46 F PULMONARY TUBERCULOSIS

 46 YEAR OLD FEMALE DAILY WAGE LABOURER BY OCCUPATION FROM NALGONDA CAME TO PULMONOLOGY OPD WITH CHIEF COMPLAINTS: C/O COUGH 15 DAYS (DRY)

C/O :BREATHLESSNESS: 7DAYS

C/O FEVER:5 DAYS.

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 15 BAYS BACK THEN SHE DEVELOPED COUGH(DRY), INSIDIOUS IN ONSET,NO SEASONAL ,DIURNAL AND POSTURAL VARIATION, NO RELIEVING AND AGGREVATING FACTORS.

C/O BREATHLESSNESS:7DAYS, MMRC GRADE :2 INSIDIOUS IN ONSET, GRADUAL IN PROGRESSION NOT ASSOCIATED WITH WHEEZE,NO SEASONAL AND DIURNAL VARIATION ,NO ORTHOPNEA, NO PND.

C/O FEVER SINCE 5 DAYS LOW GRADE ASSOCIATED WITH CHILLS AND RIGOR RELEIVED ON TAKING MEDICATION.

NO C/O CHEST PAIN,CHEST TIGHTNESS, HEMOPTYSIS,PALPITATION NO H/O SIMILAR COMPLAINTS IN PAST.

NO H/O LOSS OF WEIGHT AND LOSS OF APPETITE, NO H/O TB IN PAST

NO H/O USAGE OF INHALERS IN PAST

NO ALLERGIC H/O

N/K/C/O DM,HTN, THYROID, CAD.

AUSCULTATION:

BAE+

DECREASED BBS AT LEFT INTERSCAPULAR AREA.B/L CREPTS AT BOTH INFRASCAPULAR AREA.

VOCAL RESONANCE: REDUCED IN LEFT ISA,IAA, INFRA SA 

Investigation

2D ECHO ON 19/1/23:

RIGHT ATRIUM:NORMAL

EF:60%

NO RWMA,NON SCLEROTIC

GOOD LV SYSTOLIC FUNCTION

NO DIASTOLIC DYSFUNCTION

USG CHEST 25/01/23 :

E/O MODERATE FREE FLUID WITH INTERNAL SEPTATIONS NOTED IN LEFT PLEURAL CAVITY.

E/O COLLAPSE OF UNDERLYING LONG SEGMENTS

E/O FEW AIR SONOGRAMS NOTED.

RIGHT CHEST NORMAL IMPRESSION:

MODERATE LOCULATED PLEURAL EFFUSON WITH COLLAPSE IF UNDERLYING LONG SEGMENTS WITH CONSOLIDATORY CHANGES ON LEFT SIDE CHEST.

SPUTUM FOR C/S ON 22/1/23:ZN STAIN:NO ACID FAST BACILLI SEEN.

SPUTUM FOR CBNAAT ON 21/01/23 - NEGATIVE PLEURAL FLUID FOR CBNAAT ON - NEGATIVE

NEEDLE THORACOCENTESIS NOTES

PLEURAL FLUID TAKEN OUT 200ML, 800ML, 150ML,300ML ON 19/1/23,20/1/23,21/1/23,24/1/23

PLEURAL FLUID:

ADA: 39.4

TC: 500 CELLS

DC:90%LYMPHOCYTES

10% NEUTROPHILS

PLEURAL FLUID CBNAAT:NEGATIVE

SPUTUM CBNAAT:NEGATIVE

LIGHTS CRITERIA

1) PLEURAL FLUID/SERUM PROTEIN :0.69

2)PLEURAL FLUID/SERUM SDH:0.8

3) PLEURAL FLUD :SDH :2:5

24/1/23; GM REFERRAL I/VIO TACHYCARDIA

ADVICE- IV FLUIDS 1PINT NS @ 75ML/HR

26/1/23 GM REVIEW DONE.

TREATMENT GIVEN : 

ATT 4 TABS / DAY STARTED EMPIRICALLY 

TAB.BENADON 40 MG PO OD

TAB.PANTOP 40 MG PO OD 

TAB.PCM 650 MG PO SOS 

SYP.GRILLINCTUD PO BD

OUTCOME - COMPLETELY RECOVERED