Role of GeneXpert in the diagnosis of mycobacterium tuberculosis

Introduction: GeneXpert (GX) is a novel, integrated, cartridge-based, nucleic acid amplification test with an established role for rapid diagnosis of Mycobacterium tuberculosis and detection of rifampicin resistance.Aim: To evaluate the role of GX in pulmonary and extrapulmonary tuberculosis (TB) cases.Material and methods: A prospective study was conducted in the pulmonary medicine department of a tertiary care hospital after the Ethics Comittee permission. Data of 257 presumptive TB patients was retrieved for GX, acid fast bacilli smear and cul-ture (AFB smear and culture) and drug susceptibility test (DST). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of GX in diagnosis and determination of rifampicin resistance in pulmonary and extrapulmonary TB cases were calculated and compared with culture and DST results.Results: Our study included 132 pulmonary and 125 extrapulmonary cases. On the basis of clinicoradiological and microbiological correlation, diagnosis of TB was confirmed in 104 pulmonary and 103 extrapulmonary cases. Out of a total of 104 pulmonary TB cases, 73 were rifampicin-sensitive and 31 were rifampicin-resistant cases. 103 extrapulmonary TB patients included 66 rifampicin-sensitive and 37 rifampicin-resistant cases. The sensitivity, specificity, PPV, NPV of GX in diagnosis and detection of rifampicin resistance in pulmonary TB was 95%, 93%, 98%, 84% and 96%, 100%, 100%, 96%, respectively. The sensitivity, specificity, PPV, NPV of GX in diagnosis and detection of rifampicin resistance in extrapulmonary TB cases was 79%, 86%, 96%, 47% and 97%, 95%, 97%, 95%, respectively.Conclusions: GX results are superior to smear microscopy and comparable to culture with shorter turnaround time.We recom-mend using it in routine TB diagnosis as this will expedite the management of patients with presumptive TB

Diffuse Pan Bronchiolitis Presenting with Bronchiectasis: A Case Report

Diffuse Pan Bronchiolitis (DPB) is a peculiar airway disease with its pathogenesis enrooted in a complex interplay of various genetic and environmental factors. Airway inflammation, chronic airflow limitation and suppuratives in pulmonary infections are the distinctive features of this entity. It poses a close differential to other frequently encountered pulmonary conditions like chronic bronchitis, emphysema, bronchiectasis and constrictive bronchiolitis. Deferment in diagnosis can culminate in irreversible airway remodeling and progressive respiratory failure. Hence a punctual recognition is vital. Macrolide group of drugs are prime modality of therapy and the response to therapy is benignant. We herein describe a case of DPB with development of sequelae owing to its delayed detection

Оценка заболеваний органов грудной клетки с помощью биопсии под контролем компьютерной томографии

Computed tomography (CT) guided percutaneous procedures like the fine needle aspiration cytology (FNAC) and fine needle aspiration biopsy (FNAB) are reliable techniques for diagnosing various thoracic diseases. These modalities are used for diagnosis in suspicious lung, pleural, mediastinal and vertebral and pulmonary lesions.The aim. We conducted a study in a Pulmonary Medicine Department of tertiary care hospital to study the efficacy and safety of CT guided FNCA/FNAB in thoracic diseases.Methods. A retrospective study was conducted at a tertiary care center with Information and Ethics committee permission within a total duration of two years. The study included patients presenting with following: 1) mediastinal mass lesions, 2) pulmonary solitary pulmonary nodules/masses, 3) pulmonary cavity, cyst and consolidation of undiagnosed etiology, 4) pleural mass, nodules, loculated collections, 5) extra-pulmonary and spinal tuberculosis suspects with pre/paravertebral abscess. Procedure details, radiological images and pathological and microbiological reports were retrieved from case record book of patients available in department.Results. Study population consisted of 108 patients. Neoplastic diseases were 85 (78.70%) and Non- neoplastic diseases 23 (21.29%). In neoplastic diseases 78.82% patients had lung Cancer of which 85.07% non small cell carcinoma and 14.92% small cell lung cancer. Out of non small cell lung cancer adenocarcinoma of lung was the commonest. The most common non neoplastic diseases was tuberculosis. CT guided biopsy procedure was performed without any complications in 61.11%. The most common complication was pneumothorax (27.77%). The yield of CT guided biopsy was 98.14%.Conclusion. Percutaneous CT-guided lung biopsy is an effective, highly accurate, and safe method of obtaining tissue for the diagnosis of indeterminate pulmonary lesions especially in neoplastic diseases and tuberculosis.Чрескожные процедуры под контролем компьютерной томографии (КТ), такие как тонкоигольная аспирационная цитология (fine needle aspiration cytology – FNAC) и тонкоигольная аспирационная биопсия (fine needle aspiration biopsy – FNAB), являются надежными методами диагностики различных заболеваний органов грудной клетки. Эти методы используются для диагностики поражений легких, плевры, средостения, позвоночника и легких.Целью исследования, проведенного в отделении пульмонологии больницы третичного уровня, явилось определение эффективности и безопасности FNCA / FNAB под контролем КТ при заболеваниях органов грудной клетки.Материалы и методы. Ретроспективное исследование проводилось в течение 2 лет в центре третичной медицинской помощи с разрешения Комитета по информации и этике. В исследование были включены следующие пациенты: 1) с новообразованиями средостения; 2) с легочными солитарными узлами / новообразованиями; 3) с полостями, кистами и консолидацией в легких невыясненной этиологии; 4) с плевральными новообразованиями, узелками, осумкованными скоплениями; 5) с плевральными массами, узелками, осумкованными скоплениями, подозрением на внелегочный туберкулез и туберкулез позвоночника с пре-, паравертебральным абсцессом. Данные о проведенной процедуре, рентгеновские снимки, патологоанатомические и микробиологические отчеты были получены из историй болезни, имеющихся в отделении.Результаты. Выборку составили 108 пациентов. Опухолевые заболевания выявлены у 85 (78,70 %), неопухолевые – у 23 (21,29 %) пациентов. У 78,82 % пациентов с опухолевыми заболеваниями выявлен рак легкого, у 85,07 % из них – немелкоклеточный, у 14,92 % – мелкоклеточный рак легкого. У больных с немелкоклеточным раком легкого наиболее часто встречалась аденокарцинома легкого. Наиболее частым неопухолевым заболеванием являлся туберкулез. Биопсия под контролем КТ выполнена без каких-либо осложнений в 61,11 % случаев. Наиболее частым осложнением (27,77 %) был пневмоторакс. Биопсия под контролем КТ позволила установить диагноз в 98,14 % случаев.Заключение. Чрескожная биопсия легкого под контролем КТ является эффективным, высокоточным и безопасным методом получения ткани для диагностики неопределенных поражений легких, особенно при опухолевых заболеваниях и туберкулезе

Idiopathic lymphocytic interstitial pneumonia

Lymphocytic interstitial pneumonia (LIP) is one of the rare interstitial lung diseases exhibiting a profuse infiltration of lymphoid cells in the interstitium of the lung. It has been classified as one of the rare idiopathic interstitial pneumonias (IIPs) as per the recent American Thoracic Society/European Respiratory Society classification of IIPs. It is an uncommon entity in itself with the idiopathic variety being prodigiously singular. Diagnosis is accomplished by collaboration of clinicoradiological and histopathological attributes. Corticosteroids form the mainstay of therapy with a protean response to therapy. We hereby report a distinctive case of idiopathic LIP picked up inadvertently during a preoperative evaluation

Klippel–Feil syndrome with inherited coagulopathy: A rare case report

Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well as somatic diseases. Thromboembolism is one of the complications, which although rarely described earlier with this syndrome, can be life-threatening. Earlier case reports have attributed it to structural abnormalities seen in this syndrome. We, however, report a rare instance of inherited coagulopathy seen with Klippel–Feil syndrome, leading to pulmonary thromboembolism

Allergic bronchopulmonary aspergillosis masquerading as malignancy in a nonasthmatic: A rare case report

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by hypersensitivity reaction to antigens of Aspergillus species of which Aspergillus fumigatus is the most common culprit. ABPA is most commonly diagnosed in patients with a history of uncontrolled bronchial asthma despite optimum treatment. ABPA is rarely diagnosed in nonasthmatics. Diverse radiological appearances are known in ABPA patients; however, whole lung collapse has been rarely reported. We report a case of ABPA in a 62-year-old female with no background history of asthma, initially suspected to have bronchogenic carcinoma of the right lung. After ruling out malignancy, the diagnosis of ABPA was established based on Rosenberg-Patterson criteria. Treatment with oral steroids for 6 months in tapering doses lead to clinical and radiological improvement and decrease in IgE levels. This case is unique as ABPA masquerading as malignancy causing a lung collapse in a nonasthmatic is a very rare presentation

Treatment outcomes of drug-resistant pulmonary tuberculosis under programmatic management of multidrug-resistant tuberculosis, at tertiary care center in Mumbai

Background: This study was undertaken to analyze the clinical profile and treatment outcome in pulmonary drug-resistant tuberculosis (TB) patients under programmatic management of multidrug-resistant tuberculosis (PMDT) at a tertiary care center in Mumbai. Methodology: A retrospective study was conducted at PMDT site of a tertiary care hospital. The data of 194 pulmonary multidrug-resistant (MDR) TB patients diagnosed at our hospital or prediagnosed patients referred to our hospital were meticulously reviewed to study demography, baseline drug susceptibility to first- and second-line drugs, treatment outcomes, comorbidities, and adverse drug reactions (ADRs). Results: Out of 194 patients, 48.4% (68 cured + 26 treatment completed) were successfully treated, 22 (11.3%) failed on therapy, 39 (20.15%) patients died, 23 (11.8%) defaulted, 26 (13.4%) completed treatment with outcomes unknown, 13 (6.7%) were transferred out and in 3 patients (1.5%) treatment was stopped due to ADRs. Most common ADRs were gastrointestinal 32 (16.4%) and psychiatric 37 (19%). However, there was no statistical significance between the prevalence of ADRs and unfavorable outcomes. Most common comorbidities were GERD 27 (40.2%) and diabetes mellitus 22 (32.8%). Conclusion: Baseline drug susceptibility testing (DST) with rapid diagnostic tests, performing DST for second-line drugs, i.e., fluoroquinolones and aminoglycoside and modification of treatment regimen based on the same at start of MDR treatment has prime importance. Early detection of ADR's and comorbidities and their prompt treatment are also equally important