Summary: Toddler with fever, intermittent, s o br, hypoxemia, status epilepticus, copious oral secretions, coma+, Leucocytosis, CXR Increased BVM+, MP-ve, Raised ESR, CSF N. ? VIRAL BR PNEUMONIA WITH ENCEPHALITIS With STATUS ? ASPIRATION. ADVICED: FUNDOSCOPY, ABG , ECG , RPT CXR, Sr Electrolytes, Pupillary reflex to light, Disconjugate gaze abN, Gen Management:1)ABC care/Airway maintenance +O2/ MV if GCS<9, IV Anticonvulsants Epsolin / Levicetam Loading - maintenance IV mannitol + lasix IV Acyclovir IV Antibiotics Amp + Ceftriaxone in meningitis dose Iv Antipyretic IV fluids 2/3 of maintenance Monitor vitals, Urine output , BG, Electrolytes, Sr lactate, GCS, Temperature, Care of BBB Explain the prognosis and written consent for management,procedures and referral.
counts are mainly lymphocytic..csf m/e shows only 2 cells but both r lymphocytes.. still very high counts, short history, CXR not suggestive of tubercular etiology.. in such a dilemma treat as disseminated sepsis with mono+amika , antiepileptics and mannitol or 3%NS aftr doing the fundus examination.. still ask for family histry f koch, h/o on nd off fever, cough or wt loss Post d xray image if possible.. plzzz examine the fundus as well and get a neuroimaging( MRI ) done on urgent basis..
Cxr normal so wts 2D Echo report....cause of hypoxia to find out ...you should do EEG,MRI BRAIN,RBS,ABG,BLOOD CULTURE, CALCIUM,MAGNESIUM,ELECTROLYTE, RFT, urine routine...rashes??? Hepatosplenomegaly??? Residence of patient?? Continue inj.acivir, iv antibiotic...antiepileptic...maintain ABC.. KEEP updating of patient progress
Viral encephalitis, advised ICU management.
likely to b a case of viral encephalitis..MRI brain and CSF...study may b done..manitol can b aded..and if convulsion ..going on..convulsion should be controlled by addinng another AED
Treat as meningutus.refer if airway cannt be maintained for intubation
RBS is not done.History favour case of viral encephalitis require ct or MRI brain for hypoxic brain brain damage and other pathology.
Appears to be viral encephalitis /persistent secretions can be because of on going convulsion (iv phenytoin)may be added, iv acyclovir, csf for herpes simplex (igm) neuroimaging if gcs <8 keep on venti r/0 tbm also....
child responding to paonful stimuli with pooling of secretion....kindly secure the airway with elective ventilation start acyclovir..viral encephalitis. mri required to rule out ADEM
Clear case of infective encephalitis Total wbc count is increased CSF tapping and send it for analysis Treat with higher IV antibiotic and anti convulsions treatment and antipyratic under ICU depending on investigation report treat the patient
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Friends today I am discussion about a savere disease. Shingles/Herpes Zoster Shingles or herpes zoster is an infection which is characterized by a painful blistering skin rash. The rash usually affects one side of the body, i.e. the torso and/or one side of the face. It appears in a band formation and therefore the name ‘shingles’, which is Latin for ‘belt’. Shingles is caused by the same virus that causes chickenpox, called the varicella-zoster virus. The initial warning symptoms appear one to five days before the rash appears. You will feel the warning signs on the location where the rash will appear. These initial symptoms include itching, pain, burning, pricking and stabbing sensation, followed by high fever, chills and muscle pain. The tell-tale rash appears soon after. When a person (usually children) gets infected by the varicella-zoster virus, he/she develops chickenpox. After the chickenpox heals, the virus remains in a dormant state in the nerve roots or the dorsal root ganglia, which contains the cell bodies of sensory neurons. Years later, this virus may wake up to cause an outbreak of shingles or herpes zoster. Although the reason for its waking up is not certain, experts believe a variety of conditions can lead to its activation such as normal ageing weakening of the immune system stress and anxiety Healthy people and young children too are not exempt from the risk. In fact, anyone who has had chickenpox is at a high risk of developing herpes zoster or shingles. Appearance of the Blistering Rash The distinctive feature of this illness is the rash that appears on one side of the body. The rash is accompanied by a pricking and sometimes stabbing pain. It erupts into clusters of small red patches that develop into blisters. Within 7 - 10 days the blisters break open and a fluid comes out. During this period, if anyone who never had chickenpox before, accidentally touches the oozing blisters of the patient, he/she will develop chickenpox. Once the fluid comes out, the rash slowly begins to dry and crust. The rash disappears completely after two to four weeks. When the blisters scab and dry, the virus cannot spread anymore. Because herpes zoster affects the nerve cells in the body, it is very common for the rash to appear in the formation of a band on one side of the body along the path of a nerve. In some people, the rash may spread to the eyes, and occur inside the eyelids. This can be extremely painful, with the person experiencing stabbing pains in the eye, constant eye watering, sensitivity to light, and blurry vision. The symptoms in the eyes usually vanish within three to five weeks. A person with shingles cannot transmit shingles to another person. Though, he can transmit chickenpox to a person, who has never had chickenpox before. Post-Herpetic Neuralgia (PHN) Around 20% of the people who suffer from shingles may develop a condition known as post-herpetic neuralgia. This occurs when the proper functioning of a nerve is disrupted due to the damage caused to it by shingles. It is commonly believed that shingles causes scar tissue to develop around the nerve, which when inadvertently pressed, causes pain signals to go to the brain. The person suffering from PHN will experience a sudden throbbing, burning, shooting, or even a stabbing pain along the damaged nerve for months, or even years, after the rash has healed. In some cases, the pain may be continuous for a few months after the rash has healed, however, if the condition runs into years, the person will experience paroxysms of pain along the nerve. Who is prone to shingles/herpes zoster? a weak immune system are experiencing any stress or trauma are suffering from any illnesses such as diabetes, HIV, cancer are taking any medications that affect the immune system such as steroids are taking treatments for certain ailments such as cancer are recuperating from any illness, be it even a cold, or flu have erratic sleeping patterns are suffering from malnutrition a dull constant pain which can be mild or severe, or an intermittently shooting pain in the affected area soreness, burning sensation, itching, or numbness in the affected area exhaustion fatigue sensitivity to light fever headache the appearance of a painful, itchy and red rash on one side of the body and sometimes in and around the eyes a sensation of pins and needles piercing through in the areas of the rash throbbing pain in the eye with burning sensation and irritation soreness and redness in and around the eye extreme sensitivity to light constant eye watering blurred vision What are the complications of shingles/herpes zoster? Shingles is a self-limiting condition which disappears within three weeks. However, in people with very low immunity, it may take a serious turn. Delaying, or not undertaking medical treatment can cause serious complications which include: Postherpetic Neuralgia - which is nerve pain caused by the damage to nerves by the varicella-zoster virus. The stabbing pain can remain for months and even for years in patients. Eye Complications - which can occur if the rash spreads to the eyes. Swelling of the cornea may occur which can leave permanent scars. Shingles in the eye can also cause the retina to swell, or increase pressure in the eye which can lead to glaucoma and eventually loss of vision. Skin Infections - may occur if the area affected by the rash is not kept clean, which can lead to scarring. Neurological Complications - can ensue if the shingles affects the nerves in the brain. The neurological complications include Guillain-Barre Syndrome, Ramsay Hunt Syndrome, Bell’s palsy, encephalitis, meningitis, and even stroke anytime in the year following the illness. Disseminated Herpes Zoster- is when the virus spreads to other organs. People with compromised immune systems ( those suffering from cancer, HIV/AIDS), are at a risk of Disseminated Herpes Zoster. This can be life-threatening especially if it affects the lungs. What is the treatment for shingles/herpes zoster? Though there is no known cure or for that matter treatment for shingles, your general physician may prescribe antiviral medicines, which will reduce the pain and duration of shingles. He may also prescribe some topical antibiotics to apply on the rashes which will reduce the stinging and prevent infection. Homoeopathic medicines for Herpes Primary Remedies Arsenicum album. If a person feels chilly, anxious, restless, and exhausted during fever-and the burning pain of the eruptions is relieved by heat-this remedy may be indicated. ... Apis mellifica. ... Iris versicolor. ... Mezereum. ... Ranunculus bulbosus. ... Rhus toxicodendron. ... Clematix.Dr. Rajesh Gupta18 Likes29 Answers
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A 13 years old boy complains of fever with some chills for 3 days, with Generalized weakness, reduced appetite and headache since two days. Vitals and systemic exams are wnl and no localizing focus of infection is readily evident. CBC and widal were ordered and the reports are as attached. What is the probable diagnosis and how to approach the case?Dr. Lohitaksh Makasare2 Likes43 Answers
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