The Indian Journal of Chest Diseases and Allied Sciences

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Volume 65, Number 3, July-September 2023
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LETTER TO EDITOR

Sadananda B Naik

Kids Playing Spoil Sport for the Tobacco Addict Grandpas

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:1] [Pages No:127 - 127]

Keywords: Grand children, Grand fathers, Tabacco prevention strategy

   DOI: 10.5005/jp-journals-11007-0081  |  Open Access |  How to cite  | 

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Original Article

Anupam Parashar, Priyanka, Onno (CP) van Schayck, Malay Sarkar, Anmol K Gupta

Burden of Chronic Obstructive Pulmonary Disease and its Determinants among Patients Reporting to a Primary Health Facility in North India

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:6] [Pages No:128 - 133]

Keywords: Chronic obstructive pulmonary disease, Global initiative for chronic obstructive lung disease guidelines, Primary health care facility, Spirometry

   DOI: 10.5005/jp-journals-11007-0082  |  Open Access |  How to cite  | 

Abstract

Context: Chronic obstructive pulmonary disease (COPD) is included in the World Health Organization (WHO) global action plan for the prevention and control of non-communicable diseases (NCDs) and the United Nations 2030 agenda for sustainable development. The World Health Organization is taking action to extend the diagnosis of and treatment for COPD in several ways. Aims: (A) To determine the frequency and severity of COPD among patients attending the Outpatient Department at a Primary Health Care facility. (B) To determine the risk factors for COPD among these patients. Settings and design: Cross-sectional study. Materials and methods: This cross-sectional study was conducted among patients ≥40 years of age who had symptoms suggestive of COPD and/or the presence of its risk factors. The diagnosis of COPD and its severity was determined according to the Global initiative for chronic obstructive lung disease (GOLD) guidelines. Statistical analysis used: Data were analyzed using the statistical software IBM SPSS 28.0. The odds ratio was estimated for COPD-related factors through multivariate regression analysis. Results: 107 patients ≥40 years of age were enrolled as per GOLD guidelines, and 41 (38.3%) had spirometry-confirmed COPD. Chronic obstructive pulmonary disease was highest prevalent in the ≥70 years age group (p = 0.02) and higher in males (p = 0.01). Participants who were smokers had 12.5 times higher odds of having COPD than non-smokers. In multivariate analysis quantity of tobacco smoked in pack years was the independent risk factor for COPD. The maximum risk was associated with the quantity of tobacco smoked in ≥20 pack years (OR 36.7). Conclusion: Guideline-directed management and availability of spirometry are essential at the primary levels of care for early recognition and treatment.

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RESEARCH ARTICLE

Saleha Naseem, Parveen Naaz, Ashok Rattan, Bharti, Ishrat

Comparative Evaluation of Cartridge-based Nucleic Acid Amplification Test Smear Microscopy and Conventional Culture Techniques in Laboratory Diagnosis of Tuberculosis

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:5] [Pages No:134 - 138]

Keywords: Acid-fast bacilli smear, Cartridge-based nucleic acid amplification test, Extrapulmonary, GeneXpert MTB/RIF, Pulmonary tuberculosis

   DOI: 10.5005/jp-journals-11007-0089  |  Open Access |  How to cite  | 

Abstract

Aim: This study compared the nucleic acid amplification assay with smear microscopy and culture to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in patients with suspected pulmonary and extrapulmonary tuberculosis (TB) using pulmonary and extrapulmonary samples. Methods: The information for this retrospective study was collected from the Path Kind Laboratory—a National Accreditation Board for Testing and Calibration Laboratories (NABL) accredited lab in Gurugram, Haryana, India. We evaluated 1,520 samples with suspected TB for smear microscopy, culture, and GeneXpert between January 2019 and December 2020. These samples came from the pulmonary and extrapulmonary areas. Smear microscopy and GeneXpert's diagnostic capabilities for pulmonary and extrapulmonary TB were calculated, with Mycobacterium tuberculosis (MTB) culture from pulmonary and extrapulmonary specimens serving as the gold standard. Results: This study comprised 1,520 clinical samples altogether. Of these, 624 were extrapulmonary specimens, while 896 were pulmonary samples. Overall, acid-fast bacilli (AFB) smear microscopy's sensitivity, specificity, PPV, and NPV were 83.72, 91.91, 71.38, and 95.91%, respectively. Also, GeneXpert has overall values of 96.94, 81.22, 55.42, and 99.10% for sensitivity, specificity, PPV, and NPV, respectively. Conclusion: In both pulmonary and extrapulmonary specimens, the GeneXpert assay was shown to be a quick and reliable approach for detecting M. tuberculosis. Because GeneXpert can detect M. tuberculosis and rifampicin resistance in the same 2 hours as smear microscopy and MTB culture, it offers an advantage over those methods. Clinical significance: The early detection of TB can be greatly aided by the cartridge-based nucleic acid amplification test (CBNAAT). As an important part of the National Tuberculosis Elimination Program gene experts will certainly help in the elimination of tuberculosis from India.

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CASE REPORT

Sanjay Fotedar, Karthik A Shiv, Vikas Bhatti

Isolated Spontaneous Pneumomediastinum Associated with Paraquat Poisoning: A Case Report

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:3] [Pages No:139 - 141]

Keywords: Bipyridal herbicide, Case report, Fatal toxicity, Paraquat, Spontaneous pneumothorax, Pneumomediastinum

   DOI: 10.5005/jp-journals-11007-0079  |  Open Access |  How to cite  | 

Abstract

Paraquat bipyridal herbicide, accidental and suicidal ingestion of the compound is associated with fatal toxicity. The corrosive nature of paraquat results in local effects including oral, esophageal, and gastric ulceration with esophageal rupture at times. Oxygen reactive species generation results in systemic manifestations characterized by MODS, acute liver and kidney injury, metabolic acidosis, acute respiratory distress syndrome, and pulmonary fibrosis. Spontaneous pneumothorax (Daisley Barton syndrome) with or without associated pneumomediastinum and subcutaneous emphysema has been reported with this poisoning and represents poor prognostic markers. An adult male was referred to our Institute for Management of MODS with impending respiratory failure with a history of paraquat ingestion, contrast-enhanced computed tomography (CECT) thorax revealed Pneumomediastinum with bilateral pulmonary infiltrates. The patient was managed accordingly and continuous renal replacement therapy (CRRT) was planned for acute renal shut-down, patient expired on the next day of admission. Isolated pneumomediastinum without subcutaneous emphysema and pneumothorax is an uncommon presentation associated with paraquat poisoning. Authors report a case of pneumomediastinum associated with paraquat poisoning with the aim to stress on pulmonary complications associated with paraquat. It is recommended that in patients with unrecognizable etiology of pneumomediastinum with or without pneumothorax, paraquat poisoning should be kept as one of differential diagnosis.

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CASE REPORT

Sonam Spalgais, Parul Mrigpuri, AS Dhilnaz, Tsewang Chorol, Raj Kumar

Pulmonary Sarcomatoid Carcinoma Presenting as Massive Pleural Effusion

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:5] [Pages No:142 - 146]

Keywords: Biopsy, Case report, Effusion, Pulmonary, Sarcomatoid, Tumor

   DOI: 10.5005/jp-journals-11007-0083  |  Open Access |  How to cite  | 

Abstract

Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare subtype of non-small cell lung carcinoma (NSCLC) commonly seen in elderly smoker males with non-specific clinical features. The confirmed diagnosis is done if tumor contains both sarcomatoid and epithelial components with at least 10% of the tumor and usually requires IHC confirmation. The preoperative diagnosis is very difficult due to the rarity of the disease and histological over/under presentation. Pleural involvement with effusion is not a common presenting feature of PSC. The tumor is usually locally advanced with a poor prognosis and had poor survival rate. We report a unique and rare case of PSC in a middle-aged, non-smoker lady with massive pleural effusion. She presented with sudden onset massive effusion. The computed tomography (CT) chest showed massive effusion with multiple pleural nodules and thickening. The diagnosis was confirmed by histopathology and immune histochemical (IHC) staining of thoracoscopic pleural biopsy.

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CASE REPORT

Raghu Srikanti, Thanuja Sri Vushakoyala, Kalyan KP Venkata, Harika Atmuri, Balamani R Dollu, Uthara Natarajan, Kalaivani Shanmuganandavadivel, Dimple N Avanigadda, Siddavali Chagalamari

A Rare Case of CPFE Syndrome: An Unacknowledged Entity

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:4] [Pages No:147 - 150]

Keywords: Case report, Combined pulmonary fibrosis with emphysema, Emphysema, Fibrosis, Pulmonary hypertension

   DOI: 10.5005/jp-journals-11007-0084  |  Open Access |  How to cite  | 

Abstract

Introduction: Combined pulmonary fibrosis with emphysema (CPFE) is an under-recognized pulmonary syndrome characterized by the coexistence of the upper lobe-predominant emphysema and lower lobe-predominant fibrosis. Severe dyspnea and incommensurately impaired gas exchange with preserved lung volume are its features. Case description: A 51-year-old male smoker presented with shortness of breath for 5 months, which increased since 10 days, cough with mucoid expectoration. On examination: SPO2: 84% on room air, Grade-2 clubbing, bilateral pitting-type pedal edema, and bibasilar inspiratory fine crackles were heard. The chest radiograph showed increased translucency in the upper zone and irregular linear opacities in the lower zones of the lungs. He had uncompensated respiratory acidosis on arterial blood gas analysis with elevated total WBC counts. High-resolution computer tomography of the chest (HRCT Chest) showed dilated main pulmonary artery diameter, pan-acinar emphysematous changes in bilateral upper lobes, and subpleural basal reticular opacities with minimal honeycombing in the lower lobes. His two-dimensional echocardiography was suggestive of moderate pulmonary hypertension (PH). Pulmonary functional testing showed a low normal FEV1/FVC ratio and significantly reduced diffusing capacity of the lungs for carbon monoxide (DLCO). Discussion: Combined pulmonary fibrosis with emphysema is an uncommon syndrome with progressive dyspnea, fractious cough, and recurring exacerbations. Risk factors being male gender, smoking, and genetic susceptibility to early-onset pulmonary hypertension with an increased risk of lung cancer and reiterative exacerbations are its complications. Mortality is significantly high in patients with CPFE, with a median survival of 2–8.5 years. Conclusion: Combined pulmonary fibrosis with emphysema syndrome should be surmised in male smokers with sternly impaired DLCO and well-nigh preserved lung volumes, and the diagnosis to be confirmed using HRCT chest. Complications such as PH and increased lung cancer risk are more common in CPFE, leading to a dismal prognosis. Hence, early diagnosis and pertinent therapy are of utmost importance in ameliorating the median survival of the infirm.

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CASE REPORT

Pratap Upadhya, Sivaselvi Chellamuthu, Christie G Joseph, Bheemanathi H Srinivas

A Rare Case of Pulmonary Endobronchial Spindle Cell Carcinoma with Liver Metastasis along with Concurrent Cutaneous Neurofibroma

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:4] [Pages No:151 - 154]

Keywords: Advanced lung cancer, Case report, Chest disease, Lung and liver mass, Metastasis, Pleomorphic pulmonary carcinoma, Pleural effusion, Spindle cell carcinoma, Skin neurofibroma

   DOI: 10.5005/jp-journals-11007-0085  |  Open Access |  How to cite  | 

Abstract

Spindle cell carcinoma is one of the histological variants of pulmonary sarcomatoid carcinoma. It is a rare, poorly differentiated, highly malignant, and rapidly growing non-small cell carcinoma of the lung. Information about pulmonary spindle carcinoma incidence, clinical features, and immunohistochemical markers are not well known compared to other variants of sarcomatoid carcinoma. Most sarcomatoid carcinoma features mimic non-small cell carcinoma, so it is easily misdiagnosed. Cutaneous neurofibroma with primary lung spindle cell carcinoma has not been reported in any previous literature. Here we report a rare endobronchial sarcoma with liver metastasis and concurrent skin neurofibroma.

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CASE REPORT

Sheetal Verma, Prem P Gupta, Sandeep Nain

A Rare Case of Invasive Pulmonary Infection by Syncephalastrum racemosum in a Pulmonary Tuberculosis Patient

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:2] [Pages No:155 - 156]

Keywords: Case report, Pulmonary tuberculosis, Sputum examination, Syncephalastrum racemosum

   DOI: 10.5005/jp-journals-11007-0088  |  Open Access |  How to cite  | 

Abstract

Background: Syncephalastrum racemosum is a saprophytic and ubiquitous fungus found in soil, mainly in tropical and subtropical areas, usually does not cause human infections and if it does, affects immunocompromised persons. It mainly causes subcutaneous infections and onychomycosis and rarely pulmonary infections. Case description: We report a case of a 36-year-old female, diagnosed with pulmonary tuberculosis and on antitubercular treatment for 1 month, presented to the emergency with complaints of shortness of breath, fever, cough with sputum production and mildly blood-stained sputum since 3 days. The chest X-ray showed bilateral infiltrates in the lower zones. Sputum investigations revealed AFB negativity, sterile pyogenic culture, and positive S. racemosum fungal culture. Deoxycholate amphotericin B was started on the basis of sputum reports, but unfortunately, the patient expired within 1 day of starting treatment. Conclusion: The above case describes infection by a rare fungal species in an immunocompromised patient with tuberculosis. Few cases are reported, so limited data are available to understand the complete disease implications. However, we should keep it as a differential in an immunodeficient patient with an invasive infection for timely diagnosis and treatment.

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CASE REPORT

Vithiya Ganesan

Bronchopulmonary Infection by Lophomonas blattarum: A Case Report from South India

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:3] [Pages No:157 - 159]

Keywords: Bronchoalveolar lavage, Case report, Lophomonas blattarum, Metronidazole

   DOI: 10.5005/jp-journals-11007-0090  |  Open Access |  How to cite  | 

Abstract

Aim and background: Lophomonas blattarum, a new flagellate protozoan has been implicated in bronchopulmonary infections. Since the 1990s, reports emerged from peoples Republic of China, followed by reports from other parts of the world too. Six cases have been reported from India so far. To the best of our knowledge, this is the first case report from South India. Case description: A 68-year-old female was hospitalized with symptoms of lower respiratory infection. Computed tomography (CT) thorax showed consolidation with cavitation and centrilobular nodules in the left upper lobe. Sputum Gram, Ziehl–Neilsen stain and bacterial culture did not reveal any etiology. Wet mount of broncho alveolar lavage revealed actively motile organisms with a polar tuft of flagella identified as L. blattarum. She was treated with intravenous metronidazole for a week and oral metronidazole 400 mg thrice daily for the next 3 weeks. The patient was symptomatically better after 2 months of follow-up. Conclusion: Parasites are deterred as a significant etiology of respiratory tract infections, and perception of L. blattarum builds a new element to this assumption. Through this report, we hope to raise awareness among the medical community about this emerging infection and consider it in differential diagnosis in appropriate case settings. Clinical significance:Lophomonas blattarum is an unconventional and unusual pathogen causing bronchopulmonary infections. • It can be easily missed if not looked for.

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CASE REPORT

Sandeep Nayar, Imaad Rahman, Sunny Kalra, Manish Garg, Shreshth Nayar

Refractory Autoimmune Pulmonary Alveolar Proteinosis Treated with Inhalational GM-CSF: A Case Report

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:3] [Pages No:160 - 162]

Keywords: Case report, GM-CSF, Ground glass opacities, Pulmonary alveolar proteinosis

   DOI: 10.5005/jp-journals-11007-0092  |  Open Access |  How to cite  | 

Abstract

Aim and background: Pulmonary alveolar proteinosis is a rare entity with definite evidence to show symptomatic improvement with whole lung lavage therapy. Refractory autoimmune pulmonary alveolar proteinosis continues to be a mystery as upcoming treatment modalities still show variable results. Case description: We hereby present a case of a 40-year-old female who presented with acute severe shortness of breath with a cough for 3–4 days and was a transbronchial biopsy-proven case of pulmonary alveolar proteinosis. On admission to intensive care unit (ICU), the patient was started on inhalational granulocyte–macrophage colony-stimulating factor (GM-CSF). Conclusion: Starting a patient on inhalational GM-CSF provided significant clinical improvement with a decrease in dependence on long-term oxygen therapy thus showing the value of this possible treatment in managing refractory autoimmune pulmonary alveolar proteinosis. Clinical significance: This case highlights the importance of inhalational GM-CSF therapy as a treatment modality for refractory autoimmune pulmonary alveolar proteinosis.

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CASE SERIES

Pradeep Ravi, Deepak Amalnath

Spontaneous Alveolar Air Leak Syndromes in COVID-19 Patients: A Case Series

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:4] [Pages No:163 - 166]

Keywords: Alveolar air leak syndromes, Coronavirus disease-2019, Pneumothorax, Pneumomediastinum, Subcutaneous emphysema

   DOI: 10.5005/jp-journals-11007-0087  |  Open Access |  How to cite  | 

Abstract

The spectrum of spontaneous alveolar air leak (AAL) syndromes (AAS) includes pneumomediastinum, pneumothorax, and subcutaneous emphysema. These syndromes have been recently reported to be an uncommon complication in patients with coronavirus disease-2019 (COVID-19) pneumonia. These syndromes were found in patients with other viral respiratory diseases, such as SARS, MERS, and H1N1. The pathophysiology of which is mostly unknown but has been attributed to the diffuse alveolar injury which leads to alveolar rupture and air leak. Here, we present a case series of 11 patients with COVID-19 pneumonia who had alveolar air leak syndromes. All 11 patients had severe COVID and raised inflammatory markers. Most of them developed air leak syndromes when they were not on invasive or noninvasive ventilation. About 7 out of 11 patients expired. This case series is hereby presented because of the rarity of these complications, that is, on an extensive search of the literature, less than 20 cases of alveolar air leak syndromes in COVID-19 have been reported.

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BRIEF RESEARCH COMMUNICATION

Romman Fatima, Dharampal Bansal, Syed Taha Mahmood, Afra Fatima, Viquasuddin Mohammed

Churg–Strauss Syndrome

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:4] [Pages No:167 - 170]

Keywords: Antineutrophilic cytoplasmic antibody, Corticosteroid, Hypoxia, Pulse steroid, Respiratory distress

   DOI: 10.5005/jp-journals-11007-0086  |  Open Access |  How to cite  | 

Abstract

Churg–Strauss syndrome an antineutrophilic cytoplasmic antibody (ANCA)-mediated vasculitis has an estimated prevalence of around 10.7 cases per million adults with the median age of presentation being 40 years. It is an uncommon vasculitis to be seen in pediatric age groups which when found has a poorer prognosis due to cardiac involvement and associated manifestations. Its pathophysiology is based on the immune-mediated activation of eosinophils followed by the release of chemokines, such as eotaxin-3, CCL17, major basic protein and many other intermediates that cause tissue damage. The case described, presented with recurrent sinusitis, allergic manifestations with sudden onset purpuric ankle rash and marked hypoxia-induced respiratory distress. Workup revealed marked eosinophilia and very high IgE levels pointing towards ANCA-mediated vasculitis. The patient was managed with pulse dose steroid therapy for remission and maintenance treatment with long-term steroids. The patient was discharged in stable condition with a monthly follow-up with the primary.

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Photo Assay

Ashish Kumar Prakash, Anand Jaiswal, Sumit Paharia

Pulmonary Arteriovenous Malformation in Hereditary Hemorrhagic Telangiectasia: Coil Embolization

[Year:2023] [Month:July-September] [Volume:65] [Number:3] [Pages:1] [Pages No:171 - 171]

   DOI: 10.5005/jp-journals-11007-0091  |  Open Access |  How to cite  | 

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