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Is Fatigue And Yellow Phlegm A Symptom Of Pneumonia?

Posted on Fri, 25 Apr 2014

Question: I was diagnosed with pneumonia and small pleural effusion about a month ago. I was put on an IV and oral antibiotics, received several chest x-rays and a ct scan as well as blood tests and several (negative sputum tests for tb) About 2 weeks ago my chest x-ray appeared normal - pneumonia and pleural effusion were gone. However, I still have fatigue and some milder symptoms much reduced. I have a little phlegm- mostly white or clear, but I believe I detected a little yellow. I went back to my doctor and had another chest x-ray. Totally clear. My doctor put it down to a mild cold, sinusitis, or bronchitis following the pneumonia. Or, I've read that sputum can continue after the infection clears for awhile. However, as I live in South Korea at the moment, where there is a slightly higher incidence of TB- my doctor continues to do sputum cultures on me. Even though they have been clear multiple times as well as the clear chest x-ray and the responsiveness of my pneumonia to antibiotics. Is this likely just residue of pneumonia or a lesser infection? It seems unlikely to me to have pulmonary tb and clear x-ray and multiple clear sputum cultures.

Answered by Dr. Arnab Maji (24 minutes later)

Brief Answer: common cold, sinusitis, pneumonia been resolved Detailed Answer: Hello Thanks for your query. As there is total radiological clearance even on the repeat last chest X-ray and initial symptomatic improvement following antibiotics I do think your pneumonia had been resolved. This mild sputum and expectoration right now probably may be due to mild cold and sinusitis and smoker's cough if you are a smoker and I think your treating doctor is quite right in explaining this to you. I will suggest you to go for sputum for AFB (acid-fast bacilli) even in the absence of other systemic signs of tuberculosis and a high resolution computed tomography (HRCT) scan of thorax because it can reveal something even in the presence of apparently looking normal chest X-ray. I think these two investigations will remove your anxiety and also fulfill our purpose to exclude some underlying abnormality, though the chance of which is very minimal in this case. Thank you Regards Dr Arnab Maji MBBS, MD Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Arnab Maji (10 minutes later)

First of all, Thank you Doctor. You have given one of the clearest and most concise answers I have received. Just to be clear- I have received a CT Scan (with contrast, I think) during my initial bout with pneumonia. (I imagine this was to check for TB evidence, lung cancer, or any other abnormality?) My internal medicine doctor and radiologist found it to be clear. In addition, the sputum tests were done and all came out negative. I am just a bit nervous because in my home country (USA) the skin test is usually the first thing that is done. But here in Korea they seem to be more interested in the sputum tests- even though I have taken them many times. In your opinion- are multiple sputum tests really necessary? How about multiple CT scans? I thought one was good enough (4 weeks ago) and am worried about too much radiation exposure. I am a non-smoker. But I am sometimes exposed to "Yellow Dust" from China as I live in Korea. This past March was "Yellow Dust" Season here.

Answered by Dr. Arnab Maji (11 minutes later)

Brief Answer: Sputum is necessary as well as a follow up CT Detailed Answer: Hello Thanks for writing back. Even if your initial CT scan was normal I will suggest you to go for another though the possibility of having a normal scan again is high. But the purpose is different. Initial scans were to diagnose your case and recent scan will be a follow up scan. To be XXXXXXX skin test for TB in Asian countries have no value because it only shows infection in these highly endemic countries but if your sputum is positive for TB then it will show TB disease for which you need to be treated. Infection is very common in Asia for which no anti-TB drug is necessary until or unless you have the evidence of TB disease. Yellow dust may cause cough but that cough will be more of a dry nature and you will better to avoid that. If you are satisfied with my answer then kindly write a review for me. If you have further queries you should not hesitate to ask me. Thank you Regards Dr Arnab Maji MBBS, MD Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Arnab Maji (4 hours later)

I will be happy to write a review for you. What about the fatigue? I am still facing it at times. I feel like every night of sleep is important- and even with the clearing of most of my symptoms I feel exhausted sometimes- though not every day. And when I first came to the hospital, the doctor looked at my x-ray and said: well, it's either pneumonia or tb" and he ordered the ct scan and sputum tests- which were negative. So if he does not order a follow up ct scan should I push him on it?

Answered by Dr. Arnab Maji (1 hour later)

Brief Answer: Still I stick to CT Detailed Answer: Hello Thanks for your query. Every approach of treatment should be individualized. If you would not have any symptoms now or chest x-ray would be clearly contributory to something, I would not ask you to go for HRCT scan of thorax which is the case with most of the people. As you have symptoms persisting it is rather better to go for it in order to exclude or include some other diagnosis. It's my approach in this case which is completely individualized and opinion may vary doctor to doctor again. With due respects to all the doctors you have to choose one step at your will. I think now it is clear to you which I mean to say here. Fatigue may be because of various reasons. Most probably a post major illness fatigue which may persist for 2 weeks or so or again it could be due to other reasons like excessive work load, inadequate sleep at night, mild hyponatremia especially during summer periods. TB or pneumonia is not just a CT diagnosis and it needs sputum report as well and even in the face of sputum negativity with symptoms and positive radiological findings the diagnosis of TB may be established and you should know that one of the causes of non-resolving or delayed resolving pneumonia is TB. That's why I am giving so much stress on having a CT scan thorax here which is totally your choice. Thank you, Regards Dr Arnab Maji MBBS, MD Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar