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
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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

Bronchopneumonia

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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