Thread by @JaySavla15

We welcome all the awareness about #COVID19 and the change it has brought in the way masses give importance to healthcare. But what is silently eating poor people of India? It's much more morbid than COVID, it's #tuberculosis !
Sharing a recent case that broke me😕 1/n

34/M history of fever recurring as soon as antipyretics stopped, shortness of breath gradual onset, progressively increasing, now even at rest. H/o weight loss of over 10kgs in 2 months.
Diagnosed as typhoid first somewhere based on 1:80 titres (another nuisance) 2/

Has been constantly given antibiotics since the last 2 months by different private hospitals in rural India. Then diagnosed as pneumonia by somebody else.
When he came to us in the emergency, on examination was
In respiratory distress, febrile, pale, BP normal, pulse high 3/

RR - 22/min. Accessory muscles being used for breathing. Chest had b/l equal air entry, normal vesicular breath sounds on both sides. CVS was normal. Per Abdomen - that day i did feel it wasn't all okay, but still nothing gross. CNS - WNL.
Outside USG W/A - Normal
4/

CXR - wasn't of great quality, in supine position and AP. So seemed like ARDS.
We started him on Antibiotics, fluids, antipyretics and NRBM 10L O2/min.
Send ICU calls, as i knew, he could go downhill anytime. Initial Labs were more or less normal. 5/

No ICU beds available, as is most often the case. The next day early morning i was 24hr post duty, still I felt something was amiss, so i did go bedside, did a re exam.
On palpating the abdomen, i did feel something like 'Doughy Abdomen' - Seen in Abdominal Koch's! 6/

Only once i have felt it, long back at GS. By that time he was already on Bipap as wasn't maintaining saturation on NRBM. I was really tired to accompany the patient for radiological investigations, but i eventually did with no one else around to do it. 7/

USG WA at @SJHDELHI - showed Conglomerate Abdominal lymphadenopathy and Splenomegaly.
CXR PA (digital) - Showed Miliary Koch's.
ESR report sent overnight - 95
We finally had a diagnosis - Disseminated Koch's!
ATT started along with Steroids. 8/

But the patient was clinically worsening, going into Type 1 Resp Failure. Anaesthesia SR from ICU had come to attend the call, and intubated him under sedation. But sadly he never came back, never made it back out of sedation. I was so devastated. The fatigue only worsened it. 9/

He left behind a young wife & two girls who go to playschool. I don't know who will take care of them now. Why did it take so long for them to reach a place where he would be actually be diagnosed & treated, instead of just empirical antibiotics, so rampant in india. 10/

So many unanswered questions. So many heartbreaks. I couldn't even be happy to have made a clinical diagnosis, what is the use when I couldn't save him. We see so many patients succumbing to extra pulmonary and pulmonary Koch's every month. It is heartbreaking. 11/

Young people, young families being broken. Someone has to do something about it. Just changing RNTCP to NTEP won't achieve anything. The entire process of just registering a patient also is such a hastle even at our own hospital. If someone responsible is reading it, 12/

Please reach out to thousands of residents like me throughout India to get more inputs on how things can improve. TB has to be given much more importance than COVID. It's time we do something about it. 13/13
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