isolate.

Streptomyces belongs to the Actinomycetes group of bacteria which are gram-positive non acid-fast bacilli, widely recognised for their potential to produce antimicrobials active against bacterial, mycobacterial, parasitic and fungal infections. They commonly cause cutaneous infections following traumatic inoculation. Visceral infections are relatively rare and limited to immunocompro-mised hosts. We describe a case of Streptomyces pneumonia in a healthy immunocompetent female, who when investigated for voluntary kidney donation, resulted in the isolation of Streptomyces species from bronchial wash cultures. Streptomyces, a potential pathogen in immunocompetent hosts is frequently underdiagnosed. Once isolated, both physicians and microbiologists should pay attention to differentiate true infection from contamination.