chest infection

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CHEST INFECTION Arphan Azaad

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CHEST INFECTION

Arphan Azaad

51 year old female k/c/o AML treated with chemotherapy presented with:

Chief Complains: Fever with Cough & Sputum x 2 weeks sweating+

On Examination G/C:Fair VITALS: P:89/min

BP:80/40mmHg T:37.6C Chest:Rt. Sided Crepts+ RR:20/min CVS:S1,S2,M0 P/A:Soft,Tenderness around Rt. hypochondric area+ Rt. ileal Region+

JAUNDICE:Absent ANAEMIC:+ LYMPH NODE: Non Palpable CYANOSIS: Absent CLUBBING: Absent OEDEMA:Absent DEHYDRATION: Absent

Personal h/o:Negative Smoking and Alcohol

h/o

Medical h/o:No DM,HTN,HEPATITIS,PTB

Surgical h/o:Hysterectomy done 5 years back

INVESTIGATIONS

COMPLETE BLOOD COUNT:(Pancytopenia) WBC:1X10*9/L(N=42%),L(48%), RBC:2.55X10*12/L,HB:59g/L,MCV:81.82fl PLT:46X10*9/L, RET%:1.63%

RENAL FUNCTION TEST:Urea:3.15mmol/L,Cr:30umol/LNa:139mmol/L,K:4mmol/L

CT CHEST FINDINGS

USG FINDINGS:

Biochemistry

DIAGNOSIS

AML

B/L CHEST INFECTION

TREATMENT

Inj IMIPENEM 500mg iv tid

Tab ITRACONAZOLE 200 mg qd

Tan KETOTIFEN 2mg PO TID

OTHER Supportive management

Summary

Patient is a diagnosed case of AML previously received chemotherapy,persistent Leucopenia might have contributed to the severity of infection?

Currently being managed for Chest Infection!

Antifungal drug is being given for further prophylaxis.

DEBATABLE POINTS

IS PATENT PROGRESSING TO SEPSIS,SIRS?

Evaluation of Pleural Fluid is most for further management?

Blood c/s, Sputum c/s to select a proper antibiotic and isolating bacteria?

Does chronic prescription of G-CSF OR similar medicine improves the Leucocytes,Neutrophil count?

THANK YOU