A 1 year old boy had pericardial effusion. Mantoux test was negative. Pericardial tap showed 2 gm/dl proteins, 91 cells/hpf (15% polymorphs, 85% lymphocytes). The child was started on 4 drug Anti tubercular therapy (ATT) along with oral prednisolone (2 mg/kg/day). Repeat echocardiography at end of 2 months showed trivial pericardial effusion with thickening of pericardium. His steroids were tapered and stopped. However, he developed drug induced hepatitis within 3 weeks of starting ATT. HRZ were stopped and child was started on Ciprofloxacin & Streptomycin and Ethambutol was continued. SGPT normalized after 2 months following which HR were gradually reintroduced and Streptomycin & Ciprofloxacin were stopped. The child was subsequently continued on HRE. At the end of total 5 months of therapy, he has ascitis with pericardial effusion.
A 6 month old boy with congenital moderate ventricular septal defect (VSD) on decongestive measures consisting of frusemide and digoxin presented with irritability, vomiting and oliguria since 2 days. There is no fever, refusal of feeds or lethargy. On examination, he is malnourished (weight = 4kg), with some dehydration, has heart rate of 100/min and a pansystolic murmur at the apex. Other systems are normal.
What is the diagnosis? How to treat?
Read the entire teaching clinical query in the section of “TEACHING FILES” and try the correct answer.
Last month's teaching file: A 4-month-old boy presented with fever, cough, cold since 5 days and breathlessness since 1 day with decreased appetite. Chest X-Ray = Bilateral lower zone pneumonia with minimal pleural effusion and inter fissural effusion on right side. Which is the organism causing the pneumonia?
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