Pneumonai after submersion injury
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Transcript of Pneumonai after submersion injury
A RARE CASE OF PNEUMONIA
DR. P. REVATHI DCH PG
PROF. DR.S.SUNDARI & PROF.DR.JEYACHANDRAN
G7 WARD & IMCUICH & HC
7y / F7y / F H/O fall with facedown into pool of stagnant H/O fall with facedown into pool of stagnant
dirty water ,which the child aspirateddirty water ,which the child aspirated Admitted for Scalp laceration, Admitted for Scalp laceration,
breathlessness – Rx in private Hospital breathlessness – Rx in private Hospital CT Brain / CT ChestCT Brain / CT Chest Head injury conservatively managedHead injury conservatively managed
3 days later3 days later Cough , Fever, Breathlessness, Cough , Fever, Breathlessness,
Right Chest Pain – 4 daysRight Chest Pain – 4 days Conscious, Dyspneic, Tachypneic Conscious, Dyspneic, Tachypneic
HR – 120 / minHR – 120 / minRR – 44 / minRR – 44 / minBP – 80 / 60 mmHgBP – 80 / 60 mmHgRS - Air entry in Rt RS - Air entry in Rt Inframammary, axillary, Inframammary, axillary, infraaxillary areasinfraaxillary areas
CBC – WBC 20 x 10CBC – WBC 20 x 103 3
Hb – 10.7Hb – 10.7Platelet – 4 lakhsPlatelet – 4 lakhs
DC – PDC – P7979 L L 1313 E E88
RFT / LFT / Sr. electrolytes, Urine R/E – NRFT / LFT / Sr. electrolytes, Urine R/E – NNEC – Klebsiella growthNEC – Klebsiella growthMSAT / Widal - NegativeMSAT / Widal - Negative
TB Workup – NegativeTB Workup – Negative Throatswab for HThroatswab for H11NN11 – Negative – Negative HIV Screening – NegativeHIV Screening – Negative NBT- NegativeNBT- Negative Immunoglobin profile - NormalImmunoglobin profile - Normal
COURSE IN HOSPITALCOURSE IN HOSPITALRx Inj . Ceftriaxone, Inj cloxacillin, Inj AmikacinRx Inj . Ceftriaxone, Inj cloxacillin, Inj Amikacin
BAL on 10BAL on 10thth day – negative day – negative
Inj. Piperacillin & Tazobactam, Inj. Metronidazole T. AzithromycinInj. Piperacillin & Tazobactam, Inj. Metronidazole T. Azithromycin
T. FluconazoleT. Fluconazole
COURSE IN IMCUCOURSE IN IMCUFever , Respiratory DistressFever , Respiratory Distress
SPOSPO22 – 96% with Mask – 96% with Mask
Wet Mount – Scanty fungal filamentsWet Mount – Scanty fungal filamentsSputumSputum C/S – No growthC/S – No growth
BAL on 18BAL on 18thth day dayAspergillus & Nocardia grownAspergillus & Nocardia grown
Nocardia sensitive to linezolid, cipro, cotrimoxazole, Nocardia sensitive to linezolid, cipro, cotrimoxazole, imipenem, amikacin, gentamycinimipenem, amikacin, gentamycin
NOCARDIANOCARDIA
SDAGRAMS STAIN
ASPERGILLUS
Lacto phenol cotton Blue
LJ MEDIUM -BAL
CHALKY WHITE COLONY
SDA – water sample
BLACKFUNGALCOLONY
Recovery after RxRecovery after Rx X – ray – 4X – ray – 4thth day day Respiratory distressRespiratory distress Fever Fever
NOCARDIANOCARDIA- Gram +ve filamentous bacteria – Gram +ve filamentous bacteria –
saprophytesaprophyte- Opportunistic infection – Localized & Opportunistic infection – Localized &
DisseminatedDisseminated- Inhalation, direct inoculation, Nosocomial.Inhalation, direct inoculation, Nosocomial.
ASPERGILLUSASPERGILLUS- Monomorphic Mycelial fungi – A . Monomorphic Mycelial fungi – A .
fumigatusfumigatus- Route – Hematogenous, Inhalation, Route – Hematogenous, Inhalation,
Ingestion Skin woundIngestion Skin wound Hypersenstivity Syndrome Hypersenstivity Syndrome Saprophytic non invasive syndrome Saprophytic non invasive syndrome Invasive SyndromeInvasive Syndrome
Special thanks to EKAM Foundation Dept of pulmonology Dept of Microbiology IBMS – Taramani
Take Home Message
Mixed pneumonia should be considered with h/o aspiration or near drowning
Characteristic Radiological picture of fungal pneumonia seen in adults may not be seen in pediatric age group.
Early diagnosis & prolonged treatment improves outcome………