fever part 1

Fever – Part 1 • Presented By –

Prof.Dr.R.R.Deshpande (M.D in Ayurvdic Medicine & M.D. in Ayurvedic Physiology)

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9/25/2016 1Prof.Dr.R.R.Deshpande

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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) Leptospirosis9/25/2016 4Prof.Dr.R.R.Deshpande

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.9/25/2016 6Prof.Dr.R.R.Deshpande

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.9/25/2016 17Prof.Dr.R.R.Deshpande


• 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)9/25/2016 44Prof.Dr.R.R.Deshpande


• 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)9/25/2016 47Prof.Dr.R.R.Deshpande


• 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

• 9/25/2016 77Prof.Dr.R.R.Deshpande

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

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