A potentially serious bacterial infection that mainly affects the lungs.

1. CASE PRESENTATIONCASE PRESENTATION
BYBY
S.SANDHOSHINI MEENAS.SANDHOSHINI MEENA

2. A 22 years old male patient was admitted in hospital withA 22 years old male patient was admitted in hospital with
CHIEF COMPLAINTS :CHIEF COMPLAINTS :
IntermittentIntermittent fever since one monthfever since one month
Night sweatsNight sweats
Weight lossWeight loss
A productive cough since 1 weekA productive cough since 1 week
Chest painChest pain
HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
Dyspnea, sputum production ,fatigue and weaknessDyspnea, sputum production ,fatigue and weakness

3. PAST MEDICAL HISTORY:PAST MEDICAL HISTORY:
-Not a k/c/o asthma , COPD , HTN , DM-Not a k/c/o asthma , COPD , HTN , DM
PAST MEDICATION HISTORY:PAST MEDICATION HISTORY:
-NIL--NIL-
PERSONAL HISTORY/SOCIAL HABITS:PERSONAL HISTORY/SOCIAL HABITS:
-- smokersmoker
- Takes mixed diet- Takes mixed diet
- MarriedMarried
- Not alcoholicNot alcoholic

4. PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
-Patient is conscious and oriented-Patient is conscious and oriented
-No pallor/icterus-No pallor/icterus
-febrile-febrile
ON EXAMINATION:ON EXAMINATION:
PR:PR: 72 beats/min72 beats/min CVSCVS: S1&S2 sounds audible: S1&S2 sounds audible
RR:RR: 20 breaths/min20 breaths/min RS:RS: Dullness to chest percussionDullness to chest percussion ,,
Rales,Rales,
Increased vocal fremitus .Increased vocal fremitus .
TEMP:TEMP: 100°F100°F CNS:CNS: normalnormal
BPBP : 120/80mmHg: 120/80mmHg PP/A:/A: soft, normal bowel soundssoft, normal bowel sounds
areare audible.audible.

5. LAB INVESTIGATIONS:LAB INVESTIGATIONS:
PARAMETERSPARAMETERS OBSERVED VALUESOBSERVED VALUES NORAML VALUESNORAML VALUES
CBCCBC
HbHb 16g/dl16g/dl 14-18 g/dl14-18 g/dl
PlateletPlatelet 1,53,000 per1,53,000 per µ/lµ/l 1,50,000-4,00,000 per1,50,000-4,00,000 per
µ/lµ/l
ESRESR 12 mm/hr12 mm/hr 0-20mm/hr0-20mm/hr
RBCRBC 5.5 million cells/mcL5.5 million cells/mcL 4.32-5.72million4.32-5.72million
cells/mcLcells/mcL
BLOOD SUGARBLOOD SUGAR
FBSFBS 85 mg/dl85 mg/dl 70-115 mg/dl70-115 mg/dl

6. DIFFERENTIALDIFFERENTIAL
COUNT (DC)COUNT (DC)
NeutrophilNeutrophil 76% ↑76% ↑ 57-67%57-67%
lymphocyteslymphocytes 45% ↑45% ↑ 23-33%23-33%
esinophilsesinophils 9% ↑9% ↑ 1-6%1-6%
monocytesmonocytes 10% ↑10% ↑ 3-7%3-7%
basophilbasophil 11% ↑11% ↑ 0-7%0-7%
TOTALTOTAL
LEUKOCYTELEUKOCYTE
COUNT (TLC)COUNT (TLC)
11,200cells/mcL ↑11,200cells/mcL ↑ 3,500-3,500-
10,500cells/mcL10,500cells/mcL

7. OTHER TESTS:-OTHER TESTS:-
- Chest radiographChest radiograph
- Tuberculin skin testTuberculin skin test
- Sputum smearSputum smear
IMPERSSION:-IMPERSSION:-
-- chest radiograph – patchy or nodular infiltrates in the apicalchest radiograph – patchy or nodular infiltrates in the apical
area of the upper lobe of left lungarea of the upper lobe of left lung
- Tuberculin skin test- positiveTuberculin skin test- positive
- Sputum smear –positive (Mycobacteruim tuberculosis is seen)Sputum smear –positive (Mycobacteruim tuberculosis is seen)
DIAGNOSIS:-DIAGNOSIS:-
PulmonaryPulmonary TuberculosisTuberculosis

8. SlSl DRUGDRUG DOSEDOSE RORO
AA
FREFRE
QQ
DURATIONDURATION
1.1. T. IsoniazidT. Isoniazid 300mg300mg oraloral odod      
2.2. C. RifampinC. Rifampin 450mg450mg oraloral odod      
3.3. T. PyrazinamideT. Pyrazinamide 750mg750mg oraloral odod      
4.4. T. PyridoxineT. Pyridoxine 25mg25mg oraloral odod      
5.5. T. EthambutolT. Ethambutol 800mg800mg oraloral odod      

9. DISCHARGE ADVICE :-DISCHARGE ADVICE :-
SISI
NN
OO
BRANDBRAND
NAMENAME
GENERICGENERIC
NAMENAME
DOSEDOSE RORO
AA
FREFRE
QQ
DURATIONDURATION
1.1. AKT-4AKT-4 C.RifampinC.Rifampin
T. PyrazinamideT. Pyrazinamide
T. EthambutolT. Ethambutol
T. IsoniazidT. Isoniazid
450mg450mg
750mg750mg
800mg800mg
300mg300mg
P/OP/O
OdOd
OdOd
OdOd
First 3First 3
monthsmonths
2.2. AKT-3AKT-3 C.RifampinC.Rifampin
T. EthambutolT. Ethambutol
T. IsoniazidT. Isoniazid
450mg450mg
800mg800mg
300mg300mg
P/OP/O
OdOd
OdOd
OdOd
OdOd
Next 3Next 3
monthsmonths

10. SOAP NOTES:-SOAP NOTES:-
SUBJECTIVE:SUBJECTIVE: A 22 year old male patient was admitted inA 22 year old male patient was admitted in
hospital with c/ohospital with c/o Difficulty in breathing , night sweats, ChestDifficulty in breathing , night sweats, Chest
pain, fever, weight loss, productive cough.pain, fever, weight loss, productive cough.
OBJECTIVE:OBJECTIVE: upon examinations ,it was noted that patient hasupon examinations ,it was noted that patient has
increased white blood cell count with a lymphocyteincreased white blood cell count with a lymphocyte
predominance.predominance.
ASSESSMENT:ASSESSMENT: chest radiograph, tuberculin skin test, sputumchest radiograph, tuberculin skin test, sputum
smear are taken for further investigations and it shows that thesmear are taken for further investigations and it shows that the
patient has pulmonary tuberculosis.patient has pulmonary tuberculosis.
PLAN OF TREATMENT:PLAN OF TREATMENT: C. rifampinC. rifampin ,, T. isoniazid,T. isoniazid,
T. ethambutol, T.pyrazinamide are given for 6 months dosageT. ethambutol, T.pyrazinamide are given for 6 months dosage
regimen to treat pulmonary tuberculosisregimen to treat pulmonary tuberculosis

11. PATIENT COUNSELLINGPATIENT COUNSELLING
• To take anti-tuberculosis drug regularly.To take anti-tuberculosis drug regularly.
• Advice to cover the mouth while coughing or sneezing.Advice to cover the mouth while coughing or sneezing.
• Patients on rifampin is adviced to contact doctor if theyPatients on rifampin is adviced to contact doctor if they
notice unusual bleeding or bruising.notice unusual bleeding or bruising.
• Information is told that their urine, saliva, sweat, tears, andInformation is told that their urine, saliva, sweat, tears, and
faeces may turn a red-orange colour due to rifampin.faeces may turn a red-orange colour due to rifampin.

12. THANK YOUTHANK YOU