Pattern of Respiratory Diseases, Morbidities and Outcome in Patients Admitted in Respiratory Ward of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Pant, Pankaj; Joshi, Aishana; Shrestha, Basudha; Basnet, Babin; Bam, Niraj; Das, Santa Kumar

doi:10.31729/jnma.5613

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…In the resource-limited settings of Nepal, access to the GeneXpert MTB/Rif test may be limited 26 , 27 . In such cases, alternative diagnostic tests like CSF analysis become important 16 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenges in tuberculous meningitis: a case report with negative genexpert result

Ghimire,

Thapaliya,

Yadav

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the meninges, primarily caused by Mycobacterium tuberculosis. Diagnosis of TBM poses numerous challenges due to its non-specific clinical presentation and the limitations of diagnostic tests like GeneXpert. Case presentation: We report a case of a 22-year-old female from Eastern Nepal presenting with acute onset fever, headache, vomiting, and neck pain. CSF analysis showed lymphocytic pleocytosis, elevated protein, low glucose levels, and cobweb coagulum indicative of TBM. However, the GeneXpert test revealed negative results. Discussion: In resource-limited settings like Nepal, where access to GeneXpert MTB/Rif is limited, CSF analysis and clinical algorithms play a crucial role in diagnosing tuberculous meningitis (TBM). Relying solely on GeneXpert results may lead to false negatives, so a high level of suspicion based on patient risk factors is essential. Prompt initiation of empirical anti-tubercular therapy is vital for a favorable outcome in TBM cases. Conclusion: Negative MTB PCR results from CSF can be misleading in diagnosis of Tubercular meningitis. Therefore, comprehensive evaluations, including detailed patient history, physical examination, and CSF fluid analysis, are crucial in high TB prevalence countries to ensure accurate and timely diagnosis.

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Section: Discussionmentioning

confidence: 99%

Diagnostic challenges in tuberculous meningitis: a case report with negative genexpert result

Ghimire,

Thapaliya,

Yadav

et al. 2023

Annals of Medicine &Amp; Surgery

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Section: Introductionmentioning

confidence: 99%

“…First-line treatment with isoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E) remains the mainstay of treatment of TB, which has the adverse effects like hepatotoxicity, peripheral neuropathy, optic neuritis, and so on. [2][3][4] Cutaneous Adverse Drug reactions (CADRs) are the wellknown side effects of first-line antitubercular drugs; mild transient reactions (such as mild pruritus) do not result in treatment interruption. However, in severe cases, they can lead to life-threatening toxic epidermal necrolysis (TEN), which may necessitate to discontinuation of treatment and further complicate the treatment process.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal

Bhattarai,

Yadav,

Sapkota

et al. 2023

SAGE Open Medical Case Reports

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Cutaneous adverse drug reactions are known side effects of first-line antitubercular therapy, which ranges from mild pruritus to life-threatening toxic epidermal necrolysis. Severe cutaneous adverse drug reactions can lead to antitubercular therapy discontinuation and further complicates tuberculosis treatment. Here we present the case of a 49-year-old obese male who developed a generalized maculopapular rash within 24 hours of initiation of therapy followed by bullae over palms in 3 days. Antitubercular therapy was immediately discontinued, and he was managed with antihistamines, intravenous fluid, and electrolyte supplementation. He was discharged on antihistamines, a short course of systemic steroids, moxifloxacin, and bedaquiline (second-line antitubercular therapy (ATT)). Proper guidelines about rechallenge therapy will enormously aid in managing cutaneous adverse drug reactions, and efficient treatment of tuberculosis in these patients, and ceasing its progression to multisystemic complications. This article aims to discuss the presentation and management of cutaneous adverse drug reactions in the setting of Nepal.

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“…The standard treatment of tuberculosis is administering antitubercular drug for 6 months. The first-line drug include Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide 7 – 9 . All antituberculosis drugs are suspected to pose a risk of DRESS 10 .…”

Section: Introductionmentioning

confidence: 99%

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review

Adhikari

Bhattarai

Baral

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%. Case presentation: A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm3, 36% in peripheral blood smear). Discussion: Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement. Conclusion: Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.

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Pattern of Respiratory Diseases, Morbidities and Outcome in Patients Admitted in Respiratory Ward of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Cited by 3 publications

References 6 publications

Diagnostic challenges in tuberculous meningitis: a case report with negative genexpert result

Diagnostic challenges in tuberculous meningitis: a case report with negative genexpert result

Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal

Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review

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