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What is not?

 Impossible is not a fact, its an opinion 

TUBERCULOSIS

May 19, 2010 by dr.faraz

Case Sheet

A 34-year-old female patient came to the office with c/o cough and fever since 2 months. Fever was low grade, intermittent, not associated with chills and rigors usually during the evenings. Cough was productive, purulent, non-fowl smelling with occasional hemoptysis. Associated with decreased appetite and a weight loss of 7 kgs. It’s not associated with nausea, vomiting, abdominal pain, burning micturition, diarrhea, and sore throat. Past history- No history of TB/DM/HTN/CAD/Bronchial Asthma. No history of travel to the endemic area or any exposure to TB patients. CXR showed opacity in the right upper lobe. PPD showed an induration of 16mm. Sputum was positive for AFB. On the basis of the above findings TB was diagnosed and ATT was started.

Case Discussion: 

 

Treatment

 

(HRZE) 2 + (HR) 4

 

Rules: 

 

SIGNS AND SYMPTOMS

 

Evening rise of temperature-

Less than 15 days: –      + 10

More than 10 days : -     +30

 

Night Sweats:-   + 20

 

SOB :-   + 5

 

Weight Loss –    +10

 

Cough  --- More than 15 days: –   + 30

                  Less than 15 days: -     + 5

 

Malaise –     +10

 

Fever + wt loss +cough more than 15 days :-     +70

 

Chest Pain:-    +10

 

Wheezing:-    -20

 

Crackles :-     +10

 

Pleural rub:-  + 10

 

 

INVESTIGATIONS

 

CXR :-  upper lobe infiltrate - +60

              Lower lobe infiltrate- +5

              Lower lobe infiltrate with coexistent DM - +10

              Pleural Effusion  :- +50

 

Sputum AFB staining :- positive - +90

                                       Negative- + 10

 

PPD :- more than 20mm - +40

            10- 20 mm - +30

             less than 10 - + 10

 

FNAC LN

            Caseating granuloma :- +90

            Non caseating granuloma :- +10

            No granuloma :-     -10

 

ESR

        Raised :- +10

        Normal:- +5

 

Sputum culture for bacteria other than AFB

          Bacteria present :-    +5

          No bacteria with all the symptoms :-   +10

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions: 

What is the diagnosis? What is the best next step in managing this patient?

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