Question of the Week

Question :
Posted On : 04 Nov 2018
a 4 year old female child presented with history of cough for the last 1.6 month.The cough is productive in nature,{white coloured sputum}.Sputum is moderate in quantity.Fever was present initially during initial part of the illness for one to two week and the child is afebrile presently.The child has received three course of antibiotics and along with bronchodilators and other supportive treatment.When the child presented to me on 16, 9, 10 there was extensive crepts and ronchi bilaterally.CXR done revealed haziness in the paracardiac region and perihilar region.CT SCAN done confirmed the above findings.There was no lymphadenopathy . Mantoux test done was negative.CBC done was inconclusive.Child improved partially on antibiotics and nebulizations with asthalin and budecort.Presently she is clinically better but cough is persisting with crepts present bilaterally and ther is post tussive vomiting also.She has not recived BCG vccine so far.What diagnosis should we think of and what other investigations should be done.There is no history of contact but ther is history of weight loss but the child is not malnourished.
Expert Answer :
Since cough is persistent and the child has bilateral crepts, rule out bronchiectasis and interstitial lung disease since the child`s chest Xray is not suggestive of TB.
Answer Discussion :
denise sztajnbok
2 years ago
suhas kulkarni
the child presented with fever initially was it associated with watery nasal discharge?or any such history suggestive of viral infection.At what time cough is more? is the child eating well ?what are the findings on CBc report? as the cough is with expectoration direct zn or gram staing of sputum or withGa or IS can be done.what is the respiratory rate?
2 years ago
nayab ashfaq
history and CXR shows pulmonary tb... should do gastric aspiration for gene xpert to confirmation of TB
2 years ago
Manoj Gupta
2 years ago

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