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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 35416
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Wife having recurring symptoms of pneumonia with pleural

Customer Question

Wife having recurring symptoms of pneumonia with pleural effusions. Has been hospitalized 2x. = drained 1.1 liter of fluid and released. back 4 days later resulting in chest tube and 1.6 liters drained. discharged after 8 days. home 1 week and showing all the same signs that placed her in the hospital both times. She is petrified of having to go through the chest tupe and needle procedures again however, her fever still spiking in the evenings to 101-102....

During testing the only findings were mycoplasma in the clear fluid drained from around left lung.

Meds so far: Avelox tanked her BP and was stopped immediately.  Tygacil 100mg IV BID for 10 days.  Biaxin oral meds for past 7 days (since release from hospital)

Submitted: 5 years ago.
Category: Medical
Expert:  Dr. German replied 5 years ago.
Hi, welcome to justanswer , I am really sorry to hear about your wife situation .
I understand her situation and that she feels worried and concerned . However , at this time , the best thing and the most proper thing to do is for her to contact a doctor immediately.
Staying in the house will not solve anything at this point and will be extremely risky and dangerous .
However , it is not normal that she experiences pneumonia once and once again .
When this happens ,specially with an atypical microorganism like Mycoplasma ,is because the patient has a weakened immune system that is not working properly .
Immune deficiency disorders could be caused by :
1- A decreased white blood cell count ( including neutrophils, basophils, macrophages ,lymphocytes B or T )
2-Complement or Antibody Deficiency
3- Nutritional Deficiencies
4-Inadequate Protein consumption
6-If she has a medical condition that has been treated with corticosteroids or chemotherapy . which are treatments that affect the immune system ability to combat infections.
7-Viral infections like HIV virus
It is important that you take her to the emergency so she can receive antibiotics immediately .
At the same time, You have to talk with her doctors so She can be further investigated ,even refer to an Immunologist Specialist if it is necessary .
It is important to determine if she has an Immune Deficiency and that she receives the proper treatment to manage that underlying condition ,to stop this cycle of recurrent infections .
If you have any doubts or additional questions , just ask me , I am here to help you.
Please click accept if you like the answer, so I can get credit for my work. A bonus will always be sincerely appreciated.
Customer: replied 5 years ago.

WBC was highly elevated and did not decrease until the fluid was removed.

Definately not diabetic

not anemic, or any known nutritional deficiencies. (has a current lack of appetite because of fever and full belly makes it harder to breathe)

She had a cortisone injection in her knee 3 months after having surgery.

Expert:  Dr. German replied 5 years ago.
In this case , the main thing that should be investigated is if she has a complement or antibody deficiency .
One cortisone injection will not affect her immune system, so that is ruled out.
The other possibility that should be investigated is if she is suffering from a combined infection and besides Mycoplasma pneumoniae , there is other microorganism involved . In that case, it would be necessary to perform an antibiotic susceptibility test to determine what specific antibiotics will need to be used.
The third thing that needs to be evaluated is if she has some type of lung interstitial lung disease which could be associated to the exposure to some substances like asbestos or an autoimmune disease ( in these conditions,the immune cells that normally defend the body against infections mistakenly attack the own body 's cells like the lung tissue cells ) which could make her more prone to get recurrent pneumonia .
Please click accept if you like the answer, so I can get credit for my work. A bonus will always be sincerely appreciated.
Customer: replied 5 years ago.
HOw about this for a stretch.. Back in August we had our roof replaced and some of the sheetrock and insulation in our "florida room" (flat roofed add-on room attached to the back of the house) fell. some of it was mold stained from repeated exposure to moisture. It has since been removed. but was there for a few weeks till we could afford to fix it.
Expert:  Dr. German replied 5 years ago.
With that additional information,I will tell you mold exposure can produce . But this usually happens in patients with a weakened immune system.
Other thing that mold can produce is a condition called Hypersensitive Pneumonitis which symptoms are very similar to pneumonia symptoms . In this case , the symptoms are mainly caused by the severe lung inflammation process .
To treat this condition, the patient will need a combination of antibiotics plus Corticosteroids .
So take her to the doctor to see if what she is experiencing is hypersensitive pneumonitis for the mold exposure or this a recurrent or combined microorganism pneumonia .
Besides the other possibilities that I mentioned before .
Please click accept if you like the answer, so I can get credit for my work. A bonus will always be sincerely appreciated.
Customer: replied 5 years ago.
Relist: Incomplete answer.
Have moved out of our home, washed all items we brought with us and yet the unexplained fevers and chest pains continue. Answer did not resolve.
Expert:  Dr. Arun Phophalia replied 5 years ago.

What did her biochemistry of the pleural fluid and culture test show?
Has she any significant past medical history?

Dr. Arun
Customer: replied 5 years ago.
Fluid showed no cancer cells or any infections. Did have mycoplasma.
Cultures grew nothing.
Prior med history: multiple kidney stones,
gall bladder removed 1989,
pituitary adenoma that maxed out at 7mm treated with oral meds (dostinex) till it went away completely.
Papilary thyroid cancer- full excision and iodine oblation. 2008
Arthroscopic knee surgery (replacement in future)
Htn, Cholesterol, menopause, 5'2" 200lbs
Expert:  Dr. Arun Phophalia replied 5 years ago.

A chronic pneumonia symptoms with pleural effusion warrant that a mycobacterial culture should be done. An ordinary culture cannot detect the mycobacterium and specialized cultures are needed for the diagnosis. Apart from it, a PPD test and also a blood test, IgG, IgM for tuberculosis are advised for the diagnosis. Mycobacterial infections need special antibiotics for a long duration for the treatment. These are likely to clinch the diagnosis. Atypical infection like mycobacterium is the most likely possibility in this situation and should be the next step of the work up.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Dr. Arun
Customer: replied 5 years ago.
TB (PPD) test done may 2011 was negative. Had 14 days of IV Tygacil followed by 8 days of oral Biaxin.
Chest xray's pa-lateral and left decubitus showed no fluid, breathing better now, concern is repeated spiked fevers of 101-102 with no known cause.
Expert:  Dr. Arun Phophalia replied 5 years ago.

A persistent and chronic fever of unknown origin warrant to look into following direction;

1) An atypical infection; mycobacterial infections in this situation are not uncommon and accompany mycoplasma infections because of the lowered body immunity. A pleural fluid have been the best culture medium for it, but since that is absent now; a blood culture need to be done (for pyogenic, mycobacterium, viral and fungal culture) as the nest step of the work up. The mycobacterial infections marginally respond to the strong antibiotics, but these cannot completely eradicate it. This is the reason, fluid has disappeared but clinical disease is persisting.

2) An occult (hidden) malignancy which only present with the paraneoplastic syndrome (means manifestations are not related to the primary malignancy); a peripheral blood film, bone marrow biopsy and a positron emission tomography are advised.

It is privilege assisting you.

Dr. Arun