Background. Xpert-MTB/RIF assay or Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) helps in rapid diagnosis of tuberculosis (TB). Methods. Specific samples were collected and carried to Regional Medical Research Centre where these were taken up for CBNAAT and culture in Lowenstein-Jensen media. Appropriate samples were sent to the Designated Microscopy Centre (DMC) of our institute for acid-fast bacilli (AFB) smear examination. Diagnostic measures, such as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Xpert-MTB/RIF were reported considering mycobacterial culture and a composite reference standard (CRS) as Gold standard. Results. We studied 335 samples. Lymph node fine needle aspirate was the most common sample (32.5%) followed by pleural fluid (29.3%). The overall sensitivity and specificity of Xpert-MTB/RIF was determined to be 26.5% (95% CI [confidence interval] 20.8–32.8) and 100% (95% CI 96.8–100), respectively. The sensitivity and specificity of CBNAAT in relation to mycobacterial culture, however, was 78.8% (95% CI 61.1–91.0) and 89.1% (95% CI 85–92.4), respectively. Both were highest for pus, cerebrospinal fluid and lymph node fine needle aspirate samples. Conclusions. Xpert-MTB/RIF may be useful for samples, like cold abscess and lymph node fine needle aspirate or biopsy specimens. However, its routine use in case of serosal fluids is not recommended because of its lower sensitivity.

Background. Ambient aeroallergens and organic or inorganic air pollutants are known to cause asthma exacerbation and subsequent asthma-related hospital admissions. Methods. This study was carried out to study the impact of meteorological factors, air pollution, pollens over hospital visits for respiratory illness in north Delhi region from July 2014 to June 2015. Daily monitoring of pollen grains was done on the roof of the multistorey building (height up to 20m) of the Institute. Meteorological factors including temperature, relative humidity, and precipitations were recorded daily. Daily concentrations of nitric dioxide (NO₂), particulate matter (PM_2.5) and sulphur dioxide (SO₂) were also recorded. Number of hospital visits of patients with respiratory illness were assessed in relation to air pollutants (NO₂, SO₂ and PM_2.5) and climate change (temperature, relative humidity and rain). Results. During the study period, 113,462 pollen counts were recorded. Two highest peaks of mean pollen counts were observed in post-monsoon season (October-2014) and in the spring season (March 2015). The maximum and minimum pollen concentration was observed in the month of March 2015 (18818/m³) and August 2014 (4731/m³). Our results showed that pollen numbers significantly correlated with respiratory emergency department patient visits (P=0.037, r=0.604), and temperature and humidity (P=0.711, r=-120, and (P=0.670, r=-0.137), respectively. NO₂ significantly correlated with SO₂, respiratory emergency department patient visits and new respiratory OPD patients (P=0.017, r=0.670, P=0.031, r=0.622 and P=0.016, r=0.675, respectively). A statistically significant correlation between rainfall and SO₂ was observed (P=0.004, r=-0.757) in the present study. Conclusion. Our study suggests that significant increase in pollen concentration and air pollutants in the ambient environment causes respiratory illness.

Objectives. Interstitial lung disease (ILD) with features of pulmonary fibrosis and honey-combing is a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). High resolution computed tomography (HRCT) is the established non-invasive gold standard technique for the diagnosis of SSc related ILD. The present study was designed to characterise HRCT features of ILD in SSc and to correlate pulmonary function test (PFT) parameters with HRCT semi-quantitative scores. Methods. This is an observational, cross-sectional study including 36 patients of SSc who underwent HRCT chest. All the patients were females. Severity and extent were assessed using four HRCT features: ground-glass opacity (GGO), mixed GGO and reticular opacity, reticular fibrosis and honey-combing. Thirty-three patients were able to perform PFT. Total HRCT score, inflammatory index and fibrosis index were correlated with PFT parameters. Results. Interstitial lung disease was found in 33 patients (91.6%), 24 patients (66.6%) had mixed GGO along with reticular inter-lobular septal thickening. Majority of the patients (64%) had non-specific interstitial pneumonia (NSIP) pattern. Usual interstitial pneumonia (UIP) pattern was seen in 25% of the cases. One patient had overlapping features of both UIP and organising pneumonia. There was predominant lower lobe involvement. Among the 33 patients who were able to perform PFT, 85% had abnormal results (predicted forced vital capacity [FVC]<80%). Total HRCT score showed significant negative correlation with PFT parameters –– FVC (r=–0.48, P=0.004) and forced expiratory volume in one second (FEV₁) (r=–0.28, P=0.1), respectively. The ratio of FEV₁ and FVC had significant positive correlation with total HRCT score (r=0.5, P=0.002). Inflammatory index and fibrosis index had significant negative correlation with predicted FVC% (P<0.05). Conclusions. Mixed pattern (GGO and reticular opacity) was the most common HRCT finding. HRCT semi-quantitative scoring system is sensitive in assessing the severity and extent of ILD qualitatively and quantitatively in SSc patients.

A 75-year-old male, with multiple co-morbidities including chronic obstructive pulmonary disease, type II diabetes mellitus and bronchogenic carcinoma, presented with lung abscess, and was detected to have Salmonella entericaserovar Anatum, non-typhoid Salmonella (NTS) infection. Treatment with appropriate antibiotics and source control by image-guided drainage showed rapid clinical improvement. To the best of our knowledge, this is the first case report of lung abscess caused by Salmonella enterica species serovar Anatum.

Kytococcus has long been considered to be a skin commensal or environmental contaminant. However, it has emerged as an aetiological agent of prosthetic valve infective endocarditis, pneumonia, bacteremia, osteoarticular, and implant/device infections, especially in patients with immunocompromised conditions, such as haematological malignancies, febrile neutropaenia and in patients on immunosuppressant therapy. We report a case of prosthetic valve endocarditis associated with Kytococcus schroeteri in a patient with rheumatic heart disease and mitral valve replacement. Special efforts to reach correct identification have to be made as Kytococcusis, commonly resistant to penicillins and oxacillins; and often needs prolonged treatment with glycopeptides containing combination antimicrobial therapy.

Dactylitis due to tuberculosis (TB) is an extremely uncommon manifestation of TB. We report a unique case of isolated index finger dactylitis with right hilar adenopathy due to TB in a 15-year-old immunocompetent student. High index of clinical suspicion, radiological findings and histological confirmation helped in the diagnosis. Anti-tuberculous therapy remains the cornerstone for the management of these cases.