60/F has came with C/O cough for the past 10 days..fever 2 days on and off..high grade..no h/o breathing difficulty..h/o loose stools 5 to 6 episodes since tdy mrng.. not a k/C/o hypertension or DM..no other CO morbidities.. O/e : pt comfortable , RS: BBS Right infraclavicular region.. creps ++ over Right infraclavicular and infra axillary areas.. CBC: Tc- 10500,neut-85%,lymp 12%, ESR 20, urine R/E :normal..plz comment for appropriate management..thank u..

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ESR 20, lymphocytes 12% and near normal X-ray with fever only 2 days old ,All features go against Pulmonary kochs. It is a simple case of bronchopnemonia or Bronchitis. Rx 1.Tab Cefpodoxime 200mg + clavulanic acid 125mg. for 10 days 2.Symptomatic treatment

sir clavulanic acid again worsen loose stool

possible Rt UZ pulmonary koch's. needs Sputum AFB, GeneXpert(CBNAAT), Bactec culture. to rule out associated secondary bacterial infection get Sputum gram n C&S.. appropriate broad spectrum antibiotics as well as plan ATT after sputum reports.

sign and symptoms suggesting that's there is a definitely a lesion in right upper zone infiltration upto middle zone blood investigation suggests it's most likely a bacterial pneumonia. loose stools may be becouse he may taken some antibiotics witch may couse diarrhoea. now management plan 1.Send sputum for afb 2.bacterial culture 3.start broadspectrm antibiotics + metronidazol +low dose steroids cough expectorent antipyratic sporlac DS one week same treatment then treat according report

cough only since 10 days and fever only 2 days no clear opacification in CXR so could wait for a wk start with higher antibiotics and anti pyretics and bronchodilator and repeat CBC and CXR and decide ATK according thanks

Pulmonary tuberculosis- send sputum AFB - CBC


sputum afb& c&s till iv monocef with amikacin as hx is of loose motion After report if afb positive accordingly or otherwise as per c&s

Pulmonary koch's, advised AKT.

possibility of pulmonary Koch's is less. Sputum AFB advised, ESR 20 actually not suggestive of Koch's. do a repeat ESR. may be it is viral bronchopneumonia . manage symptomatically.

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