?Miliary TB ATT induced ?psychosis

A 25 year female presented to OPD with complaints of headache and fever almost on daily basis from last 1 month She was suspected COVID almost a month back and underwent RT PCR and it was negative, since then she has been ill She was also asked to undergo SPUTUM for AFB and CBNAAT 15 days back, but she didnt have sputum sample Investigations She underwent CXR and CT chest and shared the films over whatsapp Diagnosis Miliary Tuberculosis Management The main concern in this case are - 1) She was given 3 tablets of Akurit-4 and immediately after a while she had a vomiting. Kindly guide 2) She has also lost sense and talking absurdly How can we manage both the scenarios in the same patient?

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Adv. 1. Repeat RTPcr 2. CSF examination to exclude CNS TB 3. CBC and ESR. 4. Start treatment for Miliary TB. 5. Monitor SpO2 to exclude moderate to severe Covid.

I agree with Dr Bhaumick

Pt is certainly a c/o MILLIARY TUBERCULOSIS But since stressed and depressed to hear about illness she is not tolerating the medication Counseling Put on iv drip Tab ondestron 4mg and ppis to be given first if orally not tolerating give iv route Once optimum effect is attained ingest ATT orally Iv antibiotics inj kenamycin or amikamicin Keep monitoring of LFTS

Thanx dr Ashok Leel
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Koch's chest { milliary tuberculosis with fibrotic changes and complications. Adv. ATT Assessment of bSL and HbA1C and treatment. RT -PCR test to conclude. Immunity sr IgG IGM Protocols of COVID virus Infection must be followed till prove otherwise and as per ICMR.

Thanks Dr Shivraj Agarwal
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A good case of clinical research. This case have main reasons to develop symptoms are included behaviour patterns, physically comorbidity and possibilities of drugs use. I will suggested that a tablet Akruti 4 have contains isoniazid,rifampicin,ethanbutal,pyrazinamide. Which can be developed psychosis with gastritis problems by isoniazid rifampicin ethanbutal. Others are long term illnesses with spo2 level are included to developing behaviour disturbance due to hypoxia, poor nutrition with secondary depression gain. So this case I will be approached to treat by anti psychotic olanzepine is better for it with diet care, breathing exercises with psychological support. To Stop drugs habits as like smoking,chew Tobacco. To be required physician opinion and follow up with RX guide.

Milliary Tuberculosis Fibrosis in lungs Advised A TT Give little porridge 2 tsf before medicine s BSR & Hb A1 C Ad to rpt RT PCR Consult Chest specialist

Dear Dr.Bhomia, I agree with the diagnosis of military KOCK,S.
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? MILLIARY TUBERCULOSIS .. WITH .. FIBROTIC CHANGES .. NEED'S.. ATT .. BSR..HBA1C.. REPEAT RT..PCR..COVID-19.. FOLLOW UP ..

Tnx Dr Shivraj Agarwal sir
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Bil milliary mottling with septal fibrosis and few lesions of organising pneumonia. Central bronchiectasis Adv fiberoptic bronchoscopic bronchoalveolar lavage. Send sample for Gm Zn CBNAAT fungal koh. Sr IgE level, aspergillus specific antibodies IgM. May repeat RT PCR.

Keep vitals OK. Fibrotic changes. Needs anti tubercular. Rule out diabetes

TUBERCULOSIS Rx Indukantha Kashaya+Dasamula Katuraya Kashaya Chyavanaprash will be of use Regards

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