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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Pneumonia Be Treated?

I have a radiographically slow resolving pneumonia. Clinically improved on week #4. PCP did CXR did not pick it up. Given Prednisone, Dulera, and Levaquin. CTC in ER next day showed RLL ( at very base) T of 102, dehydration, and severe HA forehead and behind eyes, O2 sat 96. Prosit added, appropriate abc tx per EC MD. CBC & CMP normal except for ALT, probably due to RLL inflammation. Fever ( 101 X 6 days). PCP added Doxy. Fever resolved. No cough, it developed on day 2 of Doxy. Thick viscous sticky like glue white to yellow sputum, crackles and wheezing auscultated but never an elevated WBC count. Mucinex DM ER q 12 added. Repeat CXR 10 days later = RLL and left mid infiltrates. Yesterday CXR slow resolving still apparent in same areas. Crackes LML heared, O2 sat stills at 96. First AM Sputum culture today. Feel ~ 85% better, but perplexed. May need Pulm referral. Nonsmoking, non drinking, 54 y/o F. RN in Onc Uro OP clinic. Your thoughts? Appreciate it. CC
Wed, 8 Aug 2018
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General Surgeon,  's  Response
Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

Slowly resolving pneumonia detected on CT scan chest and not picked by X-ray, fever settling with Doxy but still have thick sputum as explained by indicate one of the following:
Bacterial pneumonia as discussed and being treated.
Added fungal infection needs to be rules out.
As well as tuberculosis is known to occur in medical personnel as you are a RN. Hence I would advise you the following:
Sputum also to be sent for AFB staining for tuberculosis and also to be stained for fungus.
Blood tests like Gold TB test helps.
Repeat CT scan with contrast may show any additional problems to be treated.
In some cases bronchoscopy and lavage for tests would help to have a proper diagnosis and have a proper plan of management.

Hope I have answered your query. Let me know if I can assist you further.

Regards,

Dr. T Chandrakant
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How Can Pneumonia Be Treated?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Slowly resolving pneumonia detected on CT scan chest and not picked by X-ray, fever settling with Doxy but still have thick sputum as explained by indicate one of the following: Bacterial pneumonia as discussed and being treated. Added fungal infection needs to be rules out. As well as tuberculosis is known to occur in medical personnel as you are a RN. Hence I would advise you the following: Sputum also to be sent for AFB staining for tuberculosis and also to be stained for fungus. Blood tests like Gold TB test helps. Repeat CT scan with contrast may show any additional problems to be treated. In some cases bronchoscopy and lavage for tests would help to have a proper diagnosis and have a proper plan of management. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T Chandrakant