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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Abdominal Pain With A Low Grade Fever In 5 Months Of Pregnancy. Had UTI Before

24 yrs primi with 5 month pregnancy presented with lower abdominal pain and high grade fever with chills 15 days. Initially treated on line of UTI as urine R/M shows pus cells and culture revealed yeas cells. But fever of high grade persisting with abdominal distension . USG abd. revealed mild to mod ascites with omental thickening and ascitic fluid shows exudative fluids with raised ADA & LDH. Mx negative but TB Gold +ve. Her initial TLC 10,640 and Normal KFT.
Sat, 28 May 2011
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General & Family Physician,  's  Response
welcome to healthcare magic ....
Ascities with a exudative picture on ascitic fluid analysis - suggests infection.
Now what infection is the issue ?? 1) Bacterial - yes possible , Fever with chills , exudative picture on ascitic fluid analysis is supportive. But counts TLC is not very high thats against. I would have liked to know what is the Ascitic fluid cell count and the cell type- if predonimant neutrophils (PMN s) and count > 250 is strongly suggestive of bacerial infection - treatment would be with a third gen cephalosporin like ceftriaxone and metronidazole.
2) Second possibility is TB Abdomen , Raised ADA, Tb Gold positive are supportive and mantoux negative is against Tb .I would like to knoe if ascitic fluid was examined for gram stain and AFB , if AFB is positive then its a definite Tb and requires anti tubericular treatment with 3 drugs.
I aould like to know 2 things
1) What is the Cell count and cell type report of ascitic fluid analysis?
2) What is gram stain and ZN stain for AFB report of ascitic fliud analysis ?
These can help me . help you with the diagnosis.
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Abdominal Pain With A Low Grade Fever In 5 Months Of Pregnancy. Had UTI Before

welcome to healthcare magic .... Ascities with a exudative picture on ascitic fluid analysis - suggests infection. Now what infection is the issue ?? 1) Bacterial - yes possible , Fever with chills , exudative picture on ascitic fluid analysis is supportive. But counts TLC is not very high thats against. I would have liked to know what is the Ascitic fluid cell count and the cell type- if predonimant neutrophils (PMN s) and count 250 is strongly suggestive of bacerial infection - treatment would be with a third gen cephalosporin like ceftriaxone and metronidazole. 2) Second possibility is TB Abdomen , Raised ADA, Tb Gold positive are supportive and mantoux negative is against Tb .I would like to knoe if ascitic fluid was examined for gram stain and AFB , if AFB is positive then its a definite Tb and requires anti tubericular treatment with 3 drugs. I aould like to know 2 things 1) What is the Cell count and cell type report of ascitic fluid analysis? 2) What is gram stain and ZN stain for AFB report of ascitic fliud analysis ? These can help me . help you with the diagnosis.