Previous History Of Pulmonary Tuberculosis Research Articles

Socioeconomic Determinants of Pulmonary Tuberculosis during Covid-19 Pandemic: Case Control Study

Background: Tuberculosis (TB) is a public health issue of paramount importance. Pakistan ranks 5th amongst the high burden TB countries globally with the prevalence, incidence and mortality per 100,000 population per year from TB being 348, 276 and 34 respectively. Socio-economic determinants like income, house, family size, ventilation, etc. play a vital role in the epidemiology of TB. Aim: To analyzes the socioeconomic determinants of pulmonary tuberculosis (PTB) during Covid-19 pandemic. Study Design: Case study Methodology: This case-control study was undertaken at Gulab Devi Hospital, Lahore, over a period of 8 months. 50 cases of confirmed Pulmonary tuberculosis and 50 controls were interviewed using a questionnaire containing demographic variables like gender, age, and socioeconomic status. Data was analyzed by using SPSS Results: The sociodemographic profile of our respondents showed that 62 (62%) were males, 55 (55%) belonged to rural areas and, 52(52%) were employed. The socioeconomic determinants which were significantly associated with PTB were gender, residence, occupation, number of family members, and history of smoking. Practical Implementation: Due to the emerging nature of the COVID-19 crisis, this study helped researchers investigate the role of socio-economical determinant of TB during Covid-19 pandemic infection. Conclusion: Gender, residence, occupation, number of family members, and history of smoking were significantly associated with PTB. However, ventilation, family history of TB, and previous history of PTB were not found to have a statistically significant association with PTB. Keywords: Pulmonary Tuberculosis, Covid-19, Incidence, Pandemic Condition and Socioeconomic Determinants.

Primary tuberculosis of the breast from mankweng hospital

Object of study: To share our experience with a rare case of Primary Tuberculosis of Breast.
 The problem to be solved: Tuberculosis of the breast is a rare type of extrapulmonary tuberculosis and usually affects young lactating multiparous women. It accounts for less than 0.1 % of all breast pathologies. Tuberculosis of the breast is often misdiagnosed. Therefore, a high index of suspicion is needed when evaluating cases of breast abscesses, fistulae, or mass.
 Main scientific results: A case of a 27-year-old female with no known co-morbidities, HIV negative who presented to our Surgical Outpatient Department with a 1-year history of a painless left breast lump. No previous history of pulmonary tuberculosis was reported. Breasts ultrasonography indicated BIRADS (Breast Imaging-Reporting and Data System) V: lesion highly suspicious of malignancy. Histopathological analysis of the core biopsy showed features of a necrotizing granulomatous mastitis with adjacent fat necrosis. Ziehl-Neelsen stain was negative though histological results were worrisome of a mycobacterial infection. Patient responded well to antitubercular therapy as evidenced by lump regression, ulceration healed, peau d’orage currently resolved, and the overall size of the breast is going back to its normal state.
 The area of practical use of research results: Family medicine physicians, Primary health care center, District level or regional level hospital.
 An innovative technological product: a high index of suspicion tuberculosis is needed when evaluating cases of breast abscesses, fistulae, or mass. Awareness of this condition is important as it can clinically, and radiologically mimic breast carcinoma.
 Scope of application of an innovative technological product: Family medicine physicians, Primary health care center.

Comparison of the diagnostic criteria for progressive pulmonary fibrosis in connective tissue disease related interstitial lung disease

BackgroundProgressive pulmonary fibrosis (PPF) is possible among patients with connective tissue disease (CTD) related interstitial lung disease (ILD). Our aim herein was to compare the prevalence and clinical characteristics of patients with CTD-ILD, with and without PPF, according to the different diagnostic criteria currently used in practice. MethodsThis retrospective study included patients diagnosed with CTD-ILD, with a ≥1-year follow-up of their lung function, at a single tertiary hospital in South Korea. Diagnostic criteria from two clinical trials (RELIEF and TRAIL1) and from a recently updated guideline (ATS/ERS/JRS/ALAT) were applied. ResultsOf the 107 patients included, 80% tested positive for Sjogren's disease, rheumatoid arthritis, and systemic sclerosis. The prevalence of CTD-ILD with PPF for the different diagnostic criteria was as follows: RELIEF, 25.2%; TRAIL1, 20.6%; and ATS/ERS/JRS/ALAT, 38.3%. More previous history of pulmonary tuberculosis and less positivity for antinuclear antibodies were identified in the PPF group. The radiologic pattern of ILD did not differ between patients with and without PPF, with a usual interstitial pneumonia pattern identified in 34.6% of the patients. Systemic steroids and immunomodulatory agents were used in about 80% of patients with PPF and 50% without PPF, irrespective of the diagnostic criteria used. Antifibrotic therapy was used in a limited number of patients in both groups. ConclusionsThe proportion of patients with CTD-ILD and PPF was higher for the ATS/ERS/JRS/ALAT guideline criteria, without a between-group difference in clinical characteristics.

A rare case of left atrial inflammatory granuloma associated with pulmonary tuberculosis.

A 65-year-old female was accidentally found left atrial space-occupying lesion 2 days ago. The patient had a previous history of pulmonary tuberculosis for several years. Physical examination and laboratory tests were unremarkable. An electrocardiogram suggested a sinus heart rate with a left-sided electrical axis and a slightly depressed T wave in lead I and augmented vector foot. Transthoracic echocardiography showed that a solitary 18 mm × 15 mm mass was attached to the annulus root of the anterior mitral valve and protruded to the left atrium, causing mild mitral leaflet insufficiency (Panel A). Cardiac computed tomographic angiography showed a round mass located in the left atrium adjacent to the anterior mitral valve (Panel B). The patient underwent resection of the left atrial mass under extracorporeal circulation. During the procedure, a round-like mass measuring approximately 2.2 cm × 1.8 cm × 1.5 cm was found attached to the anterior mitral valve. The patient had an uneventful recovery and was discharged 5 days later. Post-operative pathology confirmed as an inflammatory granuloma (Panels C and D).

Antibodies against Histoplasma capsulatum and Aspergillus fumigatus among chronic TB patients in Indonesia: a cross-sectional study.

Chronic pulmonary fungal infections may occur in patients with previous history of pulmonary tuberculosis (TB), and are often clinically misclassified as TB, especially when bacteriological confirmation for Mycobacterium tuberculosis is absent. In this study, we investigated the prevalence of antibody against Histoplasma capsulatum and Aspergillus fumigatus in patients with confirmed and clinically chronic TB. Antibodies against H. capsulatum and A. fumigatus were measured from serum samples using enzyme-linked immunosorbent assay (ELISA). The presence M. tuberculosis in sputum was confirmed using smear microscopy, GeneXpert MTB/RIF assay, or culture. Antibodies against H. capsulatum and A. fumigatus were elevated in 16.9% and 26.9% of bacteriologically confirmed chronic TB patients, and 12.1% and 18.2% in those without bacteriological confirmation, respectively. Approximately one-third of patients who had positive anti-Histoplasma antibody also had elevated levels of antibody against Aspergillus fumigatus (P<.001). Our study highlights the importance of chronic pulmonary fungal infection in post-TB patients with recurrent respiratory symptoms.

Help, My Lung is Trapped! – A Case Report

Trapped lung is defined as the inability of the lung to expand fully and fill up the thoracic cavity because of a restricting fibrous visceral pleural layer preventing apposition of visceral and parietal pleura. It is a sequela of a previous inflammation of the pleural space and has variety of causes. Chest radiograph and thoracic ultrasound is the key imaging modalities for the diagnosis usually with a history of preceding pleural drainage. Typical imaging features include visceral pleural peel, basal pneumothoraces, ipsilateral volume loss and lobar atelectasis. Management aims at relief of symptoms and enabling full lung re-expansion. It is usually associated with high morbidity, therefore identifying patients with trapped lung is crucial for early treatment and positive patient outcomes. We present a case of trapped lung of a patient with previous history of pulmonary tuberculosis and chronic right pneumothorax.

Bacteriologically confirmed extrapulmonary tuberculosis and the associated risk factors among extrapulmonary tuberculosis suspected patients in Ethiopia: A systematic review and meta-analysis.

The actual burden of bacteriologically confirmed extrapulmonary tuberculosis (EPTB) and risk factors in Ethiopia is not well known due to the lack of a strong surveillance system in Ethiopia. Thus, this study was conducted to estimate the pooled prevalence of bacteriologically confirmed EPTB and the associated risk factors among persons suspected to have non-respiratory tuberculosis in Ethiopia. A systematic review and meta-analysis of published studies reporting the prevalence of EPTB from searched electronic databases; Science Direct, PubMed, and Google Scholar was estimated spread across the research periods, nationally, and in different areas, using a fixed-effects model. We used I2 to analyze heterogeneity in the reported prevalence of bacteriologically confirmed extrapulmonary tuberculosis. After reviewing 938 research articles, 20 studies (19 cross-sectional and 1 retrospective) from 2003 to 2021 were included in the final analyses. The pooled prevalence of bacteriologically confirmed EPTB was 43% (95%CI; 0.34-0.52, I2 = 98.45%). The asymmetry of the funnel plot revealed the presence of publication bias. Specifically the pooled prevalence of bacteriologically confirmed EPTB based on smear microscopy, Xpert MTB/RIF assay, and culture were 22% (95%CI; 0.13-0.30, I2 = 98.56%), 39% (95%CI; 0.23-0.54, I2 = 98.73%) and 49% (95%CI; 0.41-0.57, I2 = 96.43%) respectively. In this study, a history of pulmonary tuberculosis (PTB) contact with PTB patients, contact with live animals, consumption of raw milk, HIV-positive, male, and lower monthly income, were found to be independently associated with bacteriologically confirmed EPTB. Ethiopia has a high rate of bacteriologically confirmed EPTB. A history of previous PTB, being HIV-positive and having contact with PTB patients were the most reported risk factors for EPTB in the majority of studies. Strengthening laboratory services for EPTB diagnosis should be given priority to diagnose EPTB cases as early as possible.

P203 Chronic pulmonary aspergillosis (CPA) in post tuberculosis sequele— aclinical experience from tertiary care

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionChronic pulmonary aspergillosis (CPA) is a spectrum of illnesses clinically presenting as a persistent cough, dyspnea, hemoptysis, fatigue, and weight loss and radiologically can range from single aspergilloma, Aspergillus nodule, or chronic cavitary pulmonary aspergillosis (CCPA) which can progress to chronic fibrosing pulmonary aspergillosis if left untreated.1 CPA has high morbidity, burden in India estimated to be in a 5-year prevalence of 24/100 000.2 The commonly used criteria for diagnosing CPA include cough or hemoptysis for 1 month, raised Aspergillus-specific IgG, absence of positive GeneXpert test for Mycobacterium tuberculosis and either paracavitary fibrosis or a fungal ball on imaging of the thorax or progressive cavitation (either new cavitation or deterioration of pre-existing cavitation) on serial chest radiographs. Pulmonary tuberculosis (PTB) is the important predisposing risk factor for CPA,3 India being an endemic country, incidence of CPA may be underestimated or it may be misdiagnosed as smear-negative tuberculosis. Microbiologically, diagnosis by direct confirmation of Aspergillus spp infection (microscopy or culture from respiratory samples) may not be always positive, in such a scenario the immune response to Aspergillus spp. by measuring Aspergillus specific Immunoglobulin Ig G in clinically suspected cases may be used for diagnosis of CPA.MethodThis is a cross-sectional conducted in a tertiary care hospital, New Delhi, India. The patients with previous history of pulmonary tuberculosis who presented with symptoms of cough, hemoptysis, fever, shortness of breath, chest pain, and weight loss of ˃12-week duration were enrolled in the study. Relevant investigations including blood tests, chest imaging, sputum examination for bacterial infections, fungal (KOH mount), and tuberculosis (AFB smear, CBNAAT, mycobacterial cultures) were done. Microbiological evidence included a positive Aspergillus-specific IgG (cut off >8 units/ml) or positive serum galactomannan index (GMI) (cut off >1 according to EORTC/MSG guidelines) or KOH mount on sputum showing branching hyaline septate hyphae morphologically suggestive of Aspergillus spp. Patients who were diagnosed with CPA according to criteria were treated and followed up.ResultsA total of 15 patients were screened in the study, 4 patients who had concurrently detected pulmonary tuberculosis detected by Genexpert, were excluded from the study. Majority of patients presented with complaints of recurrent episodes of cough and hemoptysis. Imaging features included cavitation, bronchiectasis, pleural thickening, and fungal ball. Sputum microscopy for fungal elements was positive only in 10 patients. The serum Aspergillus Ig G (values ranged from 19.8-200 u/mL) was raised in all patients while serum GMI above cut-off was present in only 5 patients. All confirmed CPA patients were managed with voriconazole for 4 months. Following 4 months of treatment, all patients had favorable outcomes in terms of radiological improvement and clinical cure.ConclusionCPA is an underestimated post-PTB sequel and should be considered as differentials in patients with respiratory symptoms in post TB patients. Aspergillus Ig G and chest imaging are recommended as initial diagnostic tools for diagnosing CPA.Sources:Denning DW, Cadranel J, Beigelman-Aubry C et al. European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016; 47(1): 45-68.Agarwal R, Denning DW, Chakrabarti A. Estimation of the burden of chronic and allergic pulmonary aspergillosis in India. PLoS One. 2014; 9(12): e114745.Page ID, Byanyima R, Hosmane S et al. Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J. 2019; 53: 1801184

Etiology and Clinical Evaluation of Patients with Bronchiectasis in a Tertiary Hospital in Nigeria

Background: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria.&#x0D; Objective: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria.&#x0D; Methods: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019.&#x0D; Results: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002).&#x0D; Conclusion: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.&#x0D; Authors&#x0D; V A Umoh 1, D D Alasia 2, E E Akpan 1, U Ekrikpo 1, E E Ekpe 3, M E Ekwere 4, E Peters 1

A ten-year retrospective analysis of nocardiosis in a tertiary care center of South-coastal India.

Nocardiosis is an uncommon life-threatening infection caused by Nocardia spp. This study aimed to review the distribution of risk factors, clinical characteristics, microbiological findings, treatment and outcome of patients diagnosed with nocardiosis. This study was a retrospective case record review of all nocardiosis cases that were diagnosed at our tertiary care hospital from January 2008 to December 2019. A total of 48 patients with a mean age of 52.2±16.28 years were included. Out of which forty one (85%) were diagnosed as pulmonary nocardiosis and seven (14.6%) as disseminated disease. Chronic lung disease 25 (52.1%), long term steroid use 22 (45.8%) followed by diabetes mellitus 11 (22.9%) were common predisposing factors. The common symptoms were fever (87.5%), cough (79.2%) and breathlessness (52.1%). The most frequent radiologic finding included consolidation in 38 (79.1%), cavitation with thickened wall in 2 (4.1%), reticulonodular shadows in 2 (4.1%), and unilateral pleural effusion in 5 (10.4%). Nocardia otitidiscaviarum (22.9%) was frequently isolated from cultures. Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was observed in 21% cases. Mortality was noted in 6 (12.5%) patients and all were with pulmonary involvement. The percentage of death among those with and without pulmonary tuberculosis was 33.3% and 5% respectively. Patients affected by pulmonary nocardiosis with previous history of pulmonary tuberculosis showed significant association with poor outcome (p-value=0.05). In conclusion, nocardiosis mainly affects patients with structural lung disease or immunocompromised hosts with adverse outcome. Awareness of this infection is crucial for a clinician, and any suspicion should lead to make an early diagnosis and choose an appropriate empirical treatment to improve the outcome in this population.

Molecular epidemiology and clinical risk factors for rifaximin-non-susceptible Clostridioides difficile infection in South Korea: a prospective, multicentre, observational study

This study was designed to investigate the molecular epidemiology of Clostridioides difficile isolates in South Korea and to evaluate risk factors for rifaximin-non-susceptible C. difficile infection (CDI). A total of 413 patients with CDI from two sentinel hospitals in South Korea were enrolled in this study. Putative clinical risk factors for CDI were identified using digital medical records of the patients. Pathogen profiles, including antimicrobial susceptibility, toxin production and ribotype, were evaluated for each of the causative C. difficile isolates. Of the 413 C. difficile isolates, 81 (19.6%) were shown to be rifaximin-non-susceptible, with the most common ribotypes being 018 (56.8%; 46/81), 017 (16.0%; 13/81) and 027 (6.2%; 5/81). Rifaximin-non-susceptible C. difficile isolates exhibited higher non-susceptibility rates to most of the other drugs tested in this study compared with rifaximin-susceptible isolates. Previous history of pulmonary tuberculosis and prior rifaximin treatment were shown to be associated with the occurrence of rifaximin-non-susceptible CDI compared with susceptible CDI. Non-susceptibility rates to rifaximin for the C. difficile isolates identified in this study were reasonably high with most of the resistant strains belonging to either ribotype 018 or 017. Widespread dissemination of these clones may be the result of antimicrobial selection pressure introduced by the widespread use of rifaximin. These results suggest that a sustainable surveillance programme for CDI and C. difficile resistance is needed in order to better control CDIs and to improve therapeutic efficacy.

Factors associated with bronchiectasis in Korea: a national database study.

BackgroundMany important clinical features of bronchiectasis have been reported. However, the factors were evaluated using a specific disease cohort. Thus, clinical factors associated with bronchiectasis have not been well assessed in comparison to the general population. The aim of this study was to evaluate the factors associated with bronchiectasis using a national representative database.MethodsWe conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey 2007–2009. To evaluate factors associated with bronchiectasis, a multivariable logistic analysis was used with adjustment for demographic and socioeconomic factors.ResultsIn the present study, the prevalence of bronchiectasis was 0.4%. Compared with subjects without bronchiectasis, subjects with bronchiectasis were older (55.1 vs. 44.4 years, P<0.001) and had lower body mass index (BMI) (23.2 vs. 24.2 kg/m2, P<0.001). The proportions of low family income (70.5% vs. 40.2%, P<0.001) and low educational level (less than high school) (85.3% vs. 70.6%, P=0.041) were higher in subjects with bronchiectasis than in subjects without bronchiectasis. Regarding comorbidities, subjects with bronchiectasis were more likely to have asthma (17.8% vs. 2.9%, P<0.001), previous history of pulmonary tuberculosis (TB) (43.5% vs. 5.0%, P<0.001), osteoporosis (19.1% vs. 7.8%, P=0.002), and depression (9.3% vs. 3.0%, P=0.015) compared with subjects without bronchiectasis. In addition, subjects with bronchiectasis had more respiratory symptoms and poorer quality of life measured using the EuroQoL five dimensions questionnaire (EQ-5D) index (0.87 vs. 0.93, P<0.001) than subjects without bronchiectasis. In multivariable logistic regression analysis, low family income (adjusted odds ratio, OR =3.83, 95% confidence interval, CI: 1.46–10.03), asthma (adjusted OR =3.73, 95% CI: 1.29–10.79), pulmonary TB (adjusted OR =7.88, 95% CI: 2.65–23.39), and the presence of airflow limitation (adjusted OR =2.98, 95% CI: 1.01–8.98) were independently associated with bronchiectasis.ConclusionsSubjects with bronchiectasis suffered from more respiratory symptoms with limited physical activity and poorer quality of life than the general population. Factors independently associated with bronchiectasis were lower family income and comorbid pulmonary conditions, such as previous pulmonary TB, asthma, and airflow limitation.

Mycobacterium tuberculosis burden, multidrug resistance pattern, and associated risk factors among presumptive extrapulmonary tuberculosis cases at Dessie Referral Hospital, Northeast Ethiopia

Background Tuberculosis (TB) represents one of the major challenges to global health. TB is usually classified based on the disease symptoms and the site of infection. Two types of clinical manifestation of TB are pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). Objective This study aimed at determining Mycobacterium tuberculosis and multidrug-resistant tuberculosis (MDR-TB) burden among presumptive EPTB cases and associated risk factors at Dessie Referral Hospital, North West Ethiopia. Methods A cross-sectional study was conducted from February to April, 2018. A total of 337 presumptive EPTB cases in Dessie Referral Hospital were included using convenient sampling. Data were collected using a prestructured questionnaire. Body fluid specimens were collected and processed. Cytology, GeneXpert, and GenoType MTBDR plus Line Probe Assays were used for the detection of MTB and MDR-TB. Data were entered and cleared by Epi data version 3.1 and analyzed using SPSS, version 21. Multivariate analysis was done. P value less than 0.05 at 95% confidence interval was considered as statistically significant. Results The overall prevalence of EBTB using GeneXpert and cytopathological technique was 23.4, 27.3%, respectively. TB lymphadenitis (48 and 53.3%, respectively) was the dominant type followed by pleural (27 and 25%, respectively) and peritoneal (24% and 21.7%, respectively) by GeneXpert and cytology. The prevalence of MDR-TB was one (1.3%). Previous history of PTB (P Conclusion High prevalence of EPTB (27.3%) was reported, and 1.3% of them were MDR-TB. TB lymphadenitis was dominant. History of previous PTB and HIV was significantly associated with EPTB. Therefore, clinicians, public health professionals, and health programmers should give attention to EPTB case finding, treatment as well as prevention and control of EPTB by adhering guidelines of the ministry of health and WHO recommendations.

Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions. To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups. During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165). In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease.

Factors Associated with Persistent Lower Respiratory Symptoms or Asthma among Residents Exposed to a Sulphur Stockpile Fire Incident

Introduction: Residents of Macassar, South Africa, were exposed to sulphur dioxide vapours (SO2) caused by an ignited sulphur stockpile, which produced peak hourly SO2 levels of 20–200 ppm. The aim of this study was to assess the risk factors associated with persistent lower respiratory symptoms (LRS) or asthma six years after acute exposure to high SO2 levels. Methods: A case-control study of residents that presented for a health evaluation six years after the incident was conducted. Survey instruments included a questionnaire, clinical examination and medical record review by an expert panel. A “case” was defined as a resident with persistent LRS/asthma. The Industrial Source Complex Short Term Model (ISCST 3) was used to predict time-averaged hourly SO2 levels. Results: A previous history of pulmonary tuberculosis (PTB) was associated with persistent LRS/asthma (ORudj: 3.49, CI: 1.46–8.35). Cases were more likely to report chest tightness (ORudj: 9.93; CI: 5.15–19.11) at the time of the incident. Peak exposure at hour 15 was associated with persistent LRS/asthma (ORadj: 1.04; CI: 1.01–1.07). Conclusion: LRS/asthma persisted in some individuals six years after acute SO2 exposure. Aside from peak exposures, initial chest tightness and a previous history of PTB were the strong predictors of persistent LRS/asthma.

Assessment of Extrapulmonary Tuberculosis Using Gene Xpert MTB/RIF Assay and Fluorescent Microscopy and Its Risk Factors at Dessie Referral Hospital, Northeast Ethiopia.

Background Tuberculosis is a major public health problem and extrapulmonary tuberculosis (EPTB) accounts for a significant proportion of tuberculosis cases worldwide. Objective To determine the magnitude of EPTB, associated risk factors, and agreement of diagnostic techniques at Dessie Referral Hospital. Methods A cross-sectional study was conducted on consecutive presumptive EPTB cases from March 1 to June 30, 2017. Sociodemographic characteristics and other variables were collected using a structured questionnaire. Clinical specimens were collected and processed using fluorescent microscopy and Gene Xpert assay. Data was analyzed using SPSS version 20. Chi-square test and logistic regression were done and a P value of ≤0.05 was taken as statistically significant. Results From a total of 353 presumptive EPTB cases the overall prevalence of Gene Xpert assay and smear confirmed patients was 8.8% and 2.5%, respectively. Tuberculosis lymphadenitis was the predominant (33.3%) type followed by pleural (11.9%) and peritoneal (6.7%) tuberculosis. Previous history of pulmonary tuberculosis was significantly associated with extrapulmonary infection (AOR:2.8; 95%CI: 1.05-7.54; p=0.04); however, other variables such as age, residence, sex, marital status, occupation, level of education, and monthly income did not show any association. Conclusion High proportions (71%) of Gene Xpert assay confirmed EPTB patients were smear-negative. Sensitivity of microscopy should be enhanced in resource limited countries like Ethiopia where Gene Xpert machine is not easily accessible.

Evaluation of tuberculosis-associated chronic obstructive pulmonary disease at a tertiary care hospital: A case-control study.

Context:Irreversible airway obstruction is important sequelae of pulmonary tuberculosis (TB) that might contribute to a significant proportion of chronic obstructive pulmonary disease (COPD). India has the highest TB burden in the world. However, there are limited data on the prevalence and presentation of TB-associated COPD from this region.Aims:This study aims to evaluate the prevalence of TB-associated COPD among COPD patients presenting to a tertiary care hospital.Settings and Design:It was a case–control study conducted in a tertiary care hospital.Subjects and Methods:Stable COPD patients presenting to chest OPD and an equal number of healthy controls were enrolled. COPD patients were subjected to detailed clinical evaluation and lung function test. History of pulmonary TB was evaluated from both groups through self-reporting and/or checking previous records. TB-associated COPD patients were identified and their prevalence and distinguishing features evaluated.Results:Of 74 COPD patients, 24 (32.4%) had previous history of pulmonary TB. The odds of having a previous TB in COPD patients was 3.96 (95% confidence interval: 1.64–9.55; P = 0.002) as compared to controls. Patients with TB-associated COPD were younger (P = 0.02), had lesser pack-years of smoking (P = 0.027) but had more number of hospitalizations (P = 0.01). The airflow limitation was similar in both groups.Conclusions:TB-associated COPD constitutes a significant proportion of COPD patients. It is a distinct clinical entity with preponderance in young. It may be associated with frequent hospitalizations as compared to other COPD patients.

Malignant Nerve Sheath Tumor (MPNST) in the Middle Mediastinum

SESSION TITLE: Global Case Report Poster - Lung Cancer SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: The incidence of MPNST is 0.001% in the general population. Although MPNST can be found in any part of the body including extremities, head and neck, trunk, or retroperitoneum, intrathoracic MPNST with or without NF1 is uncommon, only with several reported adult cases. We report a very rare case of MPNST presenting as an middle mediastinal mass treated by surgical excision. CASE PRESENTATION: A 29 year old non smoker woman with no previous history of pulmonary tuberculosis complained of difficulty of breathing that started one month prior to admission. The condition was associated with chest discomfort and easy fatigability which were relieved by rest. On examination, she was not in respiratory distress. Occasional fine crackles on lower lung fields were noted during chest and lung examination. She sought consult where a chest xray was done revealing a soft tissue density seen in the right hilar area considering a mediastinal mass. Eventually chest CT scan was requested which confirmed the presence of a 7 x 6 cm heterogenous mass located in the middle mediastinum with massive pericardial effusion and minimal pleural effusion. A pericardiostomy tube was initially inserted and eventually an excision of middle mediastinal mass was done. A 6 x 5 cm middle mediastinal mass was seen extending from the anterior surface of the superior vena case insinuating between the medial aspect of the SVC at the aorta. Biopsy revealed a malignant peripheral nerve sheath tumor with focal muscle differentiation. On the 8th hospital day, patient was discharged improved. DISCUSSION: MPNST is also known as malignant schwannoma, neurofibrosarcoma and neurogenic sarcoma. More than 50% patients with MPNST have NF1 with a reported five year survival of 15%. Histopathological examination remains the mainstay to arrive at the diagnosis of the malignant nature of schwannoma. CONCLUSIONS: MPNST is considered as one of the most important neurogenic tumor. Our patient presented with a MPNST in the middle mediastinum which is considered as a rarefied case. The possibility of nerve sheath tumor should be taken into consideration even if it is not manifest in the posterior mediastinum. Reference #1: Malignant peripheral nerve sheath tumor of the anterior mediastinum: a rare presentation. Babusha Kalra, Pamela Alice Kingsley, Harinder Singh Bedi, Kanwardeep Singh Kwatra, Preeti Negi, Rare Tumors 2014; volume 6:5528. Reference #2: Huge Intrathoracic Malignant Peripheral Nerve Sheath Tumor in an Adolescent with Neurofibromatosis Type 1. Yoon Et al. Case Reports in Pediatrics Volume 2014. Reference #3: Mesenchymal tumours of the mediastinum—part II. Michael A. den Bakker & Alexander Marx & Kiyoshi Mukai & Philipp Ströbel, Virchows Arch (2015) 467:501-517 DISCLOSURE: The following authors have nothing to disclose: Mark Janiel Cacanindin No Product/Research Disclosure Information

Rasmussen's Aneurysm: Rare Cause for Massive Hemoptysis in Pulmonary Tuberculosis Patients

ABSTRACT Rasmussen's aneurysm is a rare phenomenon and should be considered in patients with massive hemoptysis especially with old history of pulmonary tuberculosis (PTB). We present a case report of 62 years old diabetic lady with previous history of PTB which ended with diagnosis of Rasmussen's aneurysm. How to cite this article Tiwari VK, Bansal S, Kumar A, Kumar A. Rasmussen's Aneurysm: Rare Cause for Massive Hemoptysis in Pulmonary Tuberculosis Patients. Int J Adv Integ Med Sci 2016;1(1):36-37.

The First Korean Case of Nontuberculous Mycobacterial Lung Disease Caused byMycobacterium abscessusSubspeciesbolletiiin a Patient with Bronchiectasis

We report the first Korean case of lung diseases caused by Mycobacterium abscessus subsp. bolletii in a previously healthy male, except for a previous history of pulmonary tuberculosis and bronchiectasis. All serial isolates are identified as M. abscessus subsp. bolletii by multi-locus sequence analysis based on the hsp65, rpoB, and 16S rRNA fragments. At the genetic level, the isolate has the erm(41) gene with a T28 sequevar, associated with clarithromycin resistance, and no rrl mutation. The isolate is resistant to clarithromycin. Although the symptoms and radiographic findings have improved after combination of antibiotics, the follow-up sputum cultures are persistently positive.