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Asking for Mother, Female, 63 years old, Faisalabad
Patient has been suffering from bronchitis for last 6 weeks. Pt has been suffering with bronchitis acute attacks for past 3 years (one attack/one year). Initial symptoms were excessive discharge of white coloured phlegm, cough, sore throat, wheezing, and chest pain. Initial medicines were Deltacortil (5mg), Muconyl syrup, Bamifix (600mg). With no improvements, she was then given hyzonate corticosteroid 100 mg injections twice a day. After second day, her condition became so worsened due to vomiting and nausea, high BP, and diabetes (undiagnosed). From that time (5th week), she is not being recommended to take any expectorants and corticosteroids . She is taking avilox (400 mg for past 5 days), glucophage tab (750mg), cap esso 40, Nilstat drops, Cefspan (400mg for coming 5 days). She is still discharging saliva mixed with white coloured phlegm in less amount without any cough or chest pain. She never suffered with fever but from the last two days, she has fever between 100 to 101.8 Deg
Thanks for sharing the patient detail. Based on the history and appeared symptoms some lab findings are required like ASOT MT CBC BUN and histopathological tests . Also she need to visit Endocrinologist for Thyroid treatment because most of the findings are related to hormonal changes. Age factor is also very important so in my opinion rehabilitation and symptomatic treatment is required with regular follow up.
With all the history u mentioned, ots treatment is going on... For fever u must go for a cbc as because of the mosquito season she may have it because she is on medicines and immunity is very low so more prone to infection... Go for cbc, document fever, and must consult endocrinologist for thyroid as she is having goiter also.. Have u ever checked thyroid levels?
Patient
Post Owner
@Dr. Sania.. Mam, she has asymptomatic goiter since ages. She was very afraid to operate it, however we never checked for thyroid levels. Her CBC test was being done couple of days ago when she was admitted in the hospital but at that time she had no fever. Her WBC were bit more otherwise all other blood cell fractions were normal.
4 years ago
This patient needs some treatment for exacerbations( attacks) and later on regular treatment and follow up with pulmonologist. During this fever sputum may be tested for microbes. May need chest physiotherapy . Better visit pulmonologist at your city..
Patient
Post Owner
Many thanks for all of the feedback.
@Dr. Yasin. Sir, she is being recommended by an endocrinologist to take Cefspan (400mg) and three times nebulization per day for next five days. Please note that she was admitted in the hospital under the surveillance of the same endocrinologist. As you recommended to consult with a pulmonologist, we would also follow your advise.
Please let me know what do you think about her CT scan? This CT scan was being done when she had excessive episodes of vomiting and sputum (phlegm) discharge. Is it normal that she has very slow recovery especially what about Atelectatic bands presence on CT scan? As she has low fever as well, could be it possible because of her bronchitis or pneumonia infection. Please note that she has no breathing difficulties or any lung wheezing sounds at moment. She might has fungal infection on tongue and throat as doctor recommended her to take the drops of Nilstat. She gets fever of 101 degree and especially sputum mixed with Phlegm is the biggest problem for her.
4 years ago
MBBS, FCPS, MCPS | Abbottabad | Book Appointment
207 Positive Reviews
Yes, i also wished Endocrinologist should examine her for thyroid problem. Happy to know that you have already got endocrinologist's consult. Lung problem is somewhat being addressed as you mentioned but further checkup to be done by pulmonologist for better management . CT findings will also be addressed . There seems nothing to be worried much. Welcome for your queries in this regard.
4 years ago
One possible cause of Atelectatic CT findings may be impacted sputum and that needs to be cleared as i suggested but check up by pulmonologist is better to get detailed advice .
Patient
Post Owner
Sir, we have go through multiple tests. AFB test is negative, however, in Sputum diagnostic test, pus cells, gram positive cocci are WBCs have been found.
In blood culture sensitivity test, both blood cultures bottles are positive, Cloxacillin resistant staphylococci are found which are resistant to all currently available beta-lactam antibiotics. "No growth after five days" is also mentioned on the report. She is taking Mofest 400 mg tab at moment. She has also infection in the urine indicated by the presence of greater than 100,000 CFU gram positive bacteria. Her sputum culture sensitivity test report is still pending. Please let us know what do you recommend. Many thanks again.
4 years ago
salam.consult ur nearest pulmonologist.n please do discuss about vaccination for patient since she is having this problem yearly.thanx
Do sputum c/s for fungal infection. As she is already taking antibiotics so sputum c/s is use less. Keep this in mind that in elderly patient symptoms of pneumonia are masked. It is better if you admit her in some good hospital as she needs constant monitoring
She may has some infection in the past which on resolving causes fibrosis of some parts of lungs showing as atelectetic bands. Such bands cause chronic breathlessness but usually not represent acute infection
Patient
Post Owner
Many thanks for your feedback. She has only phlegm discharging issue at moment however sometimes she has fast heartbeat, low body temperature, and low blood pressure, but such symptoms happen only for few hours, her blood and urine reports also indicated the presence of Cloxacillin resistant staphylococci which are resistant to all currently available beta-lactam antibiotics. Since she has not any breathing difficulty at moment (in the start of infection, she had sever chest pain and breathing problem), please let me know is there still chance of fibrosis going on? She is taking Mofest tab (400 mg) at moment..
4 years ago
MBBS, FCPS, MCPS | Abbottabad | Book Appointment
207 Positive Reviews
She should be cheked by local pulmonologist or internist to decide about further management. Antibiotics to be considerd according to current status. Dr may also ask about urological consult.
4 years ago
Patient
Post Owner
Many thanks for your recommendations. Please let me know what do you think about her CT scan especially in relation to lungs? We are more confused about Atelectatic bands. As she has been suffering with bronchitis, is it normal to get these on CT scan? or it might indicate lung injury.
4 years ago