Treatment & Management

CASE #3
Proper hygiene (regular Diagnostic Test
2A GROUP 3 – Inhalation of droplet  Live, attenuated M. bovis inoculation of
handwashing, covering
CUYA, DELA COSTA, nuclei containing strain Bacille Calmette- bacteria on right
mouth when sneezing & TNF-a
EGE, FUENTES, M. tuberculosis Guerin/BCG vaccine
coughing) face Symptoms
JESSWANI, JUNIO
increase in
release
pyrogens release of hypothalamic
IL-12 cytokines and fever Paracetamol
prostaglandins temperature set Lab Test Results
Caseous necrosis inflamm.
point
mediators
entry to respiratory M. tuberculosis prevents IL-1
induction of T Cell airway migration of (1/13/18)
differentiation into fusion of the phagosome
proliferation of T lymphocytes mass on right Inflammatory neutrophils and WBC: 20.47
TH1 with lysosomes by blocking Cefalexin
in the surrounding of the face response macrophage to stimulate liver to Neutrophils: 66
early endosomal antigen 1 IL-6 CRP: 1.04
central core of the caseous inoculation site release CRP Lymphocytes: 18
penetrate alveoli (EE1)
necrosis
secretion of (1/16/18)
slight reduction
interferon WBC 13.85
of mass on right
gamma phagocytosed by fusion with other Neutrophils: 65
fibrosis and face
alveolar macrophages intracellular vesicles Lymphocytes: 20
calcification occurs

activates
infected Macrophage permits access to
granuloma formation macrophages nutrients and facilates
secrete cytokines
intravacuolar replication 2 months PTC
semiliquid necrotic
material drained into increase localized TNF-a
the bronchus or in the inflammation local baciliary multiplication reach brain
nearby blood vessel
bacteremia covering & cause bacterial meningitis
stimulate NO inflammation
production
drained into drained into vessel IGRA (In
bronchus as and enter blood or vitro IFN-ɣ Airway irritation
purulent discharge lymphatics Release enhanced CXR: pneumonia; CT Scan result: Release of digestive enzymes
Assay) cellular killing formation of
noted reticular densities 2° pneumonia hypodense focus on and Liquefactive Necrosis
increase abscesses
in the right lower lobe vermis constituent of neutrophils
infectious droplet production
transmission is new caseous
possible grnaulomas may form Cough
DDx: Pneumonia,
cytokines trigger 4 weeks duration, non-
Chronic bronchitis, CT Scan result: mass
immune response responsive to antibiotics
Viral diseases in right maxillary sinus
and anti-asthma meds increase ICP uncal herniation
Extrapulmonary TB dysphagia &
careful follow-up of
cough
their contacts with
tuberculin tests, x-
cytokines induce the Ibuprofen
rays, and Complications in the Increase skeletal
hypothalamus to  Paracetamol
appropriate different organ muscle cell damage
release prostaglandins (headache & Impinged respiratory
treatment system
fever) dizziness & left  center
minimal hemiparesis
Increase body temp set  progression
CXR: Single lesion Back pains point to fight infection impinge facial
especially at night (+) Acid-fast
in the middle or staining of sputum sample nerve
lower right lobe (+) Mycobacterium culture
with enlargement Abdomen: (+) Nucleic acid amplification test for Left hemiparesis tachypnea & labored
of draining lymph Weight loss Low-grade fever breathing
M. tuberculosis due to mass on
nodes right side of the
(+) Tuberculin brain
Skin Test

DOTS (Direct Observed Therapy, Short-Course)

2 months of standard therapy:
Monitoring of sputum until
Isoniazid
conversion of sputum is
Rifampicin
documented
Pyrazinamide 1 month PTC
Ethambutol
Monitoring for toxicity:
baseline and periodic liver
enzymes, complete blood
cell (CBC) count, and 4 months of treatment: decreased level of
serum creatinine Isoniazid consciousness
Rifampicin

Causative Agent,
Clinical manifestations Differential Diagnoses Laboratory Workup Prevention & Management
Pathogenesis

Day of consult

Mannitol
increased ICP
(115cc q6)

1st  Day of Admission

Penicillin G
(2M IV q6H
Mannitol
increased ICP
(135cc q4H)

2nd  Day of Admission

Lactulose
(10cc ODHS)

3rd  Day of Admission

Paracetamol
(300mg IV q6H)

Impingement on the Fever

VP Shunting increased ICP prain receptors on the
meninges

10mL TID PRN for Ibuprofen

pain (200mg/5mL syrup)

5th  Day of Admission

Fluctuating level of
Tachypneic Febrile episodes
consciousness

7th  Day of Admission

continuous febrile
Drowsy with labored episodes
breathing

Patient unresponsive Resuscitation

Patient died

8th  Day of Admission