Progressive Disseminated Histoplasmosis in an Immunocompetent Host: A Rare Presentation of an Uncommon Disease.

Disseminated Histoplasmosis, a systemic fungal infection caused by Histoplasma capsulatum is predominantly seen in immunocompromised cases. It is usually endemic, although sporadic cases have been reported. Following initial infection to the lungs, it disseminates to various organs by lymphatic and hematogenous routes. Clinical features are non-specific and depend on the extent and severity of organ involvement. A Biopsy is required for diagnosis and timely intervention decreases morbidity and mortality. Our case report describes an atypical association of progressive disseminated Histoplasmosis with bone marrow involvement in an immunocompetent adult from a non-endemic region and alerts the clinicians to a rare yet life-threatening mycosis.

Paraquat lung - a rare cause of diffuse parenchymal lung disease.

.

Clinico-radiological profile of connective tissue disease related-interstitial lung diseases from a tertiary care centre of India: a cross sectional study.

Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study.  27% of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis [RA] (26%), systemic sclerosis [SSC] (21%), mixed connective tissue disorder [MCTD] (19%) and Sjogren's syndrome [SS] (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa.

Duration of Viral Clearance in Children With SARS-CoV-2 Infection in Rajasthan, India.

OBJECTIVE: To study the clinical and laboratory profile and to assess period for viral clearance in COVID 19 children. METHODS: We reviewed hospital records of children (<18 years) admitted from 1 April to 31 May, 2020 at a tertiary-care public hospital and identified those positive for severe acute respiratory syndrome corona virus (SARS-CoV-2) by RT-PCR of respiratory secretions. RESULTS: 81.2% of the 85 children studied were asymptomatic and 3 (8.5%) died. Severe lymphopenia (43.8%), raised C-reactive protein (93.8%), raised erythrocyte sedimentation rate (75%) and high (>500ng/mL) levels of D-dimer (37.5%) were common. Median (IQR) duration of viral shedding was 7 (5-10) days, with range of 2 to 45 days; 96.3% had viral clearance within 14 days. CONCLUSIONS: Majority of children aged <18 years with SARS-CoV-2 infection had viral clearance within 14 days.

Asymptomatic patient with "lumpy and bumpy" airways. A case of pulmonary MALToma.

Primary pulmonary lymphoma is a rare disease. The most frequent primary pulmonary lymphoma (PPL) is extranodal marginal zone B-cell lymphoma of MALT. About half of the patients are asymptomatic at diagnosis. We report a case of a 62-year-old male referred to us for preoperative assessment of surgery for Benign Prostatic Hyperplasia (BPH). He had no respiratory complaints but on evaluation was detected to have Pulmonary MALToma. Our case highlights the importance of tissue diagnosis.

Pattern and predictors of paradoxical response in patients with peripheral lymph node tuberculosis.

INTRODUCTION: Many of the patients with lymph node tuberculosis show 'Paradoxical Response" in the form of appearance of new lymph node (LN) or increase in the size of existing LN, development of new disease in other organ and worsening of the disease while on treatment. Reason behind such response in only selective patients is not clearly understood. We evaluated the pattern and predictors for paradoxical response(s) (PR) in patients with peripheral lymph node tuberculosis (TB). MATERIALS AND METHODS: Study included patients aged > 6 years with peripheral lymphadenopathy of tubercular etiology attending a tertiary care hospital from Jan 2010 to Dec 2010. PR in our study was defined as worsening of pre-existing disease or development of new lesions in a patient who has been on anti-TB therapy for at least 2 weeks. RESULT: One hundred ten patients with peripheral lymph node TB were included. Their mean age was 27.5 ± 5 years and 68 (62%) were females. PR occurred in 28 (25%) patients, at a mean onset time of 6 weeks (range 2-12 weeks) after starting anti-TB medication. Four of these 28 patients experienced PR on two occasions. Of these, 22 (79%) patients presented with enlarged lymph nodes only, 8 (29%) with new nodes at same or different site and 2 (7%) with discharging sinus. PR was observed more in younger age group (p> 0.05), female gender (p> 0.05), unilateral lymphadenopathy (p> 0.05) and those with positive AFB on initial examination (p< 0.01). CONCLUSIONS: Paradoxical response in peripheral lymph node TB is associated with younger age, female gender, unilateral lymphadenopathy and those with positive AFB on initial examination.

Diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion.

BACKGROUND: Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups. OBJECTIVE: The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy. DESIGN: This was a cross-sectional study. SETTINGS: This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India. PATIENTS AND METHODS: A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle. MAIN OUTCOME MEASURES: The main outcome measure was diagnostic yield in the form of confirming diagnosis. RESULTS: Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis. CONCLUSIONS: Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion. LIMITATIONS: There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.

Trends of respiratory syncytial virus sub-types in children hospitalised at a tertiary care centre in Jaipur during 2012-2014.

Respiratory syncytial virus (RSV) causes high mortality and morbidity in infants. The study was planned to determine the trends of RSV sub-types in hospitalised children. Nasopharyngeal aspirate and throat swabs were collected from the hospitalised children up to 5 years of age. Viral nucleic acid was extracted using easyMAG automated extraction system, and real-time reverse transcription polymerase chain reaction was performed. Total positivity for RSV was found to be 25.40%, predominantly for RSV B (20.03%), followed by RSV A (2.90%) and RSV AB mixed infections (2.47%). Palivizumab prophylaxis can be planned to be given to infants from post-monsoon to end of winter.

Tracheobronchial compression by right-sided aortic arch in a middle aged male.

Exertional dyspnoea is a common symptom among middle-aged population. Diagnostic evaluation of such patients is often challenging and confusing. We report a patient presenting with exertional dyspnoea and an obstructive ventilatory defect on spirometry that was refractory to bronchodilator therapy. Careful review of the chest radiograph and spirometry pointed towards variable intra-thoracic airways obstruction as a cause of dyspnoea. Contrast enhanced computed tomography (CECT) of the thorax and bronchoscopy established the diagnosis of a right-sided aortic arch resulting in tracheobronchial compression and tracheomalacia.

Scimitar syndrome: A rare disease with unusual presentation.

Scimitar syndrome is a rare congenital disorder. It has a varied presentation. In adult life, it usually presents either as recurrent chest infection and/or exertional dyspnea. Pulmonary artery hypertension and hemoptysis both are uncommon features of this syndrome in adult life.