Pattern of Allergen Sensitivity among Patients with Bronchial Asthma and/or Allergic Rhinosinusitis in a Tertiary Care Centre of Southern India.

INTRODUCTION: The distribution of aeroallergens varies among various geographical areas of India and the knowledge of allergen sensitivity pattern in this part of Southern Indian (Karnataka) is limited. This data can provide clinically useful information and better understanding of common allergies prevalent in this area. AIM: To study the pattern of allergen sensitivity among patients with bronchial asthma and/or allergic rhinosinusitis. MATERIALS AND METHODS: In this retrospective study, patients diagnosed with bronchial asthma and/or allergic rhinitis who underwent skin prick testing, were included in the study. Patients who had taken drugs that could affect the test results, within one week prior to testing were excluded. Also, patients on long-acting oral antihistamines within four weeks of testing and pregnant women were excluded. A total of 64 antigens were used which included eight types of pollens, eight types of dusts, six types of fungi, eight types of insects, two types of danders, wool and 31 types of food items. Skin prick testing was done as per standard protocol. RESULTS: Out of 2219 patients, 1193 (53.8%) were males and 1026 (46.2%) were females. The mean age of the subjects was 41.47 (±14) years. There were 740 (33.3%) patients diagnosed with bronchial asthma, 357 (16.1%) allergic rhinitis and 1122 (50.6%) had both bronchial asthma and allergic rhinitis. Overall the highest percentage of skin-prick test positivity was found among insect allergens (24.45%) followed by dust (24.21%), grass and tree pollen (20.57%), fungus (13.92%) and food allergens (9.28%), in that order. Among the individual allergens, the highest percentage of skin-prick test positivity was present in rice grain dust allergen (33.30%) and the least common was chicken allergen (4.40%). CONCLUSION: Among the allergen groups, insects and dusts elicited the highest percentage of skin-prick test positive results. Whereas, among all the individual allergens rice grain dust elicited highest percentage of positives.

A Case of Lower Respiratory Tract Infection with Canine-associated Pasteurella canis in a Patient with Chronic Obstructive Pulmonary Disease.

This is the report of lower respiratory tract infection with Pasteurella canis in a chronic obstructive pulmonary disease (COPD) patient with history of casual exposure to cats. Pasteurella species are part of the oral and gastrointestinal flora in the canine animals. These organisms are usually implicated in wound infection following animal bites, but can also be associated with a variety of infections including respiratory tract infections.

PUO--a rare (and forgotten) cause!

Splenic tuberculosis is an extremely rare clinical entity and a frequently forgotten cause of pyrexia of unknown origin (PUO). We present the case of a 42 year old man who presented with fever of unknown origin. Ultrasonography revealed multiple hypoechoic areas within the spleen. As the abscesses did not respond to broad spectrum antibiotics splenectomy was done. The excised organ showed multiple cysts filled with pultaceous material. Histopathological examination revealed areas of granular caseating necrosis surrounded by epitheloid cells and Langhan's type giant cells consistent with splenic tuberculosis.There was no evidence of a primary focus in the lungs or in any other organ.The presence of isolated tubercular foci in the spleen without any evidence of tuberculosis in lung or other extra-pulmonary site prompted us to report this case.

An unusual case of a pleural effusion with an abdominal mass.

A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.