Article written by
Dr Sanjukta De
DCH (Cal), DCH (UK), DNB (Paediatric),
MRCPCH (UK), FRCPCH (UK), DIP Allergy (UK),
Clinical Director – Dept. of Paediatrics & Neonatology
Soma Nandy, a talented girl preparing for her state level championships and had no idea why she was getting frequent fever. The young 13 year old with strong dreams to make it happen in the State Athletic Championship, started having severe back pain and low grade fever since December 2019. Her paediatrician had advised her parent to keep a fever chart and not panic. Her chest hurt too but she didn’t want to stop practising. She continued to have low grade fever. Mid April as her condition needed hospitalization they ran post to pillar only to be refused by each hospital. This is because her symptoms were close to that of COVID – 19. She was having fever and respiratory distress. Finally she was brought to Peerless Hospital.
She was admitted on 24/4/2020 with chief complaints of high grade fever for 10 days associated with right sided backache which increased on coughing and deep inspiration. She had no contact history of tuberculosis. She had mild tachypnea but no respiratory distress. She had reduced air entry over right lower zone with dull note on percussion. A chest x-ray done outside was suggestive of right sided lower lobar consolidation with pleural effusion. Her baseline investigations were sent and she was started on antibiotics and other supportive medications. She tested negative for COVID -19. However lower respiratory panel was positive for Staphylococcus aureus and Haemophilus influenza. Her reports showed ESR: 56, CRP: 203.9. All other blood reports were unremarkable.
A USG guided pleural aspiration was done on 25/04/2020 and pleural fluid sent for analysis. Pleural fluid showed cell count 800 cells (N10 Lymphocyte and other 90%) Protein 5.1 ADA: 50. Gene Xpert was negative for sputum. Anti tubercular treatment was started on basis of all reports on 27/04/2020. She was also treated for H. Influenza & Staphylococcus aureus infection. Blood parameters were repeated as needed, CRP reduced to CRP: 55.8 (29/04/2020) and later to 49.5 (01/05/2020). Baseline LFT was normal. The patient improved symptomatically with treatment and now the patient is being discharged in afebrile and haemodynamically stable condition. Discharge weight= 47 kg.
Three months later, her ATD is being continued. Her chest x-ray has cleared & she has also gained weight and has no fever. All pneumonias, even during the COVID 19 pandemic might not be due to the coronavirus but tuberculosis remains an important cause in our country. Keeping our minds open and searching for appropriate answers through right diagnosis will help prevent collateral damage.