?Pneumonia ? TB

This patient works in registry office and his Xray is attached below which suggests pneumonia or TB History He is known case of Diabetes, HTN, well controlled H/O alcohol consumption on daily basis Investigations Advised for CT chest as well as sputum for AFB and Sputum for Genxpert(CBNAAT) MTB/Rif, also a 2D echo too in view of cardiomegaly, meanwhile got his CBC report in which TLC are just on the higher side Urine R,M - Normal Covid Ag test was negative, RT PCR report awaited Management He was experiencing fever on daily basis, but today it is responding well (Please check fever monitoring of 16th and 17th) He is on pulmocef CV 500 BD plus Azilide 500mg OD as he is comorbid so I choose this combination for him Kindly guide me further in this case, have a look at xray below at bottom

(Edited)

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Sir , X- ray report could not be found. In all such doubtful cases, pneumonia should be the first diagnosis until unless the HRCT and other investigations show pulmonary tuberculosis. The combination of antibiotics used by you are appropriate and should be continued for at least 2 weeks followed by a X - ray chest after 2 weeks. Then decide the future course of action

Yes sir, that's what I have considered and started Abs for the same too Sir, scroll at the bottom for CXR as it as update to previous case and give your valuable opinion
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Fever with pneumonia - WBC counts are expected to be much higher Relatively low WBC count point to possible tuberculosis infection Pneumonia is correct presumptive working diagnosis For community acquired pneumonia combination of cefalosporin with Azithromycin is appropriate c combination therapy Sputum for TB culture can also be sent, it is more sensitive for diagnosis of pulmonary tuberculosis

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Possible DD— TB, Atypical pneumonia, CoVID pneumonia. Continue same treatment and wait for reports. Can go for RT PCR for influenza or Pneumonia-panel test.

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LEUKOCYTOSIS.. SUGGESTIVE OF INFECTION.. YOUR LINE OF T/T IS CORRECT.. CONTINUE WITH THE SAME.. TILL FINAL CONCLUSION & DIAGNOSIS.. AD .. HRCT THORAX ..

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TILL the reports u recieve continue this TT Leucocytosis is there but not so high Probably he will be case of mycobacterium tuberculosis But reports are deciding. Tools

Thank you doctor
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Yes sir, add such antibiotics considering bacterial infected pneumonia,but considering hid dm and liquor consuming status chhoose such antibiotics which r second generation medicines for TB. Livo Monocef

Continue antibiotics as he is responding. Can't differentiate between TB/ pneumonia till AFB report receive. AKT only if AFB positive.

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My xray interpretation was viral pneumonitis and i stand with that Before commenting i will like RT pcr report Adv hrct Yes correct line of treatment continue the same Fever chart in my opinion favours secondary infection

Until & unless pulmonary TB is diagnosed the case should be treated in the line of pneumonia.

Rule out lobar pneumonia,collagen vascular disease,antibiotics itself are cause. 1.Laghu malini vasant 250 mgm, twice a day for 1 month or tab. Laxmivilas rasa 125 mgm,twice a day for 1 month is indicated.

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Diseases Related to Discussion

Diabetes
Pneumonia
Tuberculosis
Leukocytosis
Pulmonary Tuberculosis
Influenza
Vascular Disease

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