76yr old female diagnosed Interstitial lung disease.... Presented with fever breathlessness to casualty After careful examination Culture showed kleibshella ...pneumonia... Later patient was put on antibiotic according to culture report..... No improvent seen Patient still had wheeze and breathlessness and fever Changed the antibiotic to meropenam and colistin Still no improvement is seen Today ct showed image 1 Cavitation???? Fungal ball??? Aspergillosis?? But previous ct and X-rays in 2016 showed cavity too.... Patient is kept on ntg as Bp is 180/100 in titration dose 3ltrs of oxygen.... without tat patient not able to maintain saturation Ecg showed some irregular rhythm was taken advice from cardiologist and put on calaptin tablet 40.... Please suggest further suggestion n opinion
Trachea shifted to right. Infiltrations right upper lobe. A cavity with a fungal ball left mid zone. Old PTB with mycetoma.
Ild with fungal ball Give itracomzole 200 bd with antibiotics Also mucolytics bronchodialtor chest physiotherapy will help Manage for airway and maintain saturation As we are giving broad spectrum antibiotics can give short acting steroids also like hydrocortisone
Please think of progressive lung disease. Symptomatic treatment till investigation s available, propped up position, o2, brochodilators, steroids, PPI, ,nebul@@@ization, high protein diet,adequate hydration, ct chest, c/s sputum,braid spectrum antibiotics, i/ o chart,SpO2 monitor, isolation if possible
What is 2 decho says Is there any s/o Lv dysfunction Associated pulmonar hypertension Why not put her on digoxin rather than calaptin See is there componet of lv dysfunction as well ....even diastolic dysfunction U may also think of mycoplasma infection and add Clarithomycin Diuretics optinum dose acc to cvp Antifungal Patient may require extensive chest physitherapy Spirometer exercises Rest Bronchodilators Inhaled steroids in inhaler newer trimium Vaccinate Flucanazole fr fungal infection
I suggest to continue mero or colistin according to culture report with coverage of staph and anarobic organism Also consider for anti fungal if pt is critical Along with that physiotherapy, neb with n acetyl cystiene and rest conservatively Send all aerobic culture again of blood urine and sputum Consult cardiologist for cardiac status also go forUSG whole abdomen
If fever persist inspite of antibiotic acc to c/s report better repeat c/s if possible do brochoscopy n collect sample n send for culture,AFB,anerobic blood, fungal blood culture, look for other source of infection bedsore thromboplebitis line if you have femoral line remove n put new in IJV, change Foley , make little neg giving lasix may be component of failure, check pct, bnp, for time beining add antifungle,
ILD with aspergilloma in lt mid lobe Start ANTI FUNGAL along with antibiotics along with cardiac trtmt He is having multiple patho Give diuretics as these pts usually have pul htn Brochodilators This is a notch porch case
Add to my last ans... Also see for cor-p changes on echo TT accordingly
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