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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Severe Cough, Mucous Secretion. Suspecting Tuberculosis Or Hypersensitivity Pneuminitis. Not Able To Diagnose. Suggestions?

hello, iam subha from india i was suffering from severe cough & secretion of mucus . cough used to be cyclic in period of 1 to 2 months. for the same i firstly refered to ent , but i could not get relief after 1 1/2 month treatment. further i forced the doctor for medical test if any, so he suggested xray & hemogram. according to x ray there was diffused in filtrate in in both mid & lower zones, prminent right hylum with lobulated shadow in right paratracheal?adenopathy. so i showed to m.d (med) according to report doctor prescribed me linezolid , DOXOLLIN, hetrazan tabs for 14 days 2 times, & told me to conduct further test for afb, gram, sr ace level, srLDH. all the test reports seems o.k except gram was negative showing capsulated bacelli (++). so further doctor prscribed me macpod , doxollin, & after a period of month adviced to take xray & hemogram. so accordingly i produced the report he examined me & through reports he was un happy for the recovery.so frther c.t scan, was adviced it stated confusing impression of report was diffusely scattred centrilobular nodule as described associated with significant mediastinal lymphadenopathy and fewof them showing evedience of necrosis . findings are likely to represent infective aetology such as tuberclosis so the report was confussing to doctor. futher he adviced me to take advice of sr chest surgeon he prscribed me montoux,pft, gram, afb. now the afb is negative , gram is positive with steptococci & diplococci. over all the disease is not diagnosed. sr chest surgeon feels it may be hypersesitivity pneumonities or interstital lung disease. but yet doctors not to the conclusion. right now i am feeling relifed day by day with no cough from 25 days and chest irritation getting iradicated day by day. so would you pl put light on the case & directition to me. thankyou
Sat, 30 Mar 2013
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Pulmonologist 's  Response
hi SUBHASH

Considering your CT scan showing centrilobular nodules with hilar and rt paratracheal lymphadenopathy tuberculosis is a strong possibility. hypersensitivity pneumonitis needs a exposure of organic/inorganic irritants like hay like farm products, bird droppings, etc.
In endemic countries like India tb must be ruled out with such a clinical situation.

you may have chronic infection as repeated culture positivity..probably antibiotics have worked and you are getting relief.
if symptom persists or recurs you must go for bronchoscopy by an experienced chest physician and get bronchial brushings done and lavage done. AFB positivity in this sample will surely mean tb.
since you are recovering this time....enjoy this

best wishes
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Severe Cough, Mucous Secretion. Suspecting Tuberculosis Or Hypersensitivity Pneuminitis. Not Able To Diagnose. Suggestions?

hi SUBHASH Considering your CT scan showing centrilobular nodules with hilar and rt paratracheal lymphadenopathy tuberculosis is a strong possibility. hypersensitivity pneumonitis needs a exposure of organic/inorganic irritants like hay like farm products, bird droppings, etc. In endemic countries like India tb must be ruled out with such a clinical situation. you may have chronic infection as repeated culture positivity..probably antibiotics have worked and you are getting relief. if symptom persists or recurs you must go for bronchoscopy by an experienced chest physician and get bronchial brushings done and lavage done. AFB positivity in this sample will surely mean tb. since you are recovering this time....enjoy this best wishes