Fever part 1

Fever – Part 1
• Presented By –
Prof.Dr.R.R.Deshpande
(M.D in Ayurvdic
Medicine & M.D. in
Ayurvedic Physiology)
• www.ayurvedicfriend.c
om
• Mobile – 922 68 10 630
• professordeshpande@g
mail.com
9/25/2016 1Prof.Dr.R.R.Deshpande

Fever For Kayachikitsa Syllabus
• This PPT is based on Kayachikitsa Syllabus
( Paper 1 Part B) of CCIM formed in 2012
• Teachers of Forth BAMS & students will be
get benefitted by this ready information
,through interesting PPT

Paper 1 Part B Point 1
• Detailed description of Chikitsa Sutra and
Management of Jwara and its types.
Etiopathogenesis & relevant Ayurvedic and
Modern management of following types of Fevers
-Typhoid, Pneumonia, Pleurisy, Influenza,
Mumps, Meningitis, Encephalitis, Tetanus, Yellow
fever, Plague, Dengue Fever, Chikun Guniya,
Leptospirosis, Viral Fever, Anthrax, Masurika
(Small pox), Laghu Masurika (Chicken pox),
Romantika (Measles).

Fevers discussed in this PPT
• 1) Typhoid
• 2) Measles ( Romantika)
• 3) Chickenpox ( Laghu Masurika)
• 4) Dengue
• 5) Chikunguniya
• 6) Leptospirosis

Fevers discussed in this PPT
• 7) Meningitis
• 8) Encephalitis
• 9) Influenza
• 10) Pneumonia
• 11) Pleural Effusion

Typhoid (Enteric Fever)
• Infection by Salmonella typhe & paratyphae
• Infection occurs through food, flies, fingers,
faeces, filth & fomite
• Incubation period is 10 to 14 days.
• Onset is insidious.

Clinical features (C/F)
• 1st week - Gradual rise of Temp. (Step ladder
fashion). Fever present throughout week, so at the
end of week, temp may be about 104 F. Temp. Does
not touch the normal level.
• Pulse - Shows Relative Bradycardia
• Tongue - Coated with red margins & tip.
• Spleen - Palpable at the end of 1st wk. & is soft.

• Rash - may appear at the end of 1st week
• Found over upper abdomen & back
• 2 to 4 mm in diameter & 6 to 10 in number
• rose red in color, fade on pressure & slightly
raised
• (Due to bacterial emboli in skin capillaries)

• 2nd wk. - Temp - continuous
• Constipation is replaced by loose motions
(peasoup Diarrhoea)
• Abdomen - Distended & tender
• Spleen - enlarged (2-3 fingers & soft.)

Investigations & Treatment
• Leucopenia with Neutropenia. widal Test is
positive from 2nd wk. onwards
• Treatment
• General Nursing with special care of mouth,
eyes & skin.
• Diet - High calorie, Liquids
• Never give purgatives

Medicines for Typhoid
• Tab Ciprofloxacin 500 mg. - B.D for 10 day. or
• Tab Sparcin (sparfloxacin) 200 mg. - 1-OD x 7
day.
• + Tab Crocin - 1 QID
• + Tab B complex - 1 BD x 10 days
• Prevention
• Inj Typhim V- 1 ml I/m (Immunity for 3 yrs.).

Romantika (Measles)
• Acute Contagious viral Infection
• Epidemics occur in winter
• Young children are affected due to droplet
spread of Infection
• Incubation period is 12-14 days.

Romantika (Measles)
• 3 Stages
• A) Prodromal or Catarrhal stage (first 4 days) --
Sudden onset
• of Acute fever, nasal catarrh, sneezing,
conjunctivitis, photophobia, cough, hoarseness of
voice
• On 2nd day -- Pathognomonic - Kopliks spots appear
in mucous membrane of mouth. (Tiny whitish or
bluish white spots, against a reddish background, at
level of upper 2nd molar teeth.)

Romantika (Measles)
• B) Exanthematous stage (4th to 7th day)
• High rise of Temp. face puffy; Headache, cough,
photophobia, myalgia; lymph nodes may enlarge;
spleen-may be palpable.
• Rash - on 4th day. Maculo papular. Appear first, on
forehead & behind the ears, at the junction of skin &
hair. Spread downwards to whole of trunk & limbs up
to palms & soles.
• Initially - Discrete, pink, blanch on pressure. Later
Confluent.

Romantika (Measles)
• C) Recovery Stage - Rapid, Rashes fade away,
leaving brownish discolouration of skin &
areas of desquamation
• Complications - Laryngitis, bronchitis, broncho
pneumonia, conjunctivitis, otitis media,
Albuminuria

Romantika (Measles)
• Treatment -- Isolation of patient , Liquid diet ,Care of
mouth, eyes, bowels.
• Symptomatic
• Sy. Crocin 1 tst x 4 hrly.
• Sy Avil expectorant 2 1 tsf TDS.
• for conjunctivitis - Genticyn eye drops 1 drop x QID
• Preventive - Measles vaccine (Live attenuated
vaccine - 0.5 ml S/C, gluteal. Given between 9 to 15
months)

Laghu Masurika (Chicken pox)
• Causative virus is identical to the virus of
Herpes zoster
• Incubation period - 14 to 18 days
• C/F ( Clinical Feature)
• Onset is Acute.
• Malaise, headache, weakness, fever,
prodromal rash.
• Rash appears on first day.

• Vesicular. With each fresh crops of rash,
temperature rises. Chicken pox rash is centripetal in
appearance but centrifugal in progress. (Rash first
appears on central part of body - trunk)
• Another feature of Rash is Pleomorphism (At the
same time,all types of rashes are seen - i.e. macule,
Papules, Vesicles & Pustules) .After separation of
crusts, no scars

• Treatment
• Symptomatic -- Tab crocin 1/2 Q I D, or Sy
crocin 1 tsf TDS
• For Itching - Sy Avil 2 1 tsf TDS. & Caladryl
lotion externally
• If complication, like pustule.
• Sy. Erythrocin 1 tsf QID

• Prevention
• Inj. Varilix 0.5 ml S/C, 12 mcntns to 12 yrs.
• 2 doses at the Interual of 6 to 12 wks

Dengue Fever
• 1) Cause - Virus, from female mosquito Aedes
aegypti is transmitted to man.
• 2) Incubation period - 5 to 9 days
• 3) Symptoms - Onset is acute.
• High fever with rigor & sweating
• Severe maddening frontal headache, pain
behind eye balls severe

Dengue – Aedes Aegypti

Dengue Fever
• Severe Backache , Severe pain in long bones,
at the insertion of tendons & ligaments
• Hence disease is called as –
• "Breakbone fever"

Dengue Temperature Curve

Dengue Fever
• 4) O/E (On Examination)
• Temp. is raised, comes down by crisis on 3rd
day, but again goes up on 4th or 5th day.
• This is typical "Saddle Shaped Temperature
Curve of Dengue"

Dengue Fever
• Rash - Prodromal rash (blotchy erythema or
simple flushing of face. True rash appears on
6th day (measles like character, but on dorsal
aspect of hand & feet. Then spreads towards
trunk. (face-spared)
• Generalised Lymphadenopathy (Cervical)
• Pulse - Ralative Bradycardia (Like Typhoid)

Dengue Fever
• Delirium, Insomnia.
• Usual Course of Disease is 6 to 9 days. But
prolonged convalescence, due to muscular
weakness.
• 5) Complications
• Haemorrhage under skin or mucous
membrane. otitis media, Bronchopneumonia,
Herpes Labialis

Dengue Fever
• 6) Investigations – NS 1 Positive
• Haemogram – Reduced Platelet count
• Leucopenia ; Toxic granulation of polymorphs
• Urine Exam -- Oliguria & Albuminuria
• Immunological test --Anti Dengue IgG, IgM -
Elisa Test.

Dengue Fever – Treatment
• No specific treatment
• Symptomatic treatment with Analgesic &
Antipyretic (Never use Aspirin, due to fear of
Haemorrhage)
• Crocin 2 tab TDS.
• Prevention is better than cure (Control the
breeding of mosquito)

Dengue – Hospital Treatment
• Inj Monocef ( Ceftriaxone) 1 GM BD ,direct
•
• Inj Pan 40 mg OD
• Inj M set ( Ondansetrone) 4 mg BD
• Tab Caripril ( Papaya Extract ) 1 BD

Chikunguniya
• 1) Cause - Due to mosquito ,firstly occur in
• Tanzania (Africa) in 1952.
• 2) C/F (Clinical features)
• Fever with chill, Rash on body,
• Bodyache (especially acute severe Joint pains)
• Restriction of joint movement

Chikunguniya
• Headache, conjunctival cengesion
(photophobia)
• May be convulsions in children
• Gingival bleeding
• Sometimes concomitant infection occurs of
chikun gunya & Dengue

Chikunguniya
• 3) Investigation
• Leucopenia, Thrombocytopenia
• IgM-Elisa Test for Chikun Gunya -- 7 days after
Disease Haemaglutination inhibition Antibodies.
• 4) Treatment - Only symptomatic –
• Inj Voveron 3 ml. I/M stat.
• Then Tab Voveron 150 mg. TDS OR Tab Etioricoxib-
90 mg. BD.

Leptospirosis
• This is due to Spirochaete.
• Also called as Weil's Disease.
• Definition - This is Infective Disease, Caused by
Leptospira ictero haemorrhagiae,
Characterised by high fever, jaundice &
haemorrhagic tendency.
• Spirochaete is present in Rats & excreted in
their urine.

Leptospirosis
• Spirochaete enter in body by-abrasion in skin
& mucous membrane & through GI tract
• Infection occurs during Rainy season (Floods &
people walking bare foot), Sewage workers,
miners, rice or canesugar fields workers, fish
handlers.

Leptospirosis
• 2) Pathology - Liver is most commonly affected.
Incubation period is 7 to 13 days.
• 3) C/F (Clinical Features) -- Sudden on set - 3 Stages.
• - First stage
• 5 days - High fever, muscular pain, Headache,
Anoxia, vomiting, conjunctival congestion,
Haemorrhage into skin, Respiratory tract / GI tract;
Maculo papular rash over trunk; Haemorrhagic
herpes Labialis

Leptospirosis- Second stage
• Second Stage (Icteric or Toxic) -- Jaundice
appears, Prostration is more, Liver enlarged &
tender.
• Renal failure (oliguria, anuria, Albuminuria,
Uraemia).
• Aseptic meningitis.
• Iridocyclitis (photophobia)

Leptospirosis- Third stage
• Third Stage - Temperature comes down by lysis.
Relapse may occur.
• 4) Investigation --Leucocytosis with Neutrophilia
• Igm Elisa Test for Leptospira
• Urine culture & microscopic test -- These tests are
not routinely done in private pathological labs
• These tests are done in Govt. centers like Sasoon
Hospital ,Pune ,India
• Tridot Test for Leptospira

Leptospirosis- Investigations
• Sr Bilirubin is High
• Sr. Alkaline phosphatase is increased
• In severe cases Sr Urea is increased

Leptospirosis- Treatment
• Inj. Penicillin G 2 to 3 mega units QDS - I/V. is
a drug of choice (of course, after Test dose)
AST After sensitivity test
• Oxytetracycline (Doxy 1-100 mg.) BD/TDS -
can be tried

Leptospirosis- Caution
• If Hepatic failure is suspected due to very high
Bilirubin or Renal failure is suspected due to
very high urea – Admit patient immediately
for Hospital Management

Meningitis
• Cardinal Features
• Severe Headache, High Fever, Projectile
vomiting
• Neck rigidity, Positive Babinski's Sign.

Meningococcal Meningitis (Cerebrospinal Fever)
• Cause - Disease spread by droplet infection.
Enters the body through Naso pharynx &
carried to choroid plexus through blood
stream
• Onset is sudden

Meningitis – Clinical Features
• A) Stage of Meningeal Irritation
• High temp (102 to 104 degree F)
• Severe Headache
• Restlessness, Irritability
• Photophobia
• Generalised flexed attitude (Huddled up
position)
• Neck rigidity (chin will not touch the chest)

• Kernig's sign Positive - After Flexing the thigh,
if leg is tried to be extended at knee, spasm of
hamstring muscles will prevent it
• Brudzinski's Neck sign -- During flexing the
neck, both lower limbs are flexed
• Brudzinski's Leg Sign -- During testing for
kernigs sign, opposite leg will be flexed.

Meningitis Signs

• B) Stage of Meningeal compression.
• Headache - more intense.
• Vomiting starts (projectile)
• Patient - gradually drowsy & comatose.
• Cheyne stroke Respiration.
• Plantar Reflex Entensor (i.e. Positive
Babinski's sign)
• Bilateral 6th Nerve palsies (Oculomotor)

• C) Stage of Coma or Paralysis
• Pupils widely dilated & do not react to light.
• Papilloedema
• Involuntary evacuation of urine & faeces.

Meningitis – Investigations
• Polymorphonuclear Leucocytosis
• C S F Turbid, pus cells (+++), proteins -
Increased But sugar is markedly diminished
• 4) Complications
• Hemiplegia or Paraplegia, Septicaemia

Meningitis – Management
• Refer the patient for Hospital management
• In Hospital . Drug of choice is Benzyl penicillin
(Alternative choice is Cefotaxime)

Encephalitis
• This is inflammation of the brain
• common cause is viral Infection
• Severe cases of encephalitis, can be life-
threatening

Encephalitis - Symptoms
• Some times no symptoms or mild flu-like symptoms,
such as Headache ,Fever ,muscular & joint pains ,
Fatigue or weakness
• In serious cases --Confusion, agitation or
hallucinations ,convulsions ,Loss of sensation or
paralysis in certain areas of the face or body ,Muscle
weakness ,Double vision ,Perception of foul smells,
such as burned meat or rotten eggs ,Problems with
speech or hearing ,Loss of consciousness

Encephalitis – Symptoms
In Infants & young children
• Bulging in the fontanels of the skull in infants
• Nausea and vomiting
• Body stiffness ,Excess crying
• Poor feeding or not waking for a feeding ,
Irritability

Encephalitis Causes
• Common – Viral Infections
• Bacterial infections
• Noninfectious inflammatory conditions can
cause encephalitis

Encephalitis Causes
• Primary encephalitis -- occurs when a virus or
other infectious agent directly infects the
brain
• The infection may be concentrated in one area
or widespread
• A primary infection may be a reactivation of a
virus that had been inactive (latent) after a
previous illness

Encephalitis Causes
• Secondary (post infectious) encephalitis --- is
a faulty immune system reaction in response
to an infection elsewhere in the body
• Secondary encephalitis often occurs two to
three weeks after the initial infection
• Rarely, secondary encephalitis occurs as a
complication of a live virus vaccination

Encephalitis Causes
• Herpes simplex virus. There are two types of herpes
simplex virus (HSV). Either type can cause
encephalitis.
• HSV type 1 (HSV-1) is usually responsible for cold
sores or fever blisters around your mouth
• HSV type 2 (HSV-2) commonly causes genital herpes
• Encephalitis caused by HSV-1 is rare, but it has the
potential to cause significant brain damage or death

Encephalitis Causes
• Epstein-Barr virus -- which commonly causes
infectious mononucleosis
• Varicella-zoster virus, which commonly causes
chickenpox and shingles
• Enteroviruses which include the poliovirus
• Coxsackievirus, which usually cause an illness
with flu-like symptoms, eye inflammation and
abdominal pain.

Encephalitis Causes
• The Powassan virus is a well-known tick-
transmitted virus that causes encephalitis in
the U.S. and Canada. Symptoms usually
appear about a week after exposure to the
virus.
• Rabies virus -- Infection with the rabies virus,
which is usually transmitted by a bite from an
infected animal, causes a rapid progression to
encephalitis once symptoms begin

Encephalitis Causes
• Common childhood infections — such as
measles (rubella), mumps and German
measles (rubella) — These are causes of
secondary encephalitis.
• These causes are now rare because of the
availability of vaccinations for these diseases.

Encephalitis – Risk Factors
• Age -- Some types of encephalitis are more
prevalent or more severe in certain age groups
• In general, young children and older adults
are at greater risk of most types of viral
encephalitis
• Encephalitis from the herpes simplex virus
tends to be more common in people 20 to 40
years of age

Encephalitis – Risk Factors
• People who have HIV/AIDS, take immune-
suppressing drugs, or have another condition
causing a compromised or weakened immune
system are at increased risk of encephalitis.
• Geographic regions -- Mosquito-borne or tick-borne
viruses are common in particular geographic regions.
• Season of the year -- Mosquito- and tick-borne
diseases tend to be more prevalent in spring,
summer and early fall

Encephalitis -- Complications
• Depend on several factors -- Age, the cause
of the infection, the severity of the initial
illness and the time from disease onset to
treatment
• In most cases, people with relatively mild
illness recover within a few weeks with no
long-term complications

Encephalitis -- Complications
• Injury to the brain from inflammation can result in a
number of problems. The most severe cases can
result in coma or death.
• Other complications — vary greatly in severity —
may persist for months or be permanent
• Persistent fatigue ,Weakness or lack of muscle
coordination ,Personality changes ,Memory
problems ,Paralysis ,Hearing or vision defects
,Speech impairments

Encephalitis –Tests
• Brain imaging – CT or MRI -- is often the first
test if symptoms and patient history suggest
the possibility of encephalitis
• The images may reveal swelling of the brain
or another condition that may be causing the
symptoms, such as a tumor.

Encephalitis –Tests
• CSF Examination –Indicate infection and
inflammation in the brain. Can be tested to identify
the virus or other infectious agent.
• Haemogram – can indicate severity of Infection
• EEG --abnormal patterns in this activity may be
consistent with a diagnosis of encephalitis
• Brain biopsy - if symptoms are worsening and
treatments are having no effect

Encephalitis – Treatment
• Treatment for mild cases -- Bed rest ,Plenty of
fluids ,Anti-inflammatory drugs— such as
acetaminophen ,Ibuprofen— to relieve
headaches and fever
• Antiviral drugs – IV – like -- Acyclovir (Zovirax)

Encephalitis – Side effects of Anti Viral Drugs
• Nausea, vomiting, diarrhea,
• Muscle or joint soreness or pain
• Rare serious problems may include
abnormalities in kidney or liver function or
suppression of bone marrow activity
• Appropriate tests are used to monitor for
serious adverse effects

Encephalitis – supportive management
• Breathing assistance by ventilator .careful
monitoring of breathing and heart function
• Intravenous fluids to ensure proper hydration and
appropriate levels of essential minerals
• Anti-inflammatory drugs, such as corticosteroids,
Mannitol ,to help reduce swelling and pressure
within the skull
• Anticonvulsant medications, such as phenytoin
(Dilantin), to stop or prevent seizures

Follow up Therapy
• Physiotherapy -- to improve strength,
flexibility, balance, motor coordination and
mobility
• Occupational therapy to develop everyday
skills
• To use adaptive products that help with
everyday activities

Follow up Therapy
• Speech therapy to relearn muscle control and
coordination to produce speech
• Psychotherapy to learn coping strategies and
new behavioral skills to improve mood
disorders or address personality changes —
with medication management if necessary

Viral Fever – clinical Features
• Fevers of short duration (4 - 5 days), found in
G.P.- Self - Limiting
• No localizing symptom or signs of particular
system.
• Involvement of only mucous membrane
(Rhinitis, watering of eyes) ,Severe bodyache.
• Contagious (many family members are
affected at the same time )

Viral Fever – Management
• Symptomatic – Ayurvedic Mahasudarshan
Ghan Tab 3 TDS
• If High Fever & Severe bodyache Inj voveron 2
ml - I/M Stat.
• Rest in Bed. No Bath (only sponging) , Bland
diet
• High fever – Continuous cold sponging

Influenza
• Common cold (Acute coryza)
• Definition -- Infection & Inflammation of
Nose & Nasopharynx.
• Etiology -
• Predisposing causes -- Debilitating diseases.
• Over crowding in public places. H/o contacts
• Viruses -- Rhino or coryza

Influenza
• Watery secretions from nose – mostly suggest
Allergic or Viral etiology
• Secretions from nose – If colour changes from
white to yellow or green ,it suggests super
added Bacterial Infection due to
pneumococci, streptococci or staphylococci &
need the use of Antibiotic

Influenza
• Incubation period -- 1 to 2 days.
• Symptoms - Acute onset.
• i) Running from nose, sneezing
• ii) Sore throat, malaise, slight Temp.
• iii) If Bacterial invasion , Persistence of temp
& Purulent discharge from nose, Headache,
pain over sinuses, pre existent chr.Lung
diseases are aggravated.

Influenza – Treatment
• Viral infections are usually self limiting. But advise
the patient to take rest & avoid causative factors.
• a) Nasivion Nasal drops -- 2 drops TDS
(Decongestant) – Do not use repetedly .This drop
may cause rebound congestion
• b) Tab zyrtec D (centrizine) 1 BD for 5 days.
• c) When Nasal discharge is thick, yellow (purulent)
Cap Mox 500 mg. BD
•

Pneumonia
• Definition - Inflammation of Lung Parenchyma,
localised or patchy in distribution, caused by various
organisms
• A] Acute Lobar Pneumonia (Pneumococcal
Pneumonia)
• 1) Etiology - Commonent is adults
• Devitalising situations -- Exposure to cold, overwork,
D.M, Malnutrition, Avitaminosis.
• Precipitating cause --- Diplococcus pneumoniae

Pneumonia -- Symptoms
• 2) Symptoms - Onset is sudden.
• High fever (102 to 104 degree F) with chill &
rigor
• Cough with tenacious sputum
• Dyspnoea
• Right or left sided chest pain
• Headache, Bodyache, weakness, malaise

Pneumonia -- Signs
• Pulse - rapid, Respiration - hurried
• Pulse - Respiration ratio is markedly altered
(2:1). This is characteristic.
• High Temp
• First 2 days, in the stage of congestion
• Doctor can see that, expansion over affected
part of chest is restricted. Percussion will give
impaired resonance

Pneumonia -- Signs
• After 48 hours, in the stage of consolidation
• Restricted movements of affected side of
chest, vocal fremitus on affected side is
increased, woody dullness on Percussion
• By Auscultation -- breath sound is tubular &
vocal resonance increased.
• But Adventitious sounds are usually absent

Pneumonia – Investigations
• i) Leucocytosis (15 to 20 thousand/ cmm) with
Neutrophilia (85- 90%)
• ii) X-ray chest (PA) view -- Opacity over
affected region ,called as Pneumonic patch

X ray -- Pneumonia

Pneumonia – Treatment
• i) Tab Roxithromycin 150 mg. BD for 7 days or
• i) Tab Gattifioxacin 400 mg. OD for 7 days
• ii) Tab combiflam - 1 TDS
• iii) Benadryl cough syrup 2 tsf TDS.

Pneumonia – Treatment
• Patient should be admitted, if ----
•
• He is old, Diabetic or
• Having very high fever, Dehydrated looking
Toxic or
• X-ray shows opacity of more than one lobe or
• patient is unable to take oral drugs.

Comparison of Broncho & Lobar Pneumonia
Sr.No Lobar Pneumonia Broncho Pneumonia
1 Due to Diplococcus
pneumoniae
Due to strepto
haemolyticus.
2 Usually right lower
lobe is affected
Both Lungs diffusely
3 Acute Onset Insidious onset
4 Young Adult Extreme of age

Comparison of Broncho & Lobar Pneumonia
Sr.No Lobar Pneumonia Broncho Pneumonia
5 Temp – High continued Temp – Moderate
Intermittent
6 Course – 7 to 10 days More Longer duration
7 Temp – Fall by crisis Temp – Fall by Lysis
8 Complications are rare Complications are
common

Pleural Effusion
• 1) Definition - Accumulation of exudative
serous fluid, inside the pleural sac
• Pus collection --- Empyema
• Transudate --- --- Hydrothorax
• Blood collection -- Haemothorax

Pleural Effusion – Causes
• i) T.B. of Lung (Commonest)
• ii) Brochogenic carcinoma
• iii) Trauma
• iv) Viral Infection.

Pleural Effusion – Symptoms
• i) To begin with - in acute Dry pleurisy --
Unilateral chest pain
• ii) After few days -- Pain becomes less, but
affected side becomes heavier & patient
suffers from Breathlessness.
• iii) Anorexia (Loss of Appetite), weakness,
fatigue.iv) If onset is insidious, patient may not
give a proper History.

Pleural Effusion – Signs
• i) G.C. - Patient looks ill
moderate or mild Temperature
• ii) Pulse – Tachycardia
• iii) R.R -- Hurried
• iv) Patient lies with the affected side
downwards

• v) Inspection -- Fullness of chest & restricted
movement of affected side of chest
• vi) Palpation -- Vocal fremitus is diminished
on the affected side,in lower part, but in upper
part there may be increased vocal fremitus.
(Due to compensatory emphysema)
• Trachea & Apex beat shifted to opposite side

• vii) Percussion -- Stony Dullness of affected
side. Upper part - may be Hyper resonant note
(due to compensatory Emphysema).
• viii) Auscultation --
• To begin with - Pleural rub is Diagnostic.
• Afterwards - Breath sounds are absent or
diminished
• Vocal resonance - Absent or diminished.

Pleural Effusion – Investigation
• i) E.S.R ---- Raised
• ii) X ray chest (PA) --
• Dense homogenous opacity, obliterating
costo-phrenic & cardiophrenic angles on
affected side. Trachea & heart may be shifted
to opposite side

X ray – Pleurisy

Pleural Effusion – Investigation
• iii) Aspirated pleural fluid -----
• Characters of Exudate
• Colour is straw yellow, may clot on standing,
due to high protein content, cells are
Lymphocytes.

Pleural Effusion – Treatment
• 6] Treatment
• i) Bed Rest
• ii) AKT (Anti Koch's treatment)
• iii) Pleural Tapping, as & when necessary.
• iv) For rapid absorption, steroids can be given
orally.

TB & Pleurisy
• i) T.B --- Evening rise of temp, Loss of
appetite, Loss of weight cough more than 15
days, Haemoptysis
• 2) Pleurisy -- Chest pain during Inspiration,
pleural rub on Auscultation
• For both Diseases, confirm Diagnosis by chest
x-ray (PA)

TB Management
• 1) Basic Advice for -- Adequate rest, good food (High
protein diet), fresh Air
• ii) Drugs
• a) Sputum Positive, New patients
• HRZE for 2 months & HR for 4 months
• b) Sputum Negative, New patients
• HRZ for 2 months & HR for 4 months

TB Drugs ( AKT)
Sr No Drug Dose Side Effect
1 H = Isonex 300 mg Rash ,Neuritis
2 R = Rifampicin 450 mg Rash ,Hepatitis
3 Z = Pyrazinamide 1.5 Gm Hepatitis,Arthralgia
4 E = Ethambutol 800 Mg Optic Neuritis

Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved

Fever part 1

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