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Initially diagnosed with PUO. Having small consolidations in lung. Band cells, toxic granules present. Solution?

Hi my daughter is admited in hospital for last 14 days with initially diagnosis of PUO now 20th day of fever. 5 days back doctor has done HRCT and found multiple small consolidations with largest in left lower lung retrocardiac which is not picked up on xray. Now 5th day of in vancomycin still getting high fever. TT test is negative. TLC 0000 WITH neutrophil 78%, band cells and toxic granules present. What to do. In between fever she is fine. Doctor says normal physical examination. No wt and appetite loss. What to do next. 
Asked On : Sat, 30 Mar 2013
Answers:  2 Views:  40
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Pulmonologist 's  Response

The child is presently having a bacterial infection of lungs from what you have written. Small patch of consolidation behind the heart with similar smaller ones suggest bilateral spread of infection. Band cells and toxic granules support this contention.

Before starting antibiotics, sputum or blood cultures might have been sent by your doctor. Once culture reports are available, the antibiotic could be suitably modified.

If the cultures are negative, and if fever with raised white cell (neutrophil) counts persists, a resistant infection may have to be thought of. Then doctors usually advise one of the carbopenem antibiotics or piperacillin and tazobactum combination. While you await the culture reports, continue the current treatment. Also encourage fluids, nutritious diet and supportive therapy for the child.

Hope your daughter gets well soon. Thanks a ton for using

Answered: Sat, 30 Mar 2013
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Pulmonologist Dr. Satyadeo Choubey 's  Response
HI tusharpedsclinic....
PUO or pyrexia of unknown origin has got new definition which includes now the OPD visits as
1) 3 outpatient visits or
2)3 days in the hospital with no elucidation of a cause...or
3) 1 week of intelligent and invasive investigation..

PUO includes causes like malignant causes, connective tissue disorders, any underlying abscesses or infections,miscellaneous disorders like alcoholic hepatitis or granulomatous conditions, and finally undiagnosed conditions.

In your case band cells and toxic granules suggest some infective conditions and HRCT evidence also suggests this, one option can be go for bronchoscopy and protected brush specimen to undergo AFB staining, grams stain, culture sensitivity and cytology examination....

best wishes and thanks for considering HCM

Answered: Sat, 30 Mar 2013
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