?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
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
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
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.
LEUKOCYTOSIS.. SUGGESTIVE OF INFECTION.. YOUR LINE OF T/T IS CORRECT.. CONTINUE WITH THE SAME.. TILL FINAL CONCLUSION & DIAGNOSIS.. AD .. HRCT THORAX ..
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
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.
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.
Cases that would interest you
- Login to View the image
66yrs/M presented with 3 days of dyspnea.Known Diabetic and Asthmatic on budesonide inhaler.He has never smoked.No H/o fever,dry cough or travel.COVID 19 ÑEGATIVE,LAB REPORTS ENCLOSED.ANY THOUGHTS?
Dr. Prashant Vedwan6 Likes22 Answers - Login to View the image
64 year old male with complaints of episodic sweating for the last 4 months.Occasional dry cough.No ho fever or weight loss.Non-smoker.Hb 14,wc 14400,esr 35,FBS 114,T3T4TSH normal.
Dr. Nabarun Guha20 Likes72 Answers - Login to View the image
Dear friends and fellow colleagues, This is X Ray of a male Patient, 50 yrs old, chronic smoker, ethanolic, suffering from T2DM × 15 yrs, Old Pulmonary Tuberculosis, treated irregularly, lean with BMI of 16 kg/m2. C/O Severe Breathlessness, Cough, On & off fever × 15 days. Comments on X Ray findings & treatment. With regards, Dr Sepuri Krishna Mohan.
Dr. Sepuri Krishna Mohan14 Likes24 Answers - Login to View the image
35 yr old female with history of diabetes detected around 5 yrs back initially conttolled on OHAs then started on insulin presented with uncontrolled diabetic status, cough with minimal expectoration for 15 days and fever,generalised aches for 10 days.investigations revealed tlc 17000(90N), rft,lft normal, rbs 433, chest xray as shown, esr 100.diagnosis and management please?
Dr. Sushant Garg1 Like6 Answers - Login to View the image
27,f brought with dyspnea fever cough wt loss anorexia nausea since 2months. spo2,84%,bp 100/60,HR 140/min. poor socioeconomic status,parents died of PTB.sputum sent for evaluation. plz guide approach to this case.
Dr. Sandeep Ghodekar4 Likes16 Answers
4 Likes