Presentation on theme: "Case Presentation on Infectious Disease"— Presentation transcript:
1Case Presentation on Infectious Disease Presented By:-Vijay. Singh
2IP NO : DOA : UNIT :VII DEP: MEDICINE SEX : MALE AGE : 42 YEARS WEIGHT : 68 Kg
3SUBJECTIVEPatient came with a complain of Fever, Headache and BreathlessnessSever and generated neck stiffness and pain.History of Present IllnessC/o fever from 10 days a/w chills and rigorsBitter taste in mouth and vomiting.C/o of headache from last 8-10 daysC/o of vomiting. Only one episode yet,Not projectile ,immediate after food.Breathlessness on lying down & on walking about 500 metres
4Cough with sputumPast HistoryNo h/o of DM/HTN/EpilepsyHabitsAlcoholic – About 2-3 times / month (90 ml)Smoking – (Beedi) From last 20 years (1 pack/day)Diet- MixedAppetite- DecreasedBowl & Bladder- NormalSleep - Adequate
5Physical ExaminationPatient is conscious, co-operative & alert.PR: 88 bmpB.P: 110/70 mmHgTemperature: 109 FP¯ I¯ C¯ C¯ L¯ E¯Systemic ExaminationCNS: Neck rigidity (minimal) , Kernig’s (Negative)CVS: S1 S2 + , No MurmurR.S: NVBS + , No added sound.P/A: Hepatomegaly and tenderness is seen.
8INVESTIGATION NORMAL VALUE 05/1 07/1 08/1 13-18 11 4000 to 11,000 Hb ( gm/dl )13-1811Tc (Cells/ cmm)4000 to 11,0008,200D.C ( % ) B00-01M3-72L25-3314E1-34P40-7580ESR (mm/hr)0 to 2072BL. U (mg/dl)15-400.8S.C (mg/dl)19BLOOD PLATELETSlakhs2.14 lakhsWidal TestPossitiveHIVNigativeCSFProf246.3 mg/dlSy57 mg/dlpHAlkalineSp. G114 mol/ 2Cells20 cells/mm3
9CSF Culture and Sensitivity Occasional pus cells seen INVESTIGATIONNORMAL VALUE07/108/1CSF Fluid AnalysisChloride115 to 130107 mg /dlGlucose50 to 80108 mg/ dlProtein15 to 40288mg /dlLDH104 IU/dlUrine AnalysisAlbuminPresentSugarNilPus Cells4-6E.P Cells1-2CSF Culture and SensitivityOccasional pus cells seenOrganisms not seenVolume- 1.5 mlColor- S. reddishAppeareance- TurbidCell count: 100%
10CXR: Small cyst area are seen in both lower zone. Chest X-Ray:- P/A view - Cavities are seen which suggests presence of TBGram Staining of Sputum – Positive (+ve)Ultrasound of Abdomen and Pelvis on 09/01/12Mild Hepatomegaly (Grade –I)
11AssesmentBased 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 .
13Planning 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 RanitidineSparfloxacin should not be given with NSAID’s , there are chances of developing seizuresParacetamol increases the risk of lever damage in alcoholics and the person is already diagnosed with Hepatomegaly.Prescribe some 1st line antitubercular drug.
14Advice to Patient Adhere to dose regimen Take meal with Fatty Diet Maintain Hygienic ConditionDo not split and cough in public.Avoid going out or in area where pollution is more. (to avoid bronchopneumonia condition)