This study was designed to find prevalence of Human Immunodeficiency Virus (HIV) infection among pulmonary tuberculosis patients, their clinical profile and treatment response with antituberculous chemotherapy. 2448 consecutive patients of pulmonary tuberculosis admitted between July 1, 1993 to June 30, 1995 were assessed for HIV seropositivity. Their clinical profile treatment response and fate was also studied along with HIV infection. It is concluded that 0.7% pulmonary tuberculosis patients were infected with HIV infection with an alarming increasing trend, comprising young, promiscuous heterosexual and mobile population. Cavitary and non-cavitary diseases were seen in approximately equal number of cases. A high mortality was seen in HIV/TB infected group (66.6%), and bad prognostic factors were a negative tuberculin reaction and low expected CD4 count.

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The total T lymphocyte population (T11 counts) and relative proportions of helper T cells (T4) and suppressor T cells (T8) were determined in the peripheral blood and bronhoalveolar lavage fluid of sarcoidosis, diffuse interstitial pulmonary fibrosis and pulmonary patients to assess the state of systemic and local cell mediated immunocompetence. In peripheral blood, T4/T8 ratio in sarcoidosis (1.37 ± 0.17 vs 2.1 ± 0.35, p<0.01) and total T lymphocytes in pulmonary tuberculosis (51.2 ± 7.5 vs 64.8 ± 9.1, p<0.01) were significantly lower compared to control subjects. There was no difference in either T4/T8 ratio or total T cells in diffuse interstitial pulmonary fibrosis. The mean T4/T8 ratio in bronchoalveolar lavage fluid was 1.7 ± 0.4 in sarcoidosis, 1.4 ± 0.1 in diffuse interstitial pulmonary fibrosis and 1.9 ± 0.6 in pulmonary tuberculosis. The results indicate significant alterations in T cell subset dynamics that seem to contribute to the pathogenesis of sarcoidosis and pulmonary tuberculosis.

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Fifty five consecutive cases of sputum positive lower lung field tuberculosis were studied. It was found to be more common in females and younger age group. Diabetes mellitus was the commonest associated condition. Apical basal and posterobasal segments of the lung were predominantly involved. Lower lung field tuberculosis is not uncommon. The entity is similar to adult apical type of pulmonary tuberculosis except for its lower lung field location.

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A twenty eight year old male with Marfan syndrome, manifesting predominantly as lung involvement in the form of bullous disease and rapidly deteriorating lung function with clinically insignificant mitral valve prolapse, is reported.

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An unusual case of rifampicin – phenytoin interaction is reported where patient suffered phenytoin toxicity in the form of cerebellar ataxia, when she developed rifampicn-induced dysfunction. The underlying mechanisms and significance of this uncommon interaction are discussed.

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