Unilateral pulmonary agenesis is a rare congenital anomaly with an incidence of 1:15,000, affecting both sides and sexes equally. It's classified by Schneider-Schwalbe (Types 1–3) and Boyden systems (Groups 1–3) based on developmental severity. Children commonly experience recurrent respiratory tract infections and breathing difficulties due to aberrant tracheal function and increased vulnerability from airway constriction. A 9-year-old male presented with fever and nonproductive cough. Physical examination revealed severe malnutrition (weight and BMI < -3Z score) with tracheal deviation, decreased left chest movement, dullness to percussion, and diminished breath sounds on the left side. Chest X-ray showed complete left hemithorax opacification with mediastinal shift. High-resolution computed tomography revealed left lung aplasia with compensatory right lung hyperinflation. Computed tomography pulmonary angiogram (CTPA) confirmed left pulmonary artery agenesis. Bronchoscopy demonstrated hypoplastic left bronchial tree with blind-ending left main bronchus and tracheal bronchus supplying the right upper lobe. The patient was treated with antibiotics for secondary infection, chest physiotherapy, inhaled corticosteroids, and nutritional support. This rare congenital anomaly highlights the importance of advanced imaging in diagnosing complex respiratory presentations in pediatric patients with recurrent respiratory infections.
Immunosuppressive therapy for ANCA vasculitis significantly increases the risk of opportunistic infections. While cryptococcal meningitis is a known complication, it is typically caused by Cryptococcus neoformans or C. gattii. Infections with non-neoformans species like Cryptococcus laurentii are uncommon and can exhibit resistance to first-line antifungals. Co-infection with tuberculosis further complicates management due to diagnostic challenges and drug-drug interactions. A 17 year old male with pauci-immune crescentic glomerulonephritis secondary to MPO ANCA vasculitis, on maintenance immunosuppression with cyclophosphamide and prednisolone, presented three months into therapy with headache and vomiting. CSF analysis confirmed cryptococcal meningitis with India ink and cryptococcal antigen positivity. Despite four weeks of liposomal amphotericin B and fluconazole, his CSF remained positive. CSF showed Cryptococcus laurentii with confirmed resistance to amphotericin B (MIC ≥ 16 µg/mL). Antifungal therapy was switched to high-dose fluconazole monotherapy. During admission, he also developed sputum and GeneXpert-positive pulmonary tuberculosis. He was started on antitubercular therapy with rifampicin, necessitating close monitoring of the drug-drug interaction. His neurological and respiratory symptoms improved with therapy, though renal impairment persisted. This case demonstrates that Cryptococcus laurentii can cause cryptococcal meningitis in immunosuppressed patients with potential resistance to amphotericin B. Co-infection with tuberculosis can complicate therapy. Early recognition, drug susceptibility testing, judicious modification of immunosuppression, and monitoring of drug–drug interactions are essential for successful outcome.
With over 14 million people living above 3,500 m, the study of acclimatization and adaptation to high altitude in human populations is of increasing importance, where exposure to high altitude (HA) imposes a blood oxygenation and acid-base challenge. A sustained and augmented hypoxic ventilatory response protects oxygenation through ventilatory acclimatization, but elicits hypocapnia and respiratory alkalosis. A subsequent renally mediated compensatory metabolic acidosis corrects pH toward baseline values, with a high degree of interindividual variability. Differential renal compensation between acclimatizing lowlanders (LL) and Tibetan highlanders (TH; Sherpa) with ascent was previously unknown. We assessed ventilatory and renal acclimatization between unacclimatized LL and TH during incremental ascent from 1,400 m to 4,300 m in age- and sex-matched groups of 15-LL (8F) and 14-TH (7F) of confirmed Tibetan ancestry. We compared respiratory and renally mediated blood acid-base acclimatization (PCO2, [HCO3-], pH) in both groups before (1,400 m) and following day 8 to 9 of incremental ascent to 4,300 m. We found that following ascent to 4,300 m, LL had significantly lower PCO2 (P <0.0001) and [HCO3-] (P <0.0001), and higher pH (P = 0.0037) than 1,400 m, suggesting respiratory alkalosis and only partial renal compensation. Conversely, TH had significantly lower PCO2 (P < 0.0001) and [HCO3-] (P < 0.0001), but unchanged pH (P = 0.1), suggesting full renal compensation, with significantly lower PCO2 (P = 0.01), [HCO3-] (P < 0.0001) and pH (P = 0.005) than LL at 4,300 m. This demonstration of differential integrative respiratory-renal responses between acclimatizing LL and TH may indicate selective pressure on TH, and highlights the important role of the kidneys in acclimatization.
INTRODUCTION:The Asian elephants (Elephas maximus), despite their larger physical structure and strength, are often attacked by microorganisms, like gastrointestinal (GI) parasites, resulting in higher morbidity and mortality. AIMS:The current study aimed to determine the prevalence and diversity of GI parasites in the endangered Asiatic elephants reared in captivity in and around Chitwan National Park in Central Nepal. METHODS:With age and sex variants, 63 fresh faecal samples (N = 63) were collected non-invasively and transferred to the research laboratory for microscopic examination. RESULTS:Our findings showed a 95.2% prevalence rate, along with 17 identified diverse species of GI parasites, including protozoa (6 spp.) and helminths (11 spp.) and two unknown species (1 protozoan and 1 helminth). The prevalence of protozoa (84.1%) was higher than that of helminths (77.8%). Female/cows and old-age elephants were reported to harbour a higher rate of parasites. Sharing overlapping niches with domestic and wild animals, irregular medication and the existence of critical stressors were speculated to be the major risks for parasitosis. CONCLUSIONS:The captive elephant population in Central Nepal harbours a greater prevalence and huge diversity of GI parasites, most of which are implicated with serious pathological conditions and zoonotic potentiality. The presence of GI parasites must be considered a challenging threat. Thus, government bodies, non-governmental organizations, elephant owners and conservationists need to participate in strategic medication and seek measures to lessen the probable health risk for sustainable conservation and welfare of the endangered species in Nepal.
Introduction Fournier's gangrene, a polymicrobial infection affecting the scrotum and perineal area, predominantly affects elderly males, presenting challenges in diagnosis and management. This report examines two cases, with a focus on the rare outcome of bilateral orchidectomy. Case presentation A 69-year-old diabetic male presented with severe penile and scrotal pain, leading to the diagnosis of Fournier's gangrene. In another case, a 91-year-old male with a history of Benign Enlargement of the Prostate experienced scrotal pain and ulcerative lesions, resulting in a rapid progression of gangrene. The surgical approaches encompassed multiple debridement and bilateral orchidectomy, underscoring the intricate nature of managing Fournier's gangrene. Discussion Fournier's gangrene typically originates as a polymicrobial infection in the genitourinary or perianal regions, with common risk factors including diabetes, immunosuppression, and advanced age. Diagnosis often relies on clinical assessment, though imaging aids in complex cases. Early intervention with broad-spectrum antibiotics and repeated debridement remains the cornerstone of treatment. Conclusion Fournier's gangrene, a rare condition, poses diverse clinical presentations, management strategies, and outcomes. Early recognition, aggressive surgical debridement, and a multidisciplinary approach are essential in managing this condition.
