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Suggest treatment for pneumonia and pleural effusion - Online Doctor Chats

Date : 20-Apr-2014
User rating for this question
Very Good Posted in: Lung and Chest disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User:Hello Doctor. I am a 31 year old male non-smoker. About a month ago I was diagnosed with pneumonia and a pleural effusion. I was admitted to the hospital and put on an IV for a week and released with antibiotics. I felt significant improvement.

I have now received 2 clean chest X-rays in a row over the past 2 weeks. My doctor assures me that all signs of pneumonia are gone- as is the pleural effusion.



On the other hand, I am still feeling fatigue- particuarly if I miss any sleep at all. In addition, what I was more worried about was that I still seem to bring up sputum- sometimes white, sometimes with a yellowish look. It only comes up in the morning after I drink hot tea. The cough is mostly gone but I do have some labored breathing rarely. But I feel much improved.



I just visited my doctor today- he wanted to perform more TB tests (I have already got 5 negatives but I live in South Korea where the TB rate is slightly higher than other OECD countries). In any case, I doubt I have TB.



The doctor said the sputum may just be from a case of bronchitis or other upper respiatory infection- standard for the spring time here. He gave me a week of antibiotics just in case.



My question is- how likely is that? I feel generally okay other than fatigue. Is my sputum just leftover from my pneumonia or is it bronchitis? I was released from the hospital about 3 weeks ago and took antibiotics for about a month. What is your take on this? Is the current sputum unrelated or is it a remant (aftermath) of the original pneumnoa from 3 weeks ago?
Doctor:Hi,
Let me read your query for few minutes to be able to have a good discussion here.
Doctor:Coming from India where tubercular infections are also common, I am pleased to answer your questions. Let me answer your questions now.
Doctor:Tuberculosis is a notorious infection. It causes chronic symptoms along with weight reduction.
Doctor:Since you improved with standard antibiotic therapy and presuming you have no weight loss / appetite changes
Doctor:I am very convinced we are not dealing with tuberculosis infection here.
Doctor:Post infection symptoms does cause residual fatigue
Doctor:and the early morning cough may be from the left over infection.
Doctor:However if your health starts to decline again, I would repeat the tests to reconfirm my belief.
Doctor:Sputum test is not always diagnostic of tuberculosis.
User:I did have loss of appetite when I was suffering from pneumonia. But the appetite has returned and now I feel I eat too much. I have also had 5 blood tests and a clean chest x ray
Doctor:I would have to look into your chest X-rays, ESR values and skin montoux test also.
User:I also had a Cat Scan
Doctor:If all tests including ESR and montoux test was negative, the chances the symptoms are from tuberculosis are low.
Doctor:It is most likely the post infective bronchitis or left over infection.
Doctor:I would use expectorant syrups along with some vitamin supplements in such case and wait for you to improve.
Doctor:In extremely rare cases, though all tests are normal, we empirically start antitubercular treatment,
Doctor:if symptoms continue to last for more than 3 months.
Doctor:Did you follow what I said?
User:Yes, I understand.
Doctor:So do not be worried about tuberculosis now. It doesn't seem to be as you have already got over most symptoms with standard antibiotics.
Doctor:It is likely to improve with symptomatic measures - expectorants and vitamins.
User:Seeing as how I had confirmed pneumonia which responded to and cleared up with antiobiotics, I was personally reassured that TB was out of the question. I believe it is just standard procedure in Korea to follow through on multiple tests.
Doctor:Eat plenty of fruits and drink lots of fluids.
User:ok- yes. I will follow through on that.
Doctor:I guess due to endemic nature of tuberculosis, they did evaluate you extensively.
Doctor:But it seems like infective pneumonia.
Doctor:I wish you a faster recovery.
Doctor:Is there any other questions that you wish to ask me now?
User:One more question- since we have a little more time... What is the average course of a bacterial pneumonia?
Doctor:It depends on the type of organisms.
Doctor:It looks like you been infected with a virulent strain.
Doctor:When untreated pneumonia heals with consolidation and fibrosis.
Doctor:Rarely it spreads to cause complications including pleural effusion.
Doctor:With addition of antibiotics the process is halted, secretions get consolidated.
Doctor:Fibrosis is not significant.
Doctor:In simple words, if you were not treated with antibiotic this pneumonia would have healed with lots of scars on the lung.
User:Interesting, I see. that is scary to think about.
Doctor:Pleural effusion was one of the complications. Other complication was is sepsis and organ failure.
Doctor:Thanks to antibiotics, you may have clear lung now.
User:I appreciate modern medicine. Thank you for your advice doctor.
Doctor:You are welcome.
Doctor:Thanks for consulting me.
Doctor:Bye for now.
User:thanks. bye
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