Radiographic findings of thick walled cavities in the lungs are typically seen in mycobacterial infections, malignant lesions, fungal infections, pulmonary vasculitis or other inflammatory lesions of the lungs. Necrotizing infections of the lungs caused by gram negative bacteria (Klebsiella, Psudomonas, Legionella) and Staphylococcus aureus may also form cavities of varying thickness, with consolidation. Escherichia coli pneumonia causing pulmonary cavities is very rare and the few cases reported are of pneumatocele formation. Here we present an unusual case of Escherichia coli infection as a rare cause of bilateral cavitating necrotizing pneumoniae, in a 67 year old male with uncontrolled type 2 diabetes mellitus.

Background. Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnoea (OSA). Despite proven benefits of CPAP in OSA, adherence has been sub-optimal. The present study was designed to evaluate the compliance of CPAP therapy and factors affecting it in patients with moderate to severe OSA. Methods.Patients diagnosed to have moderate/severe OSA (apnoea-hypopnoea index [AHI] >15) during the period April to December 2015 were evaluated using a pre-defined questionnaire on the number of hours of usage, number of nights per week usage and challenges faced in using CPAP; Epworth Sleepiness Score was recorded. CPAP usage was documented from the downloaded data from their CPAP machines.Results. Forty patients (mean age 50.6±11.4 years; 29 men) were studied. Their average body mass index (BMI) was 33.2 Kg/m 2 . Of these, 31 had severe OSA (mean AHI 47.8 per hour). The objective usage of CPAP among patients with OSA was less by 89 minutes when compared with perceived duration (p=0.001). Twenty patients had used the device for less than four hours per night. Patients reported social factors, dryness of mouth, not reapplying machine after nocturia, power shut down and reduced motivation as reasons for non-adherence to use CPAP. Conclusions.Despite the recognised benefits of CPAP, the acceptance and adherence with therapy remains a considerable barrier. Objective assessment of CPAP compliance should be a part of routine follow-up in patients with OSA.

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