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Autoimmune disease, taking Rituxan, upper resperatory infection - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3388 Questions
User :   Yes. I have autoimmune disease and am taking Rituxan for it. I have little or no immunoglobulen. I came down with an upper resperatory infection on Sunday, and now have a temp. of 101.4. I have a bad cough, which is getting worse, my temp is rising, and my chest hurts. I am taking Doxycycline 100mg 2 times a day. Should I be concerned, or just wait this out?
Doctor :   Hi
User :   HI
Doctor :   May I know your age and gender?
User :   female, 56
Doctor :   Are you bringing out sputum when you cough?
User :   yes
Doctor :   May I know the colour, consistency and quantity of the sputum?
Doctor :   Is the sputum foul smelling?
User :   yellow, thick, about a quarter to a half teaspoon at a time. Not every time I cough
User :   yes, bad tasting, too
Doctor :   Can you describe the chest pain?
Doctor :   Where exactly is the pain located?
Doctor :   Does the pain increase while you breathe/cough?
User :   heaviness and soreness- much worse when I cough
User :   It is in the lower part of my chest
Doctor :   Do you have history of diabetes/bronchial asthma/
User :   sometimes I can't catch my breath when I cough
User :   yes, both
User :   my A1c is 5.7
Doctor :   Ok
Doctor :   Let me explain to you.
User :   ok
Doctor :   High grade fever, with yellow and foul smelling sputum producing cough is a sign of lower respiratory tract infection.
User :   ok
Doctor :   It is most likely bacterial infection.
User :   I am on antibiotics
User :   The doxycycline
Doctor :   Since you have history of diabetes ( though sugars are well under control) infections can flare up, if the choice of antibiotics is not appropriate.
User :   I also have no immunoglobulin, and am supposed to have had a drip, but there was an insurance mix-up, so I didn't get it.
User :   Is that contributing?
Doctor :   Immunoglobin's contribute to body resistance and in presence of low immunoglobin or immunoglobin deficiency status, infections occur easily.
Doctor :   Since I do not have much details on your immunoglobin profile, i cannot comment more on this condition.
User :   does it make it harder to get over infections once I have them?
User :   My hematologist says I have little or no immunoglobulin
Doctor :   Yes, however with good antibiotics, infection control may not be that hard.
User :   Should I call my doctor after hours and ask for a different prescription?
Doctor :   Since you have other comorbidities - both diabetes and low immunoglobulins, it is necessary that appropriate antibiotics are used early.
Doctor :   The right way to determine the choice of antibiotics in the present scenario is by doing swab and culture test on the sputum.
User :   Or should I go to the ER? I also have myasthenia gravis, addison's...
User :   OK
Doctor :   Hence you suggest you to discuss these with your physician.
User :   Tonight?
User :   Emergency room, or call the after hours number?
Doctor :   You will need evaluation consisting of blood tests, blood sugars, sputum test - both swab and culture.
User :   that sounds like the emergency room at hospital
Doctor :   If you persist to have high grade fever, you can consider visiting the ER.
User :   It is still high.
User :   How long should I give it to come down?
Doctor :   Since how many days are you on doxycycline?
User :   Yesterday evening.
Doctor :   Antibiotic medication usually may take a few days about 2-4 days to bring the infection under control.
User :   So I should just wait, and not be concerned unless this continues past two or three days.
Doctor :   In the mean time, I also suggest you to use expectorant syrups, get the tests done along and be regular with the antibiotics.
User :   OK
Doctor :   It is also necessary that be very strict with regards to your anti diabetes treatment.
User :   I use insulin and am very careful with the number of grams of carbohydrates I eat.
User :   I check my sugar 3 times a day
Doctor :   If the fever doesn't subside in another 2 days time or you develop any new symptoms such as breathing disturbances, reduced urine formation, yellowish discoloration of the eye, ]
Doctor :   you need to report back to your doctor.
User :   OK.
Doctor :   Do you have any other query?
User :   so I should go to the ER to get the tests done tonight, and continue with the antibiotics for a few days.
User :   right?
Doctor :   Yes, if there are no after hour clinics then you can visit the ER.
User :   No after hours clinics here.
Doctor :   Ok
Doctor :   Then you can consider visiting the ER.
User :   Thank you. I think I have a better idea of what to expect.
Doctor :   Do you have any other query?
User :   no. not tonight.
Doctor :   Thanks for consulting me.
Doctor :   Bye for now.
User :   bye
Doctor :   Wish you speedy recovery.
User :   thank you
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