Indian Journal of Respiratory Care

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Volume 13, Number 1, January-March 2024
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EDITORIAL

Gokul G. Krishna, Ann M Jose, Jithin K Sreedharan, KP Gireesh Kumar

Understanding E-cigarette Use in India: Challenges, Health Implications, and Regulatory Responses

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:2] [Pages No:1 - 2]

   DOI: 10.5005/jp-journals-11010-1095  |  Open Access |  How to cite  | 

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Original Article

Ayaana Jain, Shruti Gurav, Joshua T Joseph, Schulen Dias, Shashikala Wali, Revana S Devarinti

Prospective Observational Study on Assessing Medication Reconciliation and Health-related Quality of Life for Chronic Obstructive Pulmonary Disease: Emerging Role of Pharmacists

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:7] [Pages No:3 - 9]

Keywords: Clinical pharmacist, Chronic obstructive pulmonary disease, Counseling, Medication discrepancy, Quality of life

   DOI: 10.5005/jp-journals-11010-1084  |  Open Access |  How to cite  | 

Abstract

Aim and background: Chronic obstructive pulmonary disease (COPD) is a sustained obstructive airway disease that impedes normal breathing function. The most effective course of action, as deemed by clinical pharmacists, is the implementation of pulmonary rehabilitation, analyzing patient medication charts, efficacy, and safety of medications, improving/enhancing the quality of life, counseling or educating patients, etc. The aim of the present study is to evaluate medication discrepancies and provide counseling to patients to gauge the impact of pulmonary rehabilitation on their health-related quality of life (HRQoL). Materials and methods: A prospective observational study was conducted for 6 months in the Department of General Medicine and Respiratory at a tertiary care hospital. Patients aged >18 years who admitted having a history of COPD were recruited. Further, the best possible medication history (BPMH) was noted, and patients were counseled to compare the quality of life in COPD patients in the pretest and posttest using the SF-36 HRQoL questionnaire. The statistical method used was the dependent t-test. Results: A total of N = 185 patients were screened in accordance with the study's criteria, and N = 103 were enrolled. We identified that the most significant variations occurred when bronchodilator dosage schedules were prescribed upon discharge, and comparisons were made to measure quality of life. In the follow-up, there was an improvement in all domains of quality of life. The pre- and posttest scores were subjected to comparison, and an enhancement in the quality of life was documented (p-value: 0.0001). Conclusion: This study explains the pharmacist's intervention in poststudy. A significant decrease in discrepancies was found, and counseling patients helped improve the quality of life among COPD patients. Clinical significance: This study signifies the emerging role of clinical pharmacists in reviewing medication charts, identifying and resolving drug related problems, and educating patients to improve their quality of life.

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Original Article

Arjun Kumar, Ashok K Janmeja, Balbir Singh, Vijay K Verma, Ankit Lakra, Rahul Gupta

Basic Working Knowledge of Pulse Oximetry among Healthcare Workers and Patients Requiring Oxygen Therapy in a Tertiary Care Center in North India

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:5] [Pages No:10 - 14]

Keywords: Healthcare workers, Knowledge, Oxygen therapy, Patients, Pulse oximetry

   DOI: 10.5005/jp-journals-11010-1085  |  Open Access |  How to cite  | 

Abstract

Introduction: Use of pulse oximetry devices (PODs) by healthcare workers and the general population is becoming popular, especially after coronavirus disease 2019 (COVID-19) pandemic. Use of PODs has several limitations that may lead to inaccurate readings. Hence, we planned to do a study to assess the basic working knowledge of pulse oximetry among healthcare workers and patients. Materials and methods: This was a cross-sectional descriptive study conducted among the healthcare workers and patients requiring oxygen therapy admitted to MM Medical College & Hospital, Kumarhatti-Solan. Total duration of the study was 6 months from January to June 2023. A validated previously published semi-structured simplified questionnaire containing a total of 20 questions was used to assess the knowledge of pulse oximetry among the study population. The collected data were entered into Statistical Package for the Social Sciences (SPSS) version 20 for analysis. Results: Out of 290 participants in this study, 89 (30.7%) were nurses, 76 (26.2%) were doctors, 73 were (25.2%) medical students, and 52 (17.9%) were patients. Majority, 189 (68.3%), of the participants had poor knowledge of pulse oximetry. Lack of formal training of pulse oximetry was associated with poor knowledge of pulse oximetry among healthcare workers (p-value < 0.001). Lower level of education status and socioeconomic status were negatively correlated with patients’ basic working knowledge of pulse oximetry. Conclusion: Our study noted poor basic working knowledge of pulse oximetry among healthcare workers and patients requiring home oxygen therapy. There is an utmost need of pulse oximetry training for healthcare professionals and patients to ensure quality care for patients.

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Original Article

Naga Vishnu P Kasa, Narendra K Narahari, Nageswara R Modugu

A Comparative Study of Confusion, Urea Nitrogen, Respiratory Rate, Blood Pressure, Age ≥ 65 and Pneumonia Severity Index Scoring Systems in Patients with Pneumonia in a Tertiary Care Setting

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:8] [Pages No:15 - 22]

Keywords: CURB, mortality, pneumonia, pneumonia severity index, PSI

   DOI: 10.5005/jp-journals-11010-1089  |  Open Access |  How to cite  | 

Abstract

Background: Pneumonia is one of the major causes of mortality and morbidity globally. The ability to stratify the risk and early intervention is the key to survival and can decrease mortality significantly. Herein, we compare the pneumonia severity index (PSI) and confusion, urea nitrogen, respiratory rate, blood pressure, age ≥ 65 (CURB-65) in terms of predicting mortality, intensive care unit (ICU) admission, and requirement of invasive mechanical ventilation. Materials and methods: The current study is a 1-year Cohort study conducted from October 2019 to September 2020. Patients hospitalized with community-acquired pneumonia (CAP) were included in the study after fulfilling the eligibility criteria. PSI and CURB-65 scores were calculated at the time of admission and compared. Follow-up of the patients was done for 30 days after admission to observe for mortality. Results: In total, 70 subjects were admitted to hospital with CAP, with male predominance. Of 70 subjects, 28 (40%) required ICU admission. The overall mortality rate was 15.7%, higher in patients above 65 years of age (33%). PSI class ≥ 4 was more accurate in predicting mortality, and admission into ICU, and PSI class 5 for the requirement of invasive ventilation than CURB-65 score ≥ 2 as calculated from the area under the curve (AUC) for the receiver operator characteristics (ROC) curve drawn for these two scores. The AUC of PSI (0.812) was higher compared to CURB-65 (0.721) in our study, making it a better predictor of mortality. PSI class ≥ 4 had higher sensitivity for predicting ICU admission but CURB-65 score ≥ 2 had higher specificity. Conclusion: The PSI is more sensitive than CURB-65 in predicting ICU admission and death, with high prognostic capacity. Therefore, it is essential for clinicians to choose the scoring index that is suitable for their local requirements.

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Original Article

Saumy Johnson, Sami Al Abdulkareem

A Comparative Study of Sleep Hygiene Techniques’ Efficacy in Improving Sleep Quality: An Indo-Saudi Perspective

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:5] [Pages No:23 - 27]

Keywords: Pittsburgh Sleep Quality Index, Sleep hygiene, Sleep quality

   DOI: 10.5005/jp-journals-11010-1094  |  Open Access |  How to cite  | 

Abstract

Sleep quality is integral to overall health, with cultural practices potentially influencing sleep patterns. This comparative study assessed the effectiveness of sleep hygiene techniques in individuals from diverse cultural backgrounds, specifically in India and Saudi Arabia. A mixed-methods approach combined quantitative assessments and qualitative exploration. The study included 185 participants from each country, aged 18–60, experiencing poor sleep quality. Quantitative data included the Pittsburgh Sleep Quality Index (PSQI) for sleep assessment and a customized sleep hygiene questionnaire. Qualitative data were gathered through in-depth interviews exploring cultural influences, barriers, and facilitators to sleep hygiene practices. Results showed no significant difference in PSQI scores between India (7.4 ± 1.9) and Saudi Arabia (6.8 ± 1.5). However, sleep hygiene scores were significantly higher in Saudi Arabia (3.6 ± 0.8) compared to India (3.2 ± 0.9). Thematic analysis of qualitative data revealed cultural influences on sleep hygiene practices, with traditional practices in India and religious rituals in Saudi Arabia shaping participants’ routines. Family dynamics and societal expectations were also influential. Barriers included work-related stress and electronic device use, while supportive family environments and educational awareness campaigns facilitated adherence to sleep hygiene. Cultural perceptions varied, with Indian participants attributing positive sleep outcomes to traditional practices, while Saudi Arabian participants were open to evidence-based techniques. Limitations included sampling bias and reliance on self-report measures. Recommendations for future research include longitudinal studies, objective measures, and culturally adapted interventions. This study emphasizes the need for culturally sensitive sleep interventions, recognizing cultural influences on sleep patterns. Personalized, culturally tailored strategies can enhance sleep quality and overall well-being. Continued research should explore cultural nuances and develop targeted interventions for diverse populations.

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Original Article

Dhanashree V Dabhade, Manish P Shukla

Effect of Home-based Rehabilitation Program on Cardiorespiratory Fitness Level in Post-COVID-19 Patients with Type II Diabetes Mellitus: A Pilot Randomized Controlled Trial

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:6] [Pages No:28 - 33]

Keywords: 6-minute walk test, COVID-19, Diabetes mellitus, Pedometer

   DOI: 10.5005/jp-journals-11010-1097  |  Open Access |  How to cite  | 

Abstract

Background: The outbreak of COVID-19, a highly contagious disease, necessitated widespread lockdowns, leading to reduced physical activity (PA), heightened stress, increased sedentary behavior, and disruptions in glycemic control. Remarkably, type 2 diabetes mellitus (T2DM) is a primary comorbidity associated with COVID-19. This study aims to evaluate the impact of an 8-week-structured home-based rehabilitation program on cardiorespiratory fitness levels in individuals with T2DM who have recovered from COVID-19. Materials and methods: This prospective, randomized, open-label parallel trial took place in the cardiovascular and respiratory physiotherapy outpatient department (OPD) of a tertiary care hospital, spanning from April 2021 to December 2022. The study comprised 16 participants, segregated into two groups: the intervention group and the control group. Eligible participants were individuals with post-COVID-19 T2DM who had experienced a mild illness, satisfactory recovery, and had tested negative. The intervention group underwent warm-up, aerobic exercises, strength training, and cool-down sessions for 3–5 days a week over an 8-week period, totaling 150 minutes per week. Patient assessments were conducted using the blood glucose level, 6-minute walk test (6MWT). Results: While both groups demonstrated enhancements in blood glucose levels, these improvements did not reach statistical significance (p = 0.22). However, the intervention group demonstrated a more significant improvement in walking distance (p = 0.0013) by the 8th week. Notably, within-group comparisons were statistically significant (p = 0.0016) for both parameters at various timeframes, except for the 6MWT in the intervention group at baseline vs the 4th week (p = 0.2). Conclusion: This study demonstrates the effectiveness of a home-based rehabilitation program in improving cardiorespiratory fitness levels among post-COVID-19 T2DM patients.

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Original Article

Manoj K Pandey, Shiv K Verma, Vakeel Ahamad, Rinki Kumari

Circulating Inflammatory Mediators in COPD: A Multimarker Analysis of Inflammatory Biomarkers: Interleukin-6, -8, -10, and Tumor Necrosis Factor-α along with Leptin across Disease Stages

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:9] [Pages No:34 - 42]

Keywords: Chronic obstructive pulmonary disease, Disease progression, Inflammatory responses, Interleukins, Leptin, Lung function, Pulmonary biomarkers, Tumor necrosis factor-α

   DOI: 10.5005/jp-journals-11010-1096  |  Open Access |  How to cite  | 

Abstract

Introduction: This study focuses on investigating chronic obstructive pulmonary disease (COPD) at Shaikh-UI-Hind Maulana Mahmood Hasan Medical College in Saharanpur, India. With an emphasis on the intricate dynamics of COPD pathophysiology, the research aims to shed light on specific inflammatory pathways and advocate for tailored therapeutic interventions. Materials and methods: The research enrolled 1,954 participants suspected of COPD, utilizing pulmonary function tests (PFTs) to categorize 165 cases into stages (COPD I, II, III, and IV) alongside a healthy control group. Comprehensive data, including demographic details, smoking history, occupational and environmental exposures, prior asthma occurrences, infections (including tuberculosis), socioeconomic status, and body mass index (BMI), was collected. Various analyses, including analysis of variance (ANOVA) and Tukey's post hoc test, were applied to scrutinize the data. Results: The findings indicate a significant decrease in mean forced expiratory volume in 1 second (FEV1%) predicted and FEV1/forced vital capacity (FVC) in COPD cases vs controls. Moreover, elevated serum levels of interleukins (IL-6, IL-8, IL-10), tumor necrosis factor-α (TNF-α), and leptin were observed in COPD cases, with variations across stages. Notably, COPD IV displayed the highest levels for IL-6, IL-8, IL-10, and leptin, with TNF-α exhibiting a distinctive pattern. Demographic and lung function differences align with existing COPD literature, indicating the systemic inflammatory nature of COPD. Conclusion: The study concludes by emphasizing the complexity of inflammatory dynamics in COPD and advocating for a comprehensive approach. Unique TNF-α patterns warrant deeper investigation into their role in COPD subtypes. This detailed analysis of pulmonary biomarkers in COPD provides insights into their role in disease progression and suggests potential avenues for personalized therapeutic strategies targeting specific inflammatory pathways.

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REVIEW ARTICLE

Nuzhat Umran, Prabu Dhandapani

Immunoprophylaxis of Respiratory Syncytial Virus Infection: Recent Updates

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:7] [Pages No:43 - 49]

Keywords: Antiviral, Developing countries, Immune response, Respiratory syncytial virus, Vaccine, Viral pathogenesis

   DOI: 10.5005/jp-journals-11010-1087  |  Open Access |  How to cite  | 

Abstract

The respiratory syncytial virus (RSV) has been the most prevalent cause of respiratory illness in children and infants. Although the humoral immune response usually produces anti-RSV neutralizing antibodies during an infant's initial infection, they are usually insufficient. Despite the fact that RSV-specific neutralizing antibody production remains effective during infection, humoral immunity declines with time, resulting in frequent reinfection in subsequent seasons. With high prevalence and significant morbidity in young children and older adults, currently available patient care for RSV is based on supportive therapy. RSV prevention strategies have advanced significantly as a result of ongoing studies on the immunopathology, community transmission, and mechanisms underlying the virus replication. Despite the fact that RSV and poliovirus were discovered at the same time, cost-effective vaccinations for the risk groups were unavailable in many countries.

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REVIEW ARTICLE

Mohankumar Thekkinkattil

A Literature Review of Most Common Symptoms in Respiratory Therapist's Practice: How to Manage Dyspnea in Interstitial Lung Disease

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:4] [Pages No:50 - 53]

Keywords: Corticosteroids, Dyspnea, Interstitial, Lung disease

   DOI: 10.5005/jp-journals-11010-1092  |  Open Access |  How to cite  | 

Abstract

Dyspnea is a distressing symptom prevalent in interstitial lung disease (ILD) patients, significantly affecting their quality of life. Understanding the multifaceted nature of dyspnea in ILD is crucial for comprehensive patient care. This article supplies an in-depth exploration of dyspnea in ILD, covering its causes, pathophysiological mechanisms, diagnostic strategies, and treatment approaches. The causes of dyspnea in ILD encompass a spectrum of factors including restrictive lung function, alveolar damage, impaired gas exchange, pulmonary vascular involvement, inflammation, and scarring. These factors collectively contribute to the challenging symptomatology experienced by ILD patients. Pathophysiologically, dyspnea in ILD stems from altered lung mechanics, compromised gas exchange due to fibrotic changes, pulmonary vascular remodeling, and intricate neural pathways involved in dyspnea perception. Diagnosis of dyspnea in ILD necessitates a comprehensive approach involving clinical history, physical examinations, pulmonary function tests (PFTs), imaging studies, biomarkers, and functional assessments like cardiopulmonary exercise testing (CPET). Treatment strategies encompass a multidisciplinary approach, integrating pharmacological interventions such as corticosteroids, immunosuppressants, and antifibrotic agents, alongside pulmonary rehabilitation, oxygen therapy, and in severe cases, lung transplantation. This article highlights recent research developments, clinical trials, and advancements in understanding and managing dyspnea in ILD patients. Continual exploration and personalized approaches are imperative to alleviate the burden of dyspnea and enhance the lives of those affected by ILD.

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REVIEW ARTICLE

Saumy Johnson, Jerry Paul

Breathing for Two: Unraveling the Complex Interplay of Pregnancy and Respiratory Physiology

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:6] [Pages No:54 - 59]

Keywords: Pregnancy, Respiratory, Respiratory system

   DOI: 10.5005/jp-journals-11010-1093  |  Open Access |  How to cite  | 

Abstract

This review explores the distinctive physiological adjustments taking place in the respiratory system throughout a typical pregnancy. These adaptations encompass modifications in lung function, volume, respiratory resistance, and conductance. Though vital to support both the mother and the fetus, they can also heighten vulnerability to illnesses and exacerbate preexisting conditions. Additionally, the review underlines the complexities related to interpreting laboratory and imaging studies due to these physiological shifts, along with potential risks during nasal and endotracheal intubation. Nevertheless, critical pulmonary parameters, such as static and dynamic compliance, diffusing capacity, and static lung recoil pressure typically remain steady. The review concludes by delving into pathologic disorders and conditions that may manifest during pregnancy, underscoring the significance of monitoring respiratory function and promptly addressing any complications. In summary, this review offers valuable insights into the distinct respiratory transformations observed during pregnancy and their potential consequences for the well-being of both the mother and the fetus.

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CASE REPORT

Annapurna Mydavolu, Junaid Ahmed, Thippeswamy Gowda

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:4] [Pages No:60 - 63]

Keywords: Case report, Cough, Effusion, Hemoptysis, Normal D-dimer, Pneumonia, Pulmonary embolism, Pulmonary infarct, Pleural effusion

   DOI: 10.5005/jp-journals-11010-1091  |  Open Access |  How to cite  | 

Abstract

Introduction: Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism (PE) and concomitant pneumonia are uncommon. In this case report, we present a 40-year-old male patient with pneumonia and PE in whom pneumonia initially masked the diagnosis of PE. Moreover, pneumonia may occasionally mask PE, particularly in patients with predominant systemic symptoms such as fever, and with no evidence of deep vein thrombosis (DVT) or trauma. Case presentation: This patient who is an industrial worker, smoker and alcoholic presented to the ER with acute left lower chest and upper abdominal pain, shortness of breath, high grade fever and cough with hemoptysis. On examination pulse rate was 118 and normal oxygen saturation. He was admitted to the intensive care unit (ICU) and managed conservatively. His ultrasound chest and chest X-ray showed left lower lobe consolidation with effusion. His Wells score is 2.5, and D-dimer is normal, but total leucocyte counts and hemoglobin are elevated. There no signs of DVT. He was managed with intravenous antibiotics, antipyretics. He has no signs of hemodynamic instability or hypoxia. He had persistent blood clots in sputum, which warranted computed tomography (CT) pulmonary angiography. Acute pulmonary thromboembolism (PTE) with pulmonary infarct (PI) and concomitant consolidation with pleural effusion is reported. Venous Doppler study of both lower limbs was negative for deep venous thrombosis except for a slow flow vascular malformation in the left distal thigh. He was started on anticoagulation with low molecular weight heparin as per treatment guidelines for 6 days, later he improved and had no hemoptysis or any bleeding. Further investigations for hypercoagulable state done that showed high levels of serum homocysteine and low folic acid. With the advice of oral anticoagulation and folic acid supplementation, he was discharged from the hospital in a stable condition. This case is a rare entity of normal D dimer PTE with PI. This case highlights the importance of considering PE in patients with pneumonia when there would be an initial therapeutic response followed by a worsening of the condition during the treatment of pneumonia. Conclusion: When approaching an otherwise young and healthy individual with unexplained pleuritic chest pain or hemoptysis in the emergency department, a pulmonary infarction (PI) complicating an acute PE should be considered as a possible diagnosis among other conditions (e.g., pneumonia, lung neoplasia, lung granulomatous disease), when there is a strong clinical suspicion.

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CASE REPORT

Muddaiah Srinivas, Guruprasad T Jagadeesh, Prabhakar Kamarthi, NJ Patil, Jagmohan Sugnyanasagar Venkataramanappa

Effect of Telerehabilitation in a Patient with Pulmonary Tuberculosis: A Case Study

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:3] [Pages No:64 - 66]

Keywords: Case report, Pulmonary tuberculosis, Respiratory care therapy, Telerehabilitation, Yoga

   DOI: 10.5005/jp-journals-11010-1088  |  Open Access |  How to cite  | 

Abstract

Tuberculosis (TB) is one of the top communicable diseases responsible for more deaths worldwide. Patients with pulmonary TB (PTB) suffer from lung damage, including fibrosis, cavitation, muscle weakness, and other radiological changes, leading to decreased lung function, quality of life (QoL), breathlessness, and physical and psychological impairments. So, the Present case study of a 58-year-old female with sputum-positive PTB suffering from breathing difficulties after the start of anti-TB treatment (ATT) was given online pulmonary rehabilitation therapy. The present study aimed at assessing the effect of yoga and respiratory care therapy (RCT) on PTB patients. This study is unique and rare in terms of integrating two rehabilitation therapies—yoga and RCT for the betterment of patient care. The patient was administered 45 minutes of yoga and 15 minutes of RCT per day for 8 weeks and baseline and postdata were collected. Results after 8 weeks of telerehabilitation therapies were found to be positive compared to baseline parameters. In short, this case report highlights the potential benefits of telerehabilitation as a dual complementary therapy in patients with PTB along with a standard of care to improve the saturation of peripheral oxygen (SpO2) saturation levels, breath holding time, Borg rating of perceived exertion (RPE) scale scores, 6-minute walk test, and decreased heart rate. Future studies planned with more sample sizes, multicentric in nature, and randomized control trials can be planned to warrant the results.

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CASE REPORT

Varun G Bansal, Hardik Patel, Gopal Chawla, Anil Malik, Kshitij Anand

An Interesting Case Report of Legionnaires’ Disease and Acute Kidney Injury: A Case Report

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:2] [Pages No:67 - 68]

Keywords: Acute kidney injury, Atypical pneumonia, Case report, Legionnaire's disease, Rhabdomyolysis

   DOI: 10.5005/jp-journals-11010-1086  |  Open Access |  How to cite  | 

Abstract

Background: Legionella is a bacterial pathogen well-known for causing atypical pneumonia. However, extrapulmonary manifestations like rhabdomyolysis and acute kidney injury (AKI) are uncommon. There have been <50 case reports to date of extra-pulmonary Legionella and AKI. Case description: We report a 54-year-old patient with Legionnaire's disease who presented with severe rhabdomyolysis and AKI. Patient was managed with hydration, intravenous antibiotics and hemodialysis. Conclusion: Timely diagnosis and management are essential to improve outcomes in this potentially fatal condition.

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CASE REPORT

Pradnya Mukund Diggikar, Mayank Mundada, Hansini Raju Reddy, Tushar Pancholi, Bhavyasri Reddy Yammanuru, Loveleen Garg

Atypical Presentation of Tuberculous Meningitis—Challenges in Diagnosis: A Case Report

[Year:2024] [Month:January-March] [Volume:13] [Number:1] [Pages:4] [Pages No:69 - 72]

Keywords: Atypical presentation, Bacterial meningitis, Case report, Complications, Misdiagnosis, Sensitivity and specificity, Tuberculous meningitis

   DOI: 10.5005/jp-journals-11010-1090  |  Open Access |  How to cite  | 

Abstract

Tuberculous meningitis (TBM) is associated with severe mortality and morbidity. Current diagnostic modalities lack sensitivity or specificity, and culture inoculation may take up to 4–6 weeks. Atypical presentations of TBM may lead to delays in diagnosis and treatment and cause complications. We present a case of a 17-year-old male who presented with altered sensorium and was initially diagnosed as bacterial meningitis based on the cerebrospinal fluid (CSF) analysis and was treated for the same. The patient did not improve and later developed third cranial nerve (CN) palsy and obstructive hydrocephalus (HC) requiring ventriculoperitoneal (VP) shunting. Reevaluation revealed TBM and the patient was started on antituberculous therapy (ATT). He improved and had no lasting neurological deficits. A high degree of suspicion of tuberculous involvement should be maintained in all patients with meningitis, especially those who do not respond to standard treatment. Finally, we conclude through our case that early diagnosis and treatment can help prevent complications, and newer diagnostic modalities with better sensitivity are required to facilitate early diagnosis and prevent complications.

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journal videos

Computed Tomography Pulmonary Angiography (CTPA) video shows filling defects in left lower lobar basal segmental pulmonary arteries.

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

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