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Case Presentation on Infectious Disease

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Presentation on theme: "Case Presentation on Infectious Disease"— Presentation transcript:

1 Case Presentation on Infectious Disease
Presented By:- Vijay. Singh

WEIGHT : 68 Kg

3 SUBJECTIVE Patient came with a complain of Fever, Headache and Breathlessness Sever and generated neck stiffness and pain. History of Present Illness C/o fever from 10 days a/w chills and rigors Bitter taste in mouth and vomiting. C/o of headache from last 8-10 days C/o of vomiting. Only one episode yet, Not projectile ,immediate after food. Breathlessness on lying down & on walking about 500 metres

4 Cough with sputum Past History No h/o of DM/HTN/Epilepsy Habits Alcoholic – About 2-3 times / month (90 ml) Smoking – (Beedi) From last 20 years (1 pack/day) Diet- Mixed Appetite- Decreased Bowl & Bladder- Normal Sleep - Adequate

5 Physical Examination Patient is conscious, co-operative & alert. PR: 88 bmp B.P: 110/70 mmHg Temperature: 109 F P¯ I¯ C¯ C¯ L¯ E¯ Systemic Examination CNS: Neck rigidity (minimal) , Kernig’s (Negative) CVS: S1 S2 + , No Murmur R.S: NVBS + , No added sound. P/A: Hepatomegaly and tenderness is seen.

6 Provisional Diagnosis
TB Meningitis Bronchopneumonia

7 Objective

8 INVESTIGATION NORMAL VALUE 05/1 07/1 08/1 13-18 11 4000 to 11,000
Hb ( gm/dl ) 13-18 11 Tc (Cells/ cmm) 4000 to 11,000 8,200 D.C ( % ) B 00-01 M 3-7 2 L 25-33 14 E 1-3 4 P 40-75 80 ESR (mm/hr) 0 to 20 72 BL. U (mg/dl) 15-40 0.8 S.C (mg/dl) 19 BLOOD PLATELETS lakhs 2.14 lakhs Widal Test Possitive HIV Nigative CSF Prof 246.3 mg/dl Sy 57 mg/dl pH Alkaline Sp. G 114 mol/ 2 Cells 20 cells/mm3

9 CSF Culture and Sensitivity Occasional pus cells seen
INVESTIGATION NORMAL VALUE 07/1 08/1 CSF Fluid Analysis Chloride 115 to 130 107 mg /dl Glucose 50 to 80 108 mg/ dl Protein 15 to 40 288mg /dl LDH 104 IU/dl Urine Analysis Albumin Present Sugar Nil Pus Cells 4-6 E.P Cells 1-2 CSF Culture and Sensitivity Occasional pus cells seen Organisms not seen Volume- 1.5 ml Color- S. reddish Appeareance- Turbid Cell count: 100%

10 CXR: Small cyst area are seen in both lower zone.
Chest X-Ray:- P/A view - Cavities are seen which suggests presence of TB Gram Staining of Sputum – Positive (+ve) Ultrasound of Abdomen and Pelvis on 09/01/12 Mild Hepatomegaly (Grade –I)

11 Assesment Based on the Subjective and objective evidence of fever ,breathlessness ,cough, +ve CSF Culture and neck stiffness, +ve gram staining of sputum . The Patient is diagnosed with Tuberculosis, Meningitis and Bronchopneumonia .

12 BRAND NAME GENERIC NAME DOSE FREQUENCY DATE DATE END Inj-C-tri (I.V) Ceftriaxone + Salbactum 3 gm. 1-0-1 05/01 11/01 (1gm) Inj- Emeset (I.V) Ondansetron 4 mg 11/01 Inj. Pantodec (I.V) Pantoprazole 40 mg Inj. Gentamycin (I.V) Gentamycin 80 mg Stopped Salbair-I(Nebulaizer) Salbutamol 1-1-1 06/01 Budate (Nebulaizer) Budesonide 12-Hourly Syrup Ambrolite-S Ambroxol 2-2-2 tbsp. Inj. Endocin (I.V) Amikacin 500mg 11/01 Stopped Tab. Dolo-650 Paracetamol 650 mg S.O.S (It temp >105 F) Inj. Metrogyl (I.V) Metronidazole 100 ml Syrup-Chitralka Disodium Hydrogen Citrate 2-0-2 (in water) 08/01 Tab. Wispar Sparfloxacin Tab Claribid Calrithromycin 100 mg Tab. Diclofenac-P Diclofenac Inj Streptomycin (Deep I.M) Streptomycin 10/01 Syrup Digene GEL (Mg(OH)2Simethicone, Na carboxymethylcellulose, Al(OH)3 8 gm (max) 2-2-2

13 Planning Suggestion to Physician
Ondansetron may cause Bronchospasm and so instead some other type of antiemetics may presecribed E.g: Domperidone. Pantoprazole has ADR of bronchitis, cough, sinusitis and neck pain , so it should be replaced with Ranitidine Sparfloxacin should not be given with NSAID’s , there are chances of developing seizures Paracetamol increases the risk of lever damage in alcoholics and the person is already diagnosed with Hepatomegaly. Prescribe some 1st line antitubercular drug.

14 Advice to Patient Adhere to dose regimen Take meal with Fatty Diet
Maintain Hygienic Condition Do not split and cough in public. Avoid going out or in area where pollution is more. (to avoid bronchopneumonia condition)

15 Thank You

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