Isolated right pulmonary artery agenesis with agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply from celiac axis with normal venous drainage.

Isolated unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly. When detected in infancy, the condition is commonly associated with cardiovascular defects which are more frequently associated with left pulmonary artery agenesis. Patients with isolated right pulmonary artery agenesis survive into adulthood with minimal or no symptoms and are diagnosed incidentally on the chest radiographs. We report a case of a 19-year-old female patient who presented to us with recurrent haemoptysis. She was symptomatic since the age of four years. We report the rare occurrence of UAPA on right side, agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply of right lung from coeliac axis in this patient.

Bacteriological & epidemiological characteristics of diphtheria cases in & around Delhi -a retrospective study.

BACKGROUND & OBJECTIVE: Diphtheria infections caused by the different toxigenic biotypes of Corynebacterium diphtheriae are endemic in Delhi. Information on biochemical identification, toxigenicity and antimicrobial susceptibility to this bacterium is scanty. This retrospective study was carried out to identify isolated Corynebacteria biochemically, determine their toxigenicity, drug sensitivity and some epidemiological characteristics of diphtheria cases from Delhi and adjoining States for the period 1998-2004. METHODS: A total of 1118 throat and 585 nasal swabs were used to detect human pathogenic corynebacteria. WHO recommended methods were used for the detection, screening, toxigenicity and antibiogram pattern of the isolates. RESULTS: Among 493 (44.1%) cases detected positive for corynebacteria 71.8 per cent were pharyngeal, 20.9 per cent nasopharyngeal and rest 7.3 per cent nasal diphtheria cases. Biochemical identification revealed two species i.e., C. diphtheriae and C. pseudodiphtheriticum. In C. diphtheriae three biotypes were detected viz., intermedius (95.5%), gravis (3.4%) and mitis (1.1%). Toxin was expressed by 96 per cent isolates of C. diphtheriae. Cases were recorded from Delhi and four adjoining States. Sex ratio among male to female was 1.6:1. Prime victims were less than 9 yr old children (93.3%). Unvaccinated children (70.2%) were the main sufferers. Fatality rate was highest in Delhi cases (16.8%) followed by UP (14.6%) and Haryana (5.9%). INTERPRETATION & CONCLUSION: Standard methods revealed the replacement of C. diphtheriae var mitis with var intermedius and occurrence of diphtheria infections due to other human pathogenic corynebacteria. It is imperative to have good bacteriological facilities to have better surveillance with regular monitoring in the endemic areas to keep the disease under control.

Efficacy and Safety of Mycobacterium indicus pranii as an adjunct therapy in Category II pulmonary tuberculosis in a randomized trial.

Prolonged treatment of tuberculosis (TB) often leads to poor compliance, default and relapse, converting primary TB patients into category II TB (Cat IITB) cases, many of whom may convert to multi-drug resistant TB (MDR-TB). We have evaluated the immunotherapeutic potential of Mycobacterium indicus pranii (MIP) as an adjunct to Anti-Tubercular Treatment (ATT) in Cat II pulmonary TB (PTB) patients in a prospective, randomized, double blind, placebo controlled, multicentric clinical trial. 890 sputum smear positive Cat II PTB patients were randomized to receive either six intra-dermal injections (2 + 4) of heat-killed MIP at a dose of 5 × 108 bacilli or placebo once in 2 weeks for 2 months. Sputum smear and culture examinations were performed at different time points. MIP was safe with no adverse effects. While sputum smear conversion did not show any statistically significant difference, significantly higher number of patients (67.1%) in the MIP group achieved sputum culture conversion at fourth week compared to the placebo (57%) group (p = 0.0002), suggesting a role of MIP in clearance of the bacilli. Since live bacteria are the major contributors for sustained incidence of TB, the potential of MIP in clearance of the bacilli has far reaching implications in controlling the spread of the disease.

A novel ultrasound-enhanced latex agglutination test for the detection of antibodies against Mycobacterium tuberculosis in serum.

A novel ultrasound-enhanced latex agglutination test is described for the detection of serum antibodies against Mycobacterium tuberculosis. The use of ultrasound to detect the low level of antibodies in serum enhances the sensitivity of the test. The technique is based on the fact that suspended latex particles become concentrated in an ultrasonic standing wave field, thereby increasing the rate of particle-particle collisions compared to the standard agglutination test procedure. Reactions were performed on piezo-ceramic wafers, which were connected to an oscillator at a frequency of 100 kHz. This method improved sensitivity significantly so that even 20 times diluted serum samples exhibited agglutination, which was clearly visible to the naked eye.

An uncommon presentation of systemic lupus erythematosus.

A patient who had discoid facial lesion for 10 years developed a right sided pleural effusion in which LE cells were demonstrated. The case is reported due to progression of DLE into SLE after a long interval and rare occurrence of LE cells in pleural fluid.

Tuberculosis and anaesthesia.

Anaesthesiologists and other healthcare workers have been at risk for nosocomial infection with tuberculosis for many years, however the advent of effective infection control techniques and the development of antibiotics for Mycobacterium tuberculosis have decreased the risk of nosocomial infection. The risk of transmission of tuberculosis from patients to healthcare workers is a neglected problem in many developing and underdeveloped countries as they lack the resources to prevent nosocomial transmission of tuberculosis. Patients with active tuberculosis can present with problems related to tuberculosis or unrelated problems like trauma to anaesthetist for various surgeries. An attempt has been made to highlight the precautions to be taken and the risk that the anaesthesiologists are at while getting these patients operated. A detailed pre-operative examination and investigation is essential. The various drug interactions, side-effects of antituberculous drugs should be considered pre-operatively. The patients coinfected with HIV and tuberculosis have a higher risk of developing tuberculosis should be kept in mind.

Risk and outcome of multidrug-resistant tuberculosis: vitamin D receptor polymorphisms and serum 25(OH)D.

SETTING: All India Institute of Medical Sciences and Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, New Delhi, India. OBJECTIVE: To investigate the association of vitamin D receptor (VDR) polymorphisms and serum 25(OH)D with susceptibility to, and response to treatment of, multidrug-resistant tuberculosis (MDR-TB) in comparison with drug-susceptible pulmonary TB (DS-PTB) and healthy controls. DESIGN: Cross-sectional study. METHODS: A total of 897 participants from northern India were consecutively enrolled into three groups (MDR-TB 354, DS-PTB 338, controls 205). Genotypic and allelic frequencies of FokI, BsmI and TaqI VDR polymorphisms, and serum 25(OH)D, calcium and intact parathyroid hormone were measured in all participants. In those with active TB, disease severity, time to sputum smear and culture conversion were correlated with VDR genotype and biochemical parameters. RESULTS: FokI Ff genotype and TaqI t allele correlated positively with MDR-TB; Ff genotype and f allele of FokI frequency were higher in both TB groups. BsmI Bb genotype correlated inversely with MDR-TB. Serum 25(OH)D concentrations were significantly lowest in MDR-TB, correlating inversely with time to sputum smear conversion. CONCLUSIONS: VDR gene polymorphisms and hypovitaminosis D may predispose to MDR-TB. Lower serum 25(OH)D may increase time to MDR-TB sputum smear negativity.

Comparative study of three different mycobacterial antigens with a novel lipopolysaccharide antigen for the serodiagnosis of tuberculosis.

Demonstration of Mycobacterium tuberculosis in a smear or culture is the most reliable method for diagnosing tuberculosis (TB). In the last 10 years, several enzyme-linked immunosorbent assays (ELISAs) based on mycobacterial antigens (such as antigen 60, 38 kDa antigen, and antigen Kp90) have been used for the rapid diagnosis of TB. In this study, we report the isolation of an immunodominant lipopolysaccharide (LPS) antigen from M. tuberculosis H(37)Rv, which can be used for the serodiagnosis of TB. The LPS antigen was compared with three commercially available mycobacterium-specific antigens for the detection of TB. The antigens were evaluated using serum samples obtained from 59 Indian patients (19 patients with active pulmonary TB, 20 with extrapulmonary TB, and 20 with nontuberculous pulmonary disease) and 20 healthy adults. Antigen 60 IgG (sensitivity 89%, specificity 97%) and LPS (sensitivity 84%, specificity 97%) were more sensitive and specific than 38 kDa antigen IgG (sensitivity 79%, specificity 97%) and Kp90 IgA (sensitivity 82%, specificity 40%). These results indicate that the LPS antigen can be used as a sensitive tool for the serodiagnosis of TB and could be utilized to develop an ELISA for the screening of patients for TB.