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Infections continue to play a significant role in the overall global mortality and disability more so in Intensive Care Units (ICUs) and plague developing countries more intensively. The ICUs are often called “the hubs” of infections owing to highly vulnerable patients’ profile. The most important nosocomial infections in the ICU are catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. The epidemiology of ICU infections in India is different from its Western counterparts in terms of prevalence and nature of microorganisms causing it. While Gram-positive infections are more prevalent in Western ICUs, Indian ICUs are commonly afflicted with Gram-negative bugs showing a high degree of antimicrobial resistance with blurring of traditional boundaries of early drug sensitive and later drug resistance infections. Increasing number of multidrug resistance organism infections in ICUs is a big public health threat and challenge both from the perspective of prevention and treatment. Therefore, blindly following the Western guidelines may not provide the optimum results in India. The need of the hour is to develop and implement an antimicrobial stewardship program based on the local epidemiological data and international guidelines to optimize the antimicrobial use among the hospitalized patients and improve their outcomes.

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Introduction: Diffuse pulmonary meningotheliomatosis is a rare disease, with unclear clinical significance and very few reported cases in the literature. In this study, we review the demographics, presentation, imaging, diagnostic workup, and histologic findings of the 25 patients previously published in the literature with an outline of the disease history. Materials and Methods: We conducted a review of the literature through July 2016 for studies reporting cases of diffuse pulmonary meningotheliomatosis by searching multiple scholarly databases. Results: Of the 25 cases identified 2 were male (8%), and 23 were female (92%). Ages ranged from 37 to 73 with a median age of 59.5 years at diagnosis. 15 (60%) were asymptomatic and imaging abnormalities were discovered incidentally. 8 (32%) had unexplained respiratory complaints. 11 (44%) had history of or active malignancy. 3 (12%) were diagnosed by transbronchial biopsy while the remainder had surgical lung biopsies. Conclusion: Diffuse pulmonary meningotheliomatosis should be considered in all patients with diffuse bilateral pulmonary nodules on HRCT. The condition is more prevalent in females and its clinical significance is unclear, although nearly half of those diagnosed had a history of malignancy. CT imaging and surgical lung biopsy are the modalities of choice for diagnosis but transbronchial biopsies have recently been used obtain the diagnosis. Additional research needs to be done to further characterize the nature of this condition and the clinical scenarios in which is presents.

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Bacterial co-infections have been reported in association with dengue fever (DF) and can exacerbate dengue infections. However, DF with acute respiratory distress syndrome and co-infection with Alcaligenes faecalis (A. faecalis) has not been reported earlier. Most infections caused by A. faecalis are opportunistic. Urinary tract infection, bacterial keratitis, postoperative endophthalmitis, skin and soft tissue infections, bacteremia, meningitis, wound infections, and peritonitis in patients undergoing peritoneal dialysis have been described in association with A. faecalis. A. faecalis, a Gram-negative environmental organism rarely cause significant infections. Treatment can be difficult in some cases due to the high level of resistance to commonly used antibiotics. We report a case of fatal bronchopneumonia caused by extensively drug resistance A. faecalis in a patient of dengue hemorrhagic fever.

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Pulmonary embolism remains a disease which needs high clinical suspicion to prevent mortality and morbidity. More so in young healthy individuals, suspicion is very low as compared to old age individuals with multiple co-morbid conditions. Pulmonary embolism carries high mortality if not suspected and treatment initiated as early as possible. There are two case reports of young male individuals who presented as acute onset of breathlessness and later diagnosed and treated as a case of pulmonary thromboembolism.

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Mounier-Kuhn syndrome is a congenital abnormality characterized by tracheobronchomegaly as a result of atrophy or absence of elastic fibers and thinning of smooth muscle layer in trachea and main bronchi. The usual presentation is one of recurrent respiratory tract infections with a broad spectrum of functional impairment ranging from minimal disease with preservation of lung function to severe disease in the form of bronchiectasis. We describe a case of an elderly man who presented with a recurrent respiratory infection who was subsequently diagnosed as Mounier-Kuhn syndrome.

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Aspergilloma is a saprophytic infection that colonizes preexisting lung cavities that presents as a fungal ball. Typically, an aspergilloma develops in cavities formed as a result of diseases such as tuberculosis, sarcoidosis, bronchiectasis, lung abscess, and cavitary neoplasia, but it has also been reported, though rarely, in pulmonary cavities as a consequence of the removal of a hydatid cyst. The clinical features of pulmonary aspergilloma, ruptured hydatid cyst, and tuberculosis are similar in the form of cough, hemoptysis, and low-grade fever. In a developing country like India, wherein pulmonary tuberculosis is the most common cause of a chronic cough with hemoptysis; we present an unusual case of aspergilloma in a ruptured hydatid cyst masquerading as pulmonary tuberculosis.

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The absence of one of the pulmonary artery with associated hypoplasia of lung and great vessel abnormality is a rare finding. The incidence of this rare congenital abnormality is around 1 in 200,000 live birth. The absence of the left side pulmonary artery is again uncommon, and associated cardiac malformations are usually tetralogy of fallot or septal defects rather than an aortic arch defect. Our case is a unique case in It’s associated congenital anomalies. He was presented with recurrent pneumothorax and hemoptysis, and on thorough workup, he was diagnosed to have an absence of left pulmonary artery with hypoplasia of the left lung and associated right-sided aortic arch. The patient’s family has declined the surgical option, and he was managed conservatively and kept in close follow-up.

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Objectives: To evaluate the safety and efficacy of treating high-altitude pulmonary edema (HAPE) by bed rest and supplemental oxygen in hospital setting at high altitude. Materials and Methods: In a prospective case series, all patients who were diagnosed clinically with HAPE on admission to our hospital located at a height of 11,500 ft were evaluated and managed with bed rest and oxygen supplementation. Results: A total of 43 patients of HAPE with mean age of 31 years (range 20–48 years) were admitted to our hospital. Infections followed by unaccustomed physical exertion were the predominant risk factors. 95.35% of the patients improved successfully with oxygen and bed rest alone with mean hospital stay of 2.67 ± 1.06 (1–6 days). Two patients (4.65%) required nifedipine and evacuation to lower altitude. Of this, one patient suffering from concomitant viral infection expired 4 days after evacuation to near sea level. Conclusion: Majority of the patients with HAPE where medical facilities are available can be safely treated with bed rest and oxygen supplementation at moderate high altitude without descent.

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Asthma and chronic obstructive pulmonary disease (COPD) have striking differences but the similarities are also striking. Some scientists consider them as different expression of same disease. Some COPD patients show reversibility; on the other hand, asthma, a basically reversible disease, may lose its reversible nature by the process of airway remodeling and thereby blurring their differences. Although both are inflammatory diseases, they differ in the nature of inflammation and spectrum of inflammatory mediators. Clinically, most physicians can differentiate between two diseases, but the overlap also is widely recognized. The question remains whether any physiological test, among plethora available, can definitely differentiate asthma from COPD. Apart from overlap between asthma and COPD, it is now a well-established fact that asthma is a risk factor for the development of COPD. Only future can say, “whether Dutch or British hypothesis is right.”

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