Hot tub lung: an intriguing diffuse parenchymal lung disease

In pulmonary medicine, identical pathogenesis due to varied etiological agents can present with indistinguishable clinical presentation, and produce similar laboratory and radiological changes. The importance of eliciting detailed occupational and social history from patients cannot be stressed enough when dealing with patients suffering from diffuse parenchymal lung diseases. Hot Tub Lung(HTL) is a perplexing pulmonary disease attributed to the Mycobacterium Avium-intracellulare Complex (MAC). MAC is a ubiquitous atypical mycobacterium present in moist environment, and is not considered pathogenic, without the predisposing conditions like immunosuppression. However, HTL is a unique disease seen inhealthy individuals following the exposure to contaminated hot water in spas. The less virulent MAC will, in healthy individual will elicit mild granulomatous inflammation particularly around the peribronchiolar region, which leads to the development of diffuse parenchymal lung. We report a case of HTL to increase the awareness of this rare andenigmatic disease among medical professionals, and to reiterate the importance of eliciting social and occupational details in clinical practice.Keywords: Hot Tube Lung, Atypical Mycobacterium, Mycobacterium Avium-intracellulare Complex (MAC), Hypersensitivity Pneumoniti

Diaphragmatic Palsy

The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions

Acute Stroke due to Electrocution: Uncommon or Unrecognized?

The growing dependence on electricity in our daily lives has increased the incidence of electrocution injuries. Although several neurological injuries have been described previously, acute stroke due to electrocution is rare. Our patient, a previously healthy man, was electrocuted after he grabbed a “live” high-voltage wire. Although he was hemodynamically stable, he remained confused with language defects. MRI of the brain showed acute stroke in the bilateral anterior cerebral artery territory and watershed regions of the left middle cerebral artery territory. MR angiogram incidentally showed A1 segment aplasia of the right anterior cerebral artery. Electrocution is known to cause vasospasm leading to end-organ damage similar to that seen in stroke. In our patient, vasospasm of the left anterior circulation likely led to watershed infarcts in the left parietal lobe and bilateral frontal lobes. Due to aplasia of the A1 segment on the right side, perfusion to both frontal lobes was solely from the left anterior cerebral artery

Neurological Respiratory Failure

West Nile virus infection in humans is mostly asymptomatic. Less than 1% of neuro-invasive cases show a fatality rate of around 10%. Acute flaccid paralysis of respiratory muscles leading to respiratory failure is the most common cause of death. Although the peripheral nervous system can be involved, isolated phrenic nerve palsy leading to respiratory failure is rare and described in only two cases in the English literature. We present another case of neurological respiratory failure due to West Nile virus-induced phrenic nerve palsy. Our case reiterates the rare, but lethal, consequences of West Nile virus infection, and the increase of its awareness among physicians

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Not AvailablePolyphagus crop pest Spodoptera litura (Fab.) harbor various symbiotic microorganisms providing several benefits to the host with various types of interactions. The field collected and laboratory reared populations of S. litura were subjected to isolation of culturable endosymbiotic gut microflora and 16S rDNA sequence based identification. Enterobacter cloacae, Lysinibacillus macroides, Pseudomonas stutzeri, Staphylococcus saprophyticus and S. sciuri were identified as culturable gut bacterial flora These bacteria possessed enzymatic activity aiding in digestion. Apart from this, E. cloacae, P. stutzeri and S. saprophyticus were found common in both rhizospheric soil and insect gut possibly indicating their movement from soil to plants and further to the insects through feeding. Metagenomic studies by traditional cloning of 16S rDNA resulted in identification of uncultured Enterococcus sp., Parvimonas sp., Erysipelatoclostridium sp., Dysgonomonas sp. and Gilliamella sp. from the field population. An attempt was made to study the endosymbiont Wolbachia using wolbachia surface protein gene revealed absence of Wolbachia infection. Ability of S. litura gut bacteria for degradation of insecticides leading to the insecticide resistance of the host was studied by in vitro microbial degradation of insecticide imidacloprid. Luxurious growth of gut symbiont Lysinibacillus macrolides SPL-1 in insecticides amended M9 medium implied the utilization of insecticides as carbon sources for growth and its possible involvement in degradation of insecticides.Not Availabl