Cerebral Abscess in a 16 year old boy

lung disease will have met patients who fail to improve until the purulence of the sputum improves, either with time or with a change in antibiotic. In order to quantify changes in sputum purulence, this writer has for many years used an arbitrary grading system, historically called the TG system. It has a range from TG0 (white sputum) to TG4 (dark green sputum). With practice it is fairly easy to grade any sputum purely on inspection and to record changes from day to day. A failure of the sputum to improve after three days of a particular antibiotic should lead to consideration of a change in treatment. Equally, improvement in the sputum grade should encourage continuation with the current antibiotic even if sensitivities suggest otherwise. unlike the commercial scale, the TG system is completely unvalidated and as it lacks a standard reference chart there are bound to be some differences between observers. However it has the advantage of simplicity and it avoids the problems of unquantified references to " sputum purulent " found in many inpatient notes. Figure 1 shows an approximation of the grades TG1 to TG4 developed by scanning a sputum assessed as TG4 and sampling the image in Adobe Photoshop CS. The resultant average colour in the CMyk system was C46, M24, y42, k1, and the colours for TG3 to TG1 were obtained from it by reducing the opacity to 75%, 50% and 25% respectively. TG0 would be white. The sputum to be inspected should be placed in a jar, either white or transparent, rather than on a tissue where it tends to lose colour. It should be standard practice for sputum jars to be supplied to patients and not renewed until the sample has been seen, preferably on a daily basis. Extraneous colour from sweets and food is usually not a cause for confusion. I am indebted to the artists for their interpretation of the TG system shown in Figure 2. relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. We present an unusual case of Cerebral Abscess in a 16 year old boy Clinical Presentation: A 16 year old boy was admitted with a one week history of an upper respiratory tract infection (urTI). On the day of admission he complained of severe frontal headache, 10/10 in severity, and had vomited three times. He complained of neck stiffness and photophobia. …