Hypotensive with fever with cough

A 28 year old female taking treatment from elsewhere for fever, cough and weakness, she had followed up twice elsewhere and her BP was always around 90/60 and Pulse in 120s range Investigations ESR - 29 Hb 10.4 TLC was WNL several days before Diagnosis I am suspecting left lower lobe pneumonitis Management Kindly guide me in management I have started her pulmocef cv 500bd and Azilide 500mg od She in not willing for IVF and IV Abs

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Left lower lobe haziness indicative of bacterial Pneumonia ( consolidation) in X - ray chest .In Indian set up tuberculosis should also be kept in mind A HRCT chest may help for further evaluation along with CBC , ESR , sputum for AFB Better to start with Parenteral antibiotics like Piperacillin 4 gm + Tazobactum 500 mg × 8 hourly

Thank you doctor
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In a query by Dr Surbhi - regarding Parenteral antibiotics? as first line treatment in bacterial pneumonia. As - Penicillin- still remains the drug of choice for pneumococcus or streptococcus pneumoniae as per pharmacology - although macrolides remain the first line drugs for Pneumonia- but in present times , considering Covid disease with superadded infections-in hospital settings - parenteral antibiotics remain the initial treatment- till the patient recovers and then you can switch over to oral antibiotics

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She is a c/o lt lower lobe pneumonitis no doubt as chest xray shows hazinesswith rest of lung fields are hyperinflated You said pt is not willing for ivf and iv abs dear dr Ajeet Pal Singh there is no question of comprising in treatment Most likely she is covid19 pneumonitis and constant low bp suggest unstable hemodynamically she needs to workout deeply for cbc esr crp sr ferritin and D-dimer monitoring of sp02 Probably she will have to be on Remdesivir and rest of protocols

Thanx dr Sandeep Ghodekar
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Lt basal pneumonitis But further inv CBC ESR HRCT SPUTUM AFB SPUTUM CUI SENSITIVETY MOUNTOUX.TES RTPCR TILL REPORYS AVAILABLE START INJ MEROPEN 1GM BDS MACBERY XT 2TDF TDS T PARACETAMOL TDS VIT C ZIN IVERMECTIN

Left lower lobe pneumonia. Rule out COVID 19 by RTPCR and then investigate for the other causes by sending Blood c/s , sputum( if present) for AFB CBNAAT. She will be needing iv antibiotics. You can try convincing her for that, if she still doesn’t want it then there’s nothing we can do other than waiting for the c/s to come and give oral antibiotic accordingly.

Lt lower lobe pneumonitis ? I L D ? PTB Ad CBNAAT Sputum exam HRCT thorax Ad RT PCR for COVID Tab Ceftum 1000 mg bd Grilinctus BM 2 tsf tds Zerodoll P tds Tab Levocet 1 bd

Left side obliteration of cardiac border suggestive of lingular consolidation with right side paratracheal lymphadenopathy. Sputum gram staining and c/s . D/d include ? CAP ?? Tubercular , continue with same antibiotics

Its left lower lobe pneumonitis.But in current scenario needs to do Hrct chest/rtpcr to rule our covid

Left lower lobe haziness indicative of viral pneumonia. HRCt COVID RTPCr Inj Monocef sb bd Contact COVID center

Left sided pleural effusion ? Tuberculosis Adv Pleural fluid analysis TB culture Gene Xpert

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