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Suggest Treatment For Chest Congestion In A Person With Dengue Fever

Posted on Mon, 5 Jan 2015

Question: My husband was diagnosed with dengue and lower respiratory tract infection three days back. (He started a bad throat, chest congestion, cough, and fever last Tuesday and he was tested for dengue this Monday.) His platelet count has since increased and is now at 2.4 lakhs and he has no fever. However, he still seems to be having a chest congestion, cough, and wheeze. He is on Augmentin 625 mg twice a day and Ambrolite syrup, Wysolone steroid 20 mg twice a day for 3 days and once a day for 3 days after. Is this the correct treatment?

Answered by Dr. Drkaushal85 (36 minutes later)

Brief Answer:
Yes, it is the correct treatment and get Chest X ray done.

Detailed Answer:
Hello dear,

Thanks for your question on HCM.

Dengue infection causes capillary leakage in the body. Because of this, fluid accumulated in the lungs and cause pulmonary congestion. This will cause secondary bacterial infection and produce cough and wheezing.

Since his fever is gone and platelets are increasing, I think treatment is working. So continue with the same treatment. Get repeat chest x ray after 7 days. If it is improving then no treatment is required.

But if x ray is worsening then sputum culture needs to be done to identify the organism and start specific antibiotic.

But at present continue with the same treatment.

Hope I have solved your query. I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Drkaushal85 (1 hour later)

They haven't yet asked for a chest xray. He has another 2 days of antibiotics left. So having lung congestion is a side effect of dengue and nothing serious or anything to worry I hope doctor? I hope this will not cause any long term damage? He keeps spitting sputum occasionally. Earlier the sputum used to be a little discolored on and off but now for most part it is clear. Hope this is okay? He has no fever and his platelets count is increasing.

Answered by Dr. Drkaushal85 (15 minutes later)

Brief Answer:
nothing is serious.

Detailed Answer:
Hello dear, thanks for your follow up question.

Lung congestion can be seen in dengue patients. With time, congestion will start decreasing and no long term effect are seen. So no need to worry for any chronic changes.
And it is a good sign that sputum is colour less. This suggest that infection in the lung is decreasing.
So no need to worry at all. Just complete the course of treatment.
After finishing if he develops fever, cough with yellow expectoration, chest pain than get done repeat chest x ray.

Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
Wishing good health to your husband.
Thanks.

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

Follow up: Dr. Drkaushal85 (1 hour later)

Thank you so much doctor! I really appreciate you patiently answering my questions. I have one more question. Is pulmonary congestion a side effect of dengue for ALL patients? I ask because a colleague of mine didn't have the same problem when she had dengue. So I am wondering if we could have prevented this in some way. Also, should Augmentin be taken for more than 5 days or should his condition be reviewed once more by the doctor?

Thank you.

Answered by Dr. Drkaushal85 (21 minutes later)

Brief Answer:
all patients will not develop pulmonary congestion

Detailed Answer:
Hello dear, thanks for your follow up question.
Dengue behaves differently in patients. Not all patients will develop same complications. So pulmonary congestion will not occur in all dengue patients.
So complete the 5 days treatment of augmentin. And if he feels fever, cough and chest pain than consult doctor and get done chest x ray.
Otherwise no need to review.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
Wishing good health to your husband.
Thanks.

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

Follow up: Dr. Drkaushal85 (18 hours later)

Hello doctor,

Today we did a chest xray since my husband's wheeze and cough were not subsiding. They say it is initial phase of pneumonia. His sputum is still discolored on and off. They are doing a culture too. Right now they have increased Augmentin from 625 mg to 1 gm 3 times a day and giving mucolyte syrup- 2tsps 3 times a day. He has no fever. Anything to worry about doctor?

Thank you,

XXXXXXX

Answered by Dr. Drkaushal85 (11 minutes later)

Brief Answer:
Continue with same treatment.

Detailed Answer:
Hello dear,

Thanks for your follow up question on HCM.

I want to know few things.
1. Weight of your husband.
2. Pulmonary Function Test (PFT) done or not.

Ideal dose of augmentin is 625mg thrice daily. But even 1 gm can also be prescribed. So no harm in giving it.
And yes sputum culture is necessary now to identify the organism and guiding the antibiotic therapy.

In my opinion you should also give him asthalin nebuliser thrice daily. It will helpful in wheezing and cough.

Let me know above things for better assistance.
I will be happy to help you further.

Wishing good health to your husband.

Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Drkaushal85 (14 minutes later)

Thanks doctor. PFT hasn't been done. His weight is about 80 kgs. We will be giving him nebulizer doctor.

Answered by Dr. Drkaushal85 (7 minutes later)

Brief Answer:
Continue same treatment.

Detailed Answer:
Hello dear, thanks for your follow up question.

For 80kgs, dose of augmentin is 625mg thrice daily. So continue with same dose. And yes, asthalin will help him.
Ask him to drink plenty of fluids and keep himself hydrated.
And do let me know sputum culture report and his progression.

I will be happy to help you further.
Wishing good health to your husband
Thanks.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Drkaushal85 (4 minutes later)

Doctor, they have said augmentin 1 g thrice daily. Is that okay doctor? Thank you!

Answered by Dr. Drkaushal85 (7 minutes later)

Brief Answer:
No it will be high dose.

Detailed Answer:
Hello dear, thanks for your follow up question.
Augmentin 625 thrice daily will be good.
Or augmentin duo 1000 mg twice daily is good.
But augmentin 1000 thrice daily will be higher dose for him. Better discuss about this with your doctor.
I will be happy to help you further.
Wishing good health to your husband
Thanks.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Drkaushal85 (26 hours later)

Hello doctor,

So far he has taken two doses of 1000 mg (morning and afternoon) plus a 1000 mig dosage last night. He is feeling extremely weak and tired after the increased dosage. The doctor here said 1000 mg thrice a day is fine for him, but I dont think he can take such a high dosage. What would you recommend doctor?

Thanks,

XXXXXXX

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
1000 mg twice daily is sufficient for him.

Detailed Answer:
Hello dear, thanks for your follow up question.
In my opinion 1000 mg twice daily is sufficient for him. No need to give 1000 mg three times. This is high dose for him. Please discuss about my views with the treating doctor

And I want to ask a question.
1. is he having diarrhea after augmentin?
I will be happy to help you further.
Wishing good health to your husband.
Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Drkaushal85 (2 hours later)

I talked to the doctor, and she has changed the dosage like you suggested to 1000 mg twice a day. We are still waiting for the sputum culture report. He has no diarrhea but feels very gassy and distended in the stomach. He was also asked to take 2 tsps of S- mucolite, so the codeine in that probably and heavy medication has made him very weak and tired today. Also his appetite is not what it was till yesterday. His wheeze and cough is less although he still does cough on and off and experiences catch like pain in the back while doing so. On the whole, he is not feeling too great today. How long does pneumonia take to clear up doctor?

Answered by Dr. Drkaushal85 (4 hours later)

Brief Answer:
it will take 10-12 days for symptomatic improvemen

Detailed Answer:
Hello dear, thanks for your follow up question.
Pneumonia will take 10-12 days for symptomatic improvement. And radiological improvement can be expected after 2 weeks.
So for pneumonia minimum 10 days of treatment is necessary.
Do let me know his progression.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
Wishing good health to your husband.
Thanks.
If

Above answer was peer-reviewed by : Dr. Prasad