75 yrs M cough fever anorexia TLC 16800 DLC 80 16 2 2 ESR 90 TLC decreased with 5 day treatment with Augmentin 625 then again raises to 22400 after 5 days plz give you valuable opinion



This patient seems to be suffering from PTB and secondary infection. As the antibiotics have shown response, these should be continued along with clarithromycin 500 BD. Go for gene X pert MTB test to rule out MDR TB and send at least three samples of 24 hours collection for AFB and other pathogens. There is a faint cavitous lesion in mid zone on the left side which should be ruled out in repeated skiagrams at intervals . If the lesion is visible even after adequate therapy then the possibility of KOCH'S is dominant. The non tubercular treatment should be carried out according to the sensitivity of sputum culture findings. The persistence of infective shadow after adequate treatment will guide you for further action regarding the management. CECT chest will also be helpful in such cases to confirm the DD. Do not start anti tubercular treatment at the same time bcz in that case the treatment will be continued for minimum 6 months assuming TB to be the cause. Now the dillema of dillemas rarely troubles u regarding the diagnosis being TB or otherwise, in that case do a therapeutic trial with all four or other antibiotics for TB for a period of six weeks. The tubercular lesion will certainly show regression and help you to achieve cure with full course.The possibility of other ailments will also clear by this approach. Must advise the patient to have high protein and multivitamins regularly along with personal hygiene

exactly sir

The x-ray chest of this patient shows multiple Bilateral cystic Spaces suggestive of extensive bronchiectasis.. With secondary infection.. If AFB smear is negative less likely to be tuberculosis.. I suggest to send sputum for AFB culture bactec and for culture and sensitivity.. Shift treatment to pipercillin tazobactam combination with clindamycin.. TO cover the anaerobic infection very common with bronchiectasis.. HRCT thorax to confirm the diagnosis of bronchiectasis.. Postural drainage and chest physiotherapy to expell the secretions out of the lung.. Influenza and pneumcoccal vaccine regularly..

Thank you sir. pt is improving with Ceftriaxone salbactum and amikacin after 3 days of treatment. but anorexic

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pt have bl pulmonary tuberculosis and secondary infection so 1st treat with iv ceftrixone amikacin for 5days and send sputum for afb the confirmation report comes if report what ever pt must be treated with ATT Take past history it may taken ATT previously so send sputum for culture to rule out MDTB and HIV test is also done such type of patients bcz it is bl extensive k chest.

I have already started him on ceftriaxone salbactum and amikacin. TLC has started decreasing

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unlikely to be TB.Send sputum for AFB, gram stain, fungal stain , culture. Blood sugar, HIV, creat. Bronchoscope and BAL if available. Add antifungal and inj clathromycin emperically to Your antibiotic regimen. Inj Ulinostatin if pt can afford to prevent septic shock.

Elderly with acute respiratory symptoms, raised counts, X-ray with features of Pneumonia, most probably due to streptococci, warrants aggressive management with sputum culture specific IV antibiotics.

If the previous h/O ATD intake, he requires sputum for CBNAAT.Considering his age sputum for malignant cell to be advised. If all this negative then go for FOB and CECT thorax.

sputum for afb for continuous four days c.t.scan to rule out lung abscess & malignancy in due consideration of the age of pt. sputum for culture sensitivity(bectac )

Bilateral pulmonary tuberculosis with associated pneumonitis. .is the first possibility. Interstitial lung disease with pneumonitis is second possibility

Left upper and mid zone consolidation. Ill defined radiopacities in right upper and mid zone suggestive of infective etiology.

Admitt the patient and give imperical injectable antibiotic and then treat according to sputum culture and sensitivity

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