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Posted On : 08 Feb 2015

7 years male child, brought with c, o fever, since 1 month,
nonproductive,intermittent cough 15 days back,
RS - air entry reduced in rt lower zone,
CXR reveals obliteration of RT CP Angle,
USG shows very minimal {non tappable} pleural effusion with underlying consolidation.
Hb- .8.3, TLC-13800, raised neutrophils,
pt has received iv cefotaxim, genta for 7 days.
he has improved a bit , but still he is spiking { 100 f} , twice a day.

how should i proceed_?

Expert Answer :

Answer Discussion :

No answer discussion available.

Answer 1

HRCT thorax needs to be done to look for extent of parenchymal involvement and amount of pleural fluid. If possible, CT guided pleural tap should be done, and fluid sent for culture and antibiotic sensitivity. Antibiotics can then be changed accordingly. Also, intercostal drain tube placement or VATS may be required depending on the extent of fluid.

As the complaints are since a month, tuberculosis needs to be considered. Mantoux Test and Gastric Lavage for AFB needs to be sent. Family screening should be done. Child may have to be started on AKT as per above findings.

Anaemia needs to be tackled. Child needs to be started on iron, Folic acid and Vitamin B12 supplements. Diet needs to be improved. High calorie and high protein diet needs to be started.

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