?Pneumonia ?TB
A 24 year old female housewife by occupation delivered a baby by LSCS in Jan 2021, but she has been having complaints of fever since December end Chief Complaints She reported to OPD with complaints of ongoing fever especially in the nights, and recently when she was undergoing treatment from elsewhere she experienced episodes of hemoptysis too History She also admits having undergone elsewhere sputum for AFB which was negative, also Mantoux which was negative too She even admits that her clothes are bit loosened too from before Investigations I had advised her to undergo a CXR PA view(attached), CBC, ESR, Sputum for CBNAAT(Genxpert) MTB/Rif ( except CXR, all awaited) Management Meanwhile, I have started her on - Cefuroxime 750mg IV 8 hourly plus Clindamycin 500 BD Along with other supportive treatment, until reports become available Kindly give your valuable suggestions for this case
1st cxray shows soft inhomogenous opacities bilaterally with left basal consolidation seen. In Sec Cxray changes of bronchopneumonia with persisted left basal density. Adv HRCT thorax Sputum analysis Continue same antibiotics. If nosresolving shadows, may consider AKT.
First and second x rays look quite different,in first x ray there is massive fibrosis with lt sided pleural effusion while in 2nd x ray there is rt middle lower lobe and lt lower lobe pneumonitis,it's quite confusing.adv HRCT chest,and review after reports
Sir, U are right in keeping PTB as first possibility in given scenario, pictures suggest LLL pneumonia which considering long history may be non resolving, Go for Sputum culture Rpt montoux HIV HRCT CHEST may be FOB later if needed
Xray chest shows GGOs bilateral in lower and mid zones Along with investigations suggested by you also go with RT pcr to r/o covid infection D/d pulmonary tuberculosis Covid19 infection
Right middle zone and left lower zone reticulonodular infiltration and left sided pleural effusion suggestive of pulmonary tuberculosis Adv Sputum for AFB gene Xpert and AFB culture
Agree with@Sandeep Ghodekar @Kute Ankush Rx Sitoapaldi 1 teaspoon + 1 teaspoon bd honey Sanjivani vati 2bd Triki tab 2 bd SH tab 1bd Shunthi dhanayak fant for 4 to 6 days. Shadbindu oil for daily nasya
Pneumonites.rt.mif and lower zone And V HRCT RTPCR CBNAAT CBC REPEAT SPUTUM AFB START TT AFTER INV REPORT TILL TJEN GIVE BROAD SPECTRUM ANTIBIOTIC ANTIPYRETIC
P T B ? COVID infection Ad RT PCR for COVID Ad CBNAAT Sputum exam HRCT thorax
ILD Pneumonitis Symptomatic T/T clinical correlation
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