Please Review My Labs And Let Me Know Your Concerns

Posted on Thu, 21 Feb 2019

Question: Please review my labs and let me know your concerns about the abnormal values. I am in the hospital with pneumonia for second time in the past 30 days.

I had Legionnaires Disease pneumonia that started on 1/6/2019. I was treated with IV and oral azithromycin and it was cured by 1/20/2019. The same symptoms reoccurred on 1/30/2019 and I was diagnosed on 2/1/2019 with bronchitis. On 2/3/2019 I was diagnosed with pneumonia again and put back on IV azithromycin. Is it possible I was never really cured of Legionnaires Disease? Or if was cured, I got it again? Is there anything else that can be done to cure it for good this time?

Follow up: Dr. Drkaushal85 (1 minute later)

Please see the uploaded lab reports

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Bronchoscopy and XXXXXXX should be done.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the reports you have attached.
It would be of great help if you can send me picture of your chest x rays, from first admission and also from recent admission.
You should ask for bronchoscopy and XXXXXXX (bronchoalveolar lavage). XXXXXXX fluid culture and sensitivity report will guide about effective antibiotic treatment.
It is very difficult to say that it is cured or not cured or re infection without seeing chest x rays.
So please send me all your chest x rays so that I can guide you better.
Also let me know if you are a smoker.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Drkaushal85 (24 minutes later)

I have never smoked. I will attach my X-ray taken on 1/20/2019 when I was cured. I don’t yet have the one showing I have pneumonia again.

Follow up: Dr. Drkaushal85 (2 hours later)

The hospital refuses to let me see my X-ray while I’m an inpatient. They will mail it to me after I’m discharged from the hospital. So I can’t show it to you. They also will not let me see the report from my X-ray.

Answered by Dr. Drkaushal85 (10 minutes later)

Brief Answer:
Ok. I will wait for your x rays.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
OK. I will wait for your x ray picture.
What about bronchoscopy and BAL?
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (1 hour later)

I will ask the pulmonologist about a bronchoscopy with XXXXXXX

Answered by Dr. Drkaushal85 (2 minutes later)

Brief Answer:
Do let me know what your pulmonologist say about this.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
Do let me know what your pulmonologist say about this.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (7 hours later)

The pulmonologist showed me my chest ct scan. He pointed out patchy areas in my right upper lobe and lower lobe that is pneumonia. He said it was similar areas as before but worse in my lower lobe, which means it is the same infection with Legionella, not a different bacteria. He is going to give me 21 days of azithromycin this time. He might give me something else. If I’m not better by Wednesday he is going to do a bronchoscopy with lavage. He said I never did recover from the first bout because I didn’t take the antibiotics for long enough. Medicare said I was cured and kicked me out of the hospital prematurely.

Have you ever heard of a case like this? I fear I will never get better. I’m afraid I might die.

Answered by Dr. Drkaushal85 (41 minutes later)

Brief Answer:
No need to worry for death.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
First of all, no need to worry for death.
Yes, I have come across such cases daily.
Honestly speaking, in your case antibiotic should be changed.
You need higher antibiotic like amoxicillin and clavulinic acid combination or flauroquinolon group of antibiotic.
Do let me know your bronchoscopy and XXXXXXX report.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Drkaushal85 (56 minutes later)

The pulmonologist started me on Azactam IV, Mucinex, and percussive breathing treatments.

Follow up: Dr. Drkaushal85 (25 minutes later)

I am alergic to penicillin (anaphylactic shock) and levofloxacin (red itchy rash) so does that mean I cannot take any of the medicines you recommend? In there any other stronger antibiotic?

Answered by Dr. Drkaushal85 (5 hours later)

Brief Answer:
You can try doxycyclin or rifampicin along with azithromycin.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Since you are allergic to help penicillin and having reaction with levofloxacin, better not to take them.
You can take combination of doxycyclin or rifampicin along with azithromycin, combination therapy.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D