16 yrs female presented with 7 days h/o fever intermittent ( 98 - 104) , no rigors n chills, mild cough, headache. No sore throat, vomiting, pain abdomen, loose motions, burning micturition , lymphadenopathy, joint pains, backache, loss of appetite, neck stiffness, ear discharge. hb 8.5, tlc 2 days ago 3100 today 5300, platelets 74000 now 239000, dengue n malaria serology negative, To 1:160, CRP 48.26, urine 7-8 pus cells, u/s abd. - rt kidney not found , h/o ectopic kidney in mother.
Rx given cefime 200 bd * 7 days , ceftriaxone 1gm bd, amikacin 250mg bd, artemether + lumefantrine 80 bd, pcm , nimesulide, bovine colostrum caps 500 mg bd, iv fluid R.L, N D10 for past two days , NO RESPONSE . what next ? Look for rt kidney n urine c/s ?
