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<ul><li>PRESENTATION  </li></ul><ul><li>By DR. Ramesh Bhargava </li></ul>
Mr. R aged 17 yrs, Male admitted to my HOSPITAL ON 3/08/2008 with H/O High Grade Fever, Vomiting, Loose Motions & Breathle...
<ul><li>ON INVESTIGATION  </li></ul><ul><li>1.CBP-  Hb 6 gm % </li></ul><ul><li>TWBC- 11,200 </li></ul><ul><li>P- 64% </li...
<ul><li>X- RAY [ NAD ] </li></ul>
<ul><li>TREATMENT GIVEN   </li></ul><ul><li>Blood Transfusion II  </li></ul><ul><li>Inj Arteethar 150 mg daily for three d...
<ul><li>On 4/10/2008 he again admitted to private Hospital with H/O Fever, Vomiting where he was again investigated  </li>...
<ul><li>TREATMENT GIVEN   </li></ul><ul><li>IV  Ceftrixone 1 gm bd .. </li></ul><ul><li>IV   GM 80 mg IV bd..  </li></ul><...
<ul><li>Again he came to my clinic on 16/12/08 with H/O Fever, vomiting  </li></ul><ul><li>O/E  </li></ul><ul><li>Hb – 4.0...
<ul><li>Bone Marrow Examination </li></ul><ul><li>CELLULARITY - Hypercellular  </li></ul><ul><li>M: E Ratio :- 1:3 (revers...
<ul><li>Blood Transfusion II  </li></ul><ul><li>INJ – chloroquine </li></ul><ul><li>TAB- Primaquine </li></ul><ul><li>Symp...
Oral: 600 mg stat then 300 mg base after 6 hours then 300 mg ODx2 days. Injectable in a dose of 10 mg per kg by slow infus...
Adults: 15-25 mg/kg Children: 25mfg / kg  GI intolerance, dizziness, extrasystole, syncope rarely neuropsychiatric symptom...
Adults: Parenteral: 120 mg first day; 60mg next 4 days. Oral: 100 mg BD first day; 50 mg BD x 4 days  Children: 1.2 mg /kg...
For prophylaxis: 0.6-0.7 g/week  For treatment  0.9 gm on first day  0.6 gm on second and third day  0.3 gm on fourth, fif...
<ul><li>THANK YOU   </li></ul>
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case presentation dr ramesh bhargava Slide 1 case presentation dr ramesh bhargava Slide 2 case presentation dr ramesh bhargava Slide 3 case presentation dr ramesh bhargava Slide 4 case presentation dr ramesh bhargava Slide 5 case presentation dr ramesh bhargava Slide 6 case presentation dr ramesh bhargava Slide 7 case presentation dr ramesh bhargava Slide 8 case presentation dr ramesh bhargava Slide 9 case presentation dr ramesh bhargava Slide 10 case presentation dr ramesh bhargava Slide 11 case presentation dr ramesh bhargava Slide 12 case presentation dr ramesh bhargava Slide 13 case presentation dr ramesh bhargava Slide 14 case presentation dr ramesh bhargava Slide 15
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case presentation dr ramesh bhargava

  1. 1. <ul><li>PRESENTATION </li></ul><ul><li>By DR. Ramesh Bhargava </li></ul>
  2. 2. Mr. R aged 17 yrs, Male admitted to my HOSPITAL ON 3/08/2008 with H/O High Grade Fever, Vomiting, Loose Motions & Breathlessness for Last 8 days O/E S/E P.120 per min A/S- ABD SOFT BP 100/70 R-34/M LIVER - JP T-102 F SPLEEN – JP JVPNR NO-F.F. ICTERUS + CYANOSIS ABSENT CLUBBING ABSENT R/S B/L CLEAR NOACC OEDEMA ABSENT CVS. FAINT SYSTOLIC MUMER TONGUE - DRY CNS – CLINICALLY NAD MILD DEHYDRATION +
  3. 3. <ul><li>ON INVESTIGATION </li></ul><ul><li>1.CBP- Hb 6 gm % </li></ul><ul><li>TWBC- 11,200 </li></ul><ul><li>P- 64% </li></ul><ul><li>L- 30% </li></ul><ul><li>M- 3% </li></ul><ul><li>E- 3% </li></ul><ul><li>2. Urine Routine & Microscopic test - NAD </li></ul><ul><li>3. PS FOR MP- NEGATIVE </li></ul><ul><li>4. X- Ray Chest – NAD </li></ul><ul><li>5. Blood Widal -VE </li></ul><ul><li>6.Blood Glucose R-98 mg % </li></ul><ul><li>7. S. Bilirubin 6.00 mg % </li></ul><ul><li>SGOT -70 </li></ul><ul><li>SGPT -60 </li></ul><ul><li>Hbs Ag- NEGATIVE </li></ul><ul><li>8. Blood Urea 30 mg % </li></ul><ul><li>S. Creatinine 1.4 mg % </li></ul><ul><li>9. Widal – ve </li></ul><ul><li>10. Ultra Sonography shows Hepatosplenomegaly </li></ul><ul><li>11.Echo- NAD </li></ul>
  4. 4. <ul><li>X- RAY [ NAD ] </li></ul>
  5. 5. <ul><li>TREATMENT GIVEN </li></ul><ul><li>Blood Transfusion II </li></ul><ul><li>Inj Arteethar 150 mg daily for three days </li></ul><ul><li>Inj Cefotaxim 1 gm bd </li></ul><ul><li>Inj metrogyl 500 mg 8 hourly </li></ul><ul><li>Symptomatic & Supportive Treatment </li></ul><ul><li>He responded to treatment & became afebrile on 3rd day remained in the hospital for 10 days, recovered and then discharged. </li></ul>
  6. 6. <ul><li>On 4/10/2008 he again admitted to private Hospital with H/O Fever, Vomiting where he was again investigated </li></ul><ul><li>1. CBP Hb 8 gm % </li></ul><ul><li>TWBC 9,300 P- 70% </li></ul><ul><li>L- 20% </li></ul><ul><li>M- 3% </li></ul><ul><li>E- 3% </li></ul><ul><li>B- 4% </li></ul><ul><li>2. PS for MP -ve </li></ul><ul><li>3. Urine Routine Microscopic Test / NAD </li></ul><ul><li>4. X- Chest – NAD </li></ul><ul><li>5. S. Bilirubin 3.0 mg % SGOT & SGPT </li></ul><ul><ul><li> 30 40 </li></ul></ul><ul><li>6. Reticulocyte count – 3% </li></ul><ul><li>7. G6PD deff – Not Detected </li></ul><ul><li>8. Sickling Test- -ve </li></ul><ul><li>9. Coomb’s Test- -ve </li></ul><ul><li>10. Hb Electrophoresis (N) </li></ul><ul><li>11. USG-Hepatosplenomegaly </li></ul><ul><li>12. ECG Within normal limit ( WNL) </li></ul>
  7. 7. <ul><li>TREATMENT GIVEN </li></ul><ul><li>IV Ceftrixone 1 gm bd .. </li></ul><ul><li>IV GM 80 mg IV bd.. </li></ul><ul><li>IV Artesunate 120 gm IV Stat than 60 mg IV daily for Four Day </li></ul><ul><li>Remained in the Hospital for 5 days than discharged </li></ul>
  8. 8. <ul><li>Again he came to my clinic on 16/12/08 with H/O Fever, vomiting </li></ul><ul><li>O/E </li></ul><ul><li>Hb – 4.0 gm % </li></ul><ul><li>TWBC - 2800 </li></ul><ul><li>P- 50% </li></ul><ul><li>L- 47% </li></ul><ul><li>M- 02 </li></ul><ul><li>E- 01 </li></ul><ul><li>PS- MP -VE </li></ul><ul><li>S. Bilirubin – 3.6 mg % </li></ul>
  9. 9. <ul><li>Bone Marrow Examination </li></ul><ul><li>CELLULARITY - Hypercellular </li></ul><ul><li>M: E Ratio :- 1:3 (reversal) </li></ul><ul><li>ERYTHROPOISIS : Show marked erythrorid hyperplasia with many precursors and few macronormoblasts with feature of dyserythropoisis few trophozoits and schizoni of P. Vivax seen. </li></ul><ul><li>LYMPHOPOISIS :- Shows mild increase in lymphocytes.. </li></ul><ul><li>MEGAKARYOCYTES :- Normal in number but functioning </li></ul><ul><li>IMPRESION :- Macronormoblastic erythrorid hyperplasia secondary to P.Vivax </li></ul>
  10. 10. <ul><li>Blood Transfusion II </li></ul><ul><li>INJ – chloroquine </li></ul><ul><li>TAB- Primaquine </li></ul><ul><li>Symptomatic & supportive </li></ul>
  11. 11. Oral: 600 mg stat then 300 mg base after 6 hours then 300 mg ODx2 days. Injectable in a dose of 10 mg per kg by slow infusion over a period of 8 hrs followed by 5 mg/kg every 8 hrs until a total dose of 25 mg/kg IM : 3.5 mg (base)/kg every 6 hours GI intolerance, pruritus, dizziness, anorexia, malsise rare- psychosis convulsions, blood dyscrasia Treatment of all forms of malaria except for infection due to resistant strains of P. falciparum Chloroquine Phosphate Dose Adverse side effects Indication Drug
  12. 12. Adults: 15-25 mg/kg Children: 25mfg / kg GI intolerance, dizziness, extrasystole, syncope rarely neuropsychiatric symptoms Used for oral prophylaxis and treatment of chloroquin resistant and multidrug resistant P.falciparum malaria Mefloquine hydrochloride
  13. 13. Adults: Parenteral: 120 mg first day; 60mg next 4 days. Oral: 100 mg BD first day; 50 mg BD x 4 days Children: 1.2 mg /kg x 5 days Transient and reversible reticulocytopena, drug fever, drug rash, bradycardia, transient first degree heart block Servere malaria including cerebral malaria. Second line treatment of chloroquin resistant falciparum malaria Artesonate Adults: 300-600 mg thrice daily 5-7 days Children: 25 mg/kg/day 8 hourly for 7 days Cinchonism, acute hemolytic anemia, tinnitus, headache, GI intolerance Resistant falciparum malaria Quinine Suphate
  14. 14. For prophylaxis: 0.6-0.7 g/week For treatment 0.9 gm on first day 0.6 gm on second and third day 0.3 gm on fourth, fifth, and sixth day Dizziness GI disturbances yellow discoloration of skin on prolonged use Drug resistant falciparum malaria. Prophylaxis chloroquin resistant falciparum malaria Mepacrine Adults: 80 mg (1 amp) IM BD on day 1. followed by 80 mg IM OD X 4 days. Children's: 1.6 mg/kg BDx3 days Recticulocytopenia Server falciparum malaria cerebral malaria multidrug resistant malaria Artemether (Latrither)
  15. 15. <ul><li>THANK YOU </li></ul>
  • ElizabethBeaudette

    Nov. 27, 2021

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