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Hi Dr, I Need Some Advice On Behalf Of My
Question: Hi Dr,
I need some advice on behalf of my mother who is 67 years old and lives in XXXXXXX
For 12 days my mother has been experiencing: pain in throat area, feels like something is stuck, vomiting mucous, weakness, body aches, white tongue, difficulty swallowing, vomiting feeling when talking and eating. Vomits about twice a day. Has seen ENT and Internal Medicine doctor in square hospital dhaka. ENT dismissed her after nothing found in throat using camera but internal medicine dr did some investigations. Results showed UTI (epithelial cells 20-25/HPF and Pus cells 30-35) and TSH (13.5) raised as well as Candida albicans growth from throat swab. Urine culture also done but was normal. She has had this issue every few months and normally clears up on its own, but this time it is very severe and not going away.
Current medication: Cefotil (Cefuroxime 500mg & Clavulanic acid 125mg), Gelora Gel for oral thrush (Miconazole BP 2%), Motigut for vomiting 10mg) Thyroxine (50 mcg currently but internal medicine doctor asked to increase dose to 1.5 tablets daily due to high TSH)
Urine culture was done and it was normal. I query whether this is a bad infection, not bacterial but a growth of Esophageal candidiasis and can be treated by anti fungal therapy - fluconazole? No improvements at all seen with many days of various antibiotics. Oral thrush Candida was found on initial appointments and also Candida in throat swab.
Would there be any harm in trying a course of flucnazole? She has had a history of fungal infections in the throat which normally clear up on its own. This time it seems much more serious. If it is ok, what dosage would you recommend and for what period? Should she carry on with her other medications including antibiotics?
Would be grateful for your advice doctor.
Many thanks
Zahid Ahsan
I need some advice on behalf of my mother who is 67 years old and lives in XXXXXXX
For 12 days my mother has been experiencing: pain in throat area, feels like something is stuck, vomiting mucous, weakness, body aches, white tongue, difficulty swallowing, vomiting feeling when talking and eating. Vomits about twice a day. Has seen ENT and Internal Medicine doctor in square hospital dhaka. ENT dismissed her after nothing found in throat using camera but internal medicine dr did some investigations. Results showed UTI (epithelial cells 20-25/HPF and Pus cells 30-35) and TSH (13.5) raised as well as Candida albicans growth from throat swab. Urine culture also done but was normal. She has had this issue every few months and normally clears up on its own, but this time it is very severe and not going away.
Current medication: Cefotil (Cefuroxime 500mg & Clavulanic acid 125mg), Gelora Gel for oral thrush (Miconazole BP 2%), Motigut for vomiting 10mg) Thyroxine (50 mcg currently but internal medicine doctor asked to increase dose to 1.5 tablets daily due to high TSH)
Urine culture was done and it was normal. I query whether this is a bad infection, not bacterial but a growth of Esophageal candidiasis and can be treated by anti fungal therapy - fluconazole? No improvements at all seen with many days of various antibiotics. Oral thrush Candida was found on initial appointments and also Candida in throat swab.
Would there be any harm in trying a course of flucnazole? She has had a history of fungal infections in the throat which normally clear up on its own. This time it seems much more serious. If it is ok, what dosage would you recommend and for what period? Should she carry on with her other medications including antibiotics?
Would be grateful for your advice doctor.
Many thanks
Zahid Ahsan
Brief Answer:
Hello
Detailed Answer:
Hi
Welcome to ask a doctor.
Thank you for your query. I understand your concern.
Have noted the reports you uploaded.
Well slightly odd presentation for candida. Can try a course of fluconazole 150 mg once a day for 10 days after consulting your doctor. Vomiting is unusual in esophageal candidiasis. Antibiotics may actually increase fungal infections if any. Also can add an antacid like pantoprazole 40 mg twice a day if she is not taking any.
Tell her to take soft diet and avoid sleeping 2 hrs after meals.
Also worthwhile getting an endoscopy done to look for the cause (very important). If endoscopy is not available can consider doing an barium swallow (x ray done after drinking a peculiar liquid).
Hope this answers her query.
Wish her a speedy recovery.
Happy to help.
Hello
Detailed Answer:
Hi
Welcome to ask a doctor.
Thank you for your query. I understand your concern.
Have noted the reports you uploaded.
Well slightly odd presentation for candida. Can try a course of fluconazole 150 mg once a day for 10 days after consulting your doctor. Vomiting is unusual in esophageal candidiasis. Antibiotics may actually increase fungal infections if any. Also can add an antacid like pantoprazole 40 mg twice a day if she is not taking any.
Tell her to take soft diet and avoid sleeping 2 hrs after meals.
Also worthwhile getting an endoscopy done to look for the cause (very important). If endoscopy is not available can consider doing an barium swallow (x ray done after drinking a peculiar liquid).
Hope this answers her query.
Wish her a speedy recovery.
Happy to help.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you dr. Her infectious disease specialist has said ok to flucanazole but to take only 50mg for 21 days. I want to ask, in your opinion is this dose too low to treat a severe fungal infection in throat and oesophagus? Secondly, if she tolerates the 50mg for a few days, is there any harm im upping the dose to 150mg?
He also said to not stop the antibiotics. Strangely she has a UTI as the urine report shows pus cells but urine culture was negative with zero growth. Is there any explanation for this? (sorry i know it is not your speciality) Could it be the candida causing this too? She vomited 5 times today and says it feels like something is stuck in her throat, which means she is struggling to eat and thus getting very weak. She also has lot of body pain. She just takes chicken soup for last 10 days.
Finally based on her symptoms please let me know if there are any other tests you would recommend to get done, either bloods or scans etc, apart from the endoscopy which i have noted.
Many thanks
Zahid
He also said to not stop the antibiotics. Strangely she has a UTI as the urine report shows pus cells but urine culture was negative with zero growth. Is there any explanation for this? (sorry i know it is not your speciality) Could it be the candida causing this too? She vomited 5 times today and says it feels like something is stuck in her throat, which means she is struggling to eat and thus getting very weak. She also has lot of body pain. She just takes chicken soup for last 10 days.
Finally based on her symptoms please let me know if there are any other tests you would recommend to get done, either bloods or scans etc, apart from the endoscopy which i have noted.
Many thanks
Zahid
Brief Answer:
Hello
Detailed Answer:
Thank you for your query.
I understand your concern.
Well dose of fluconazole can be increased to 150 mg / day provided there is no renal or liver problem and she is not taking any medication whose blood level may fluctuate after fluconazole therapy (for a duration of 7 days). Also there is hardly any evidence of fungal infection on scopy done (swab noted).
She needs an upper gi endoscopy at earliest after consulting your gastroenterologist.
Urine culture report may be negative in presence of an infection especially if she has received any antibiotic in recent past.
Worthwhile getting her electrolytes, liver function and creatinine (repeat) done too.
best wishes.
Hello
Detailed Answer:
Thank you for your query.
I understand your concern.
Well dose of fluconazole can be increased to 150 mg / day provided there is no renal or liver problem and she is not taking any medication whose blood level may fluctuate after fluconazole therapy (for a duration of 7 days). Also there is hardly any evidence of fungal infection on scopy done (swab noted).
She needs an upper gi endoscopy at earliest after consulting your gastroenterologist.
Urine culture report may be negative in presence of an infection especially if she has received any antibiotic in recent past.
Worthwhile getting her electrolytes, liver function and creatinine (repeat) done too.
best wishes.
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Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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