pleural effusion

Good evening friends, 65 yr old female with history of fever, cough n dyspnoea for last 1 month taken multiple antibiotics at GP level. Rt scapular n infrascapular coarse crepitations on auscultation. ESR 110 HIV non reactive. HbA1C.. 5.5 WBC 28500 Neutrophilia with toxic granules n shift to left. Plt 3.2 lac normal RFT n LFT Sputum AFB negative. Pt is on IV meropenem, Levoflox n Linezolid for last 10 days. Empirical ATT initiated 6 days back. still fever n leukocytosis persisted. TLC n ESR as well as X ray remained same. Now CECT Thorax is planned. what else can be done in this situation? Kindly give your expert opinion on further management. Regards.

4 y female with fever of 6 days and pain abdomen, sick looking. admitted, investigation ordered_ TLC 27700 , N- 91 %, WIDAL TO, TH both 1: 160. other inv- WNL. Started on inj crftriaxone and oral azithro. Fever continued high grade with fast breathing . Repeat counts 35000 , N- 71. Diagnosis Typhoid fever with sepsis. CXR done as shown. Large consolidation with pl.effusion. Added inj. vancomycin. Patient slightly better with improved activity and fever subsiding.

A 69 year old male presented with productive cough 4 days. The sputum is thick and yellow with streaks of blood. He had fever, shaking, chills and malaise along with the cough. Yesterday he had right chest pain that increases with inspiration. The patient lost 7 kg over the past few months without loss of appetite. PMH includes mild, non-productive chronic smoker's cough for 10 or 15 years. He smoked 2 packs of cigarettes per day for the past 50 years. BP: 152/90, apical heart rate: 112/minute and regular, RR: 24/minute, Temp: 102.6 F. Examination shows large, non-tender hard lymph nodes in the right supraclavicular fossa. Both lungs are resonant by percussion but the right mid-anterior and right mid-lateral lung fields are dull. Auscultation reveals bilateral diminished vesicular breath sounds. Labs: WBC 17,000/mm3; neutrophils 70%, bands 15%, lymphocytes 15%. What his Chest x-ray shows? And what are your comments on serotype count?

80/F admitted with history of breathing difficulty since yesterday. h/o passing black and tarry stools since 2 days. h/o dyspnea on exertion present. h/o fever since 2 days. k/c/o T2DM, HTN, parkinsonism on rx s/p left hip reconstruction with proximal femur nail for left hip intertrochanteric fracture. O/E conscious, dyspneic, tachypneic HR:102/min. BP:140/70mmhg. spo2:89%in RA previously admitted for bronchopneumonia and urosepsis 2 months ago

45 yr old male presented in unconscious state with history of right gluteal abscess. TLC 45000, urea 135, creatinine 7.5.