Journal of Advanced Lung Health

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Background and Objective: Extrapulmonary tuberculosis (EPTB) affects about 25% of patients presenting with Tuberculosis (TB). Tuberculous pleural effusion is the second-most common type of EPTB, after lymph node TB. Although the molecular TB diagnostics have lower turnaround time compared to traditional testing methods, the sensitivity in microscopy negative specimens are low. Higher cost and infrastructure requirements are other disadvantages. Truenat, developed by Mobilio diagnostics and validated by ICMR, is a rapid, polymerase chain reaction (PCR)-based diagnostic test to detect Mycobacterium Tuberculosis (MTB) and also rifampicin resistance. According to the WHO, the accuracy of Truenat is comparable to Xpert PCR. We report our experience in using Truenat for EPTB, specifically, pleural TB. Methods: We retrospectively analyzed data from thoracoscopy over the past 2 years. All data pertaining to the use of Truenat for TB in pleural fluid and thoracoscopic biopsy specimens, histopathology, and mycobacterial cultures were analyzed. Results: We had a total of 114 patients with undiagnosed pleural effusion who underwent thoracoscopy during the study. Forty-five patients (39%) had a diagnosis of TB, among the total 114 patients. The sensitivity of tissue Truenat was 51.11 (95% confidence interval [CI]: 35.77–66.30), tissue culture 37.50% (95% CI: 22.73–54.20), pleural fluid Truenat 20% (95% CI: 8.44–36.94), and fluid culture 14.29% (95% CI: 5.43–28.54). The specificities of all the confirmatory tests were 100% when compared to a reference standard which was taken as a combination of histology and culture as the reference standard with or without acid-fast bacilli in the histology samples. Tissue Truenat was significantly more sensitive than fluid Truenat (P < 0.05). Likewise, tissue culture was more sensitive than fluid culture (P < 0.05). Among all microbiology confirmatory tests performed, Truenat of pleural tissue had the highest yield (51.11). Conclusion: Thoracoscopic pleural biopsy Truenat results in improved sensitivity in cases of EPTB.

Hemoptysis is not a common symptom in bronchial asthma. We aim to discuss the approach to a patient with uncontrolled asthma with recurrent hemoptysis in this case-based discussion. Causes in such cases include pulmonary tuberculosis, bronchiectasis, endobronchial lesions, bronchial carcinoid, factitious hemoptysis, allergic bronchopulmonary aspergillosis, granulomatosis with polyangiitis, allergic angiitis (hypersensitivity vasculitis), Churg-Strauss syndrome, and valvular heart disease which can coexist with asthma.

Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi, mostly affecting the nasal mucosa. Extranasal involvement is also reported involving eyes, oral cavity, and skin. Herein, we present a rare case of a patient with disseminated rhinosporidiosis who presented with pulmonary lesions which resembled metastasis.

Tuberculosis (TB) can affect various organs besides the lungs. Among the extrapulmonary sites, pleura and gastrointestinal tract are the second- and sixth-most common sites, respectively. Pleural involvement usually occurs in the form of pleural effusion, and the sites most commonly involved in gastrointestinal TB are the peritoneum and ileocecal area. Here we present an interesting case of a 23-year-old female who presented to the gastroenterologist with symptoms of dysphagia, regurgitation of food, and weight loss. Esophagogastro duodenoscopy showed an esophageal ulcer which was confirmed to be due to TB. Incidentally, this patient also had multiple pleural nodules due to TB. This case is unique since there is a simultaneous occurrence of two different sites of occurrence of extrapulmonary TB.

A case of fever, cough, and hemoptysis in a young female which could not be diagnosed by routine investigations is presented here. Confirmatory diagnosis was established after a long period of 2 years. Difficulty in diagnosis itself points to a rare cause for this presentation. The case is presented here with expert comments from specialists working in related specialties.

In a country like India where the burden of tuberculosis is high, pulmonary tuberculosis is the first differential diagnosis when a patient presents with chronic cough, fever, and weight loss. However, many other infectious and noninfectious diseases also can present with similar symptoms. Infra diaphragmatic lesions also can present with chronic cough with fever and weight loss. We present a rare case of bilateral suprarenal mass diagnosed as Non-Hodgkin lymphoma presenting with chronic cough, fever, and weight loss. We aim to highlight extra thoracic causes for chronic cough with fever in this article.

Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. Even with advancement in understanding the pathophysiology and various monitoring tools and treatment measures, sepsis still remains a major cause of mortality and morbidity in critically ill patients. Over the last three decades, significant changes were seen regarding understanding the pathophysiology of sepsis. The management of sepsis has evolved over the last two decades by the advent of the Surviving Sepsis Campaign Guidelines which recommends early recognition and prompt treatment without delay.

Online since 22^nd September 2020