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Case Conferences

   

December 18, 2013

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Joined 2014-04-02

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Twelve year old female from India recently immigrated presents with one week of mild headache and malaise. No fevers, chills, cough, wieght loss, night sweats. Noted to be very irritable with personality changes and went to emergency department.

     
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Joined 2014-04-14

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This is an excellent case discussion.

     
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Joined 2014-05-06

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I agree this is an excellent discussion

     
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Joined 2014-05-04

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How to diagnose this condition at bedside?

     
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Joined 2014-05-05

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What was the biochemical picture for each case How we can correlateclinically and come to final Diagnosis?

     
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Joined 2014-05-30

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Both of these cases highlight the need for extensive evaluations to come to the final diagnosis.  The clinical syndromes by themselves have large differential diagnoses making a ‘bedside’ diagnosis challenging or impossible.  While TB may be suspected in each of these cases based on the clinical presentations, there are other infectious and non-infectious etiologies that had to be ruled out.  In the 12 year old, for example, one must consider the full differential for lymphocytic meningitis after receiving the LP results (biochemical and other lab results were included in the slides).  In these cases the clinicians were luckily able to make confirmed diagnoses of active TB on the basis of culture.  Rapid molecular tests may allow for a quicker diagnosis, but sensitivity is still not as high as mycobacterial culture.  Moreover, it requires relatively few bacilli to cause extensive pleural disease or menignitis; as such, even mycobacterial cultures can sometimes be negative in these conditions.  The other biochemical profile of the pleural or CSF fluid were used as adjunctive tools in these cases to help come to the diagnosis.  But ultimately, diagnosis remains challenging.

     
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Total Posts: 24

Joined 2014-05-05

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Maunak , thank yu for the response

     
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Joined 2014-05-07

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Interesting cases.

With regard to the first case :What was the nutritional status of the 12 year old girl from India? Specifically what was her weight?

We often teach students that ‘BCG vaccine protects children from severe childhood forms of TB like TB meningitis and miliary tuberculosis.‘Does this protection wane with age.Is it more pronounced in the first few years of life?Up to what age is BCG protective?