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Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts?

DOCTOR OF THE MONTH - Aug 2012
Aug 2012
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Diabetologist
Practicing since : 1999
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my fiance is suffering from fever for last 2 weeks, in between she was tested positive for malaria and now recovered, tested negative for dengue, has been having headaches, leg cramps for last 2 days, nose bleeding last night which was on the higher side, tested positive for blood culture. hence need to check your thoughts
Posted Wed, 12 Dec 2012 in Infections
 
 
Answered by Dr. Madhuri Patil 5 hours later
Hi there.

Your fiancee tested positive for blood culture means she needs antibiotics in her treatment. Recently due to acute renal failure (road accident and the subsequent need of dialysis), and malaria her immunity has gone for toss and she needs appropriate antibiotic treatment against the blood infection. She must be taken to a very good physician for this without any delay.
Bleeding from the nose might be due to the infection spreading in the blood (sepsis) or due to dengue kind of hemorrhagic fever itself. Other possibility- Headache and nose bleeding happen when BP reading goes very high. In this case, her kidney functions must be checked again to make sure that it is not causing uncontrolled BP and hence the bleeding.You please do not wait for any second opinion and take her for hospital treatment right away.
After she comes out of this infection etc , she must take enough rest and very good nutrition to build immunity to avoid such infections again.
Please let me know what does the physician say. Come back here for any further query.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 9 hours later
Hi Doctor, thank you so much for your suggestion, while we are doing immidiately what you have suggested, like to have your opinion on level of seriousness or is it something that would take a little time but eventually she will recover.
Look forward to your opinion.
In addition to the above doctor, also wanted to inform that we are getting her admitted to a hospital. Hence, like to also have your opinion on how many days would it take before she is discharged and free to come back home.

Regards,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 38 minutes later
If the bleeing is there and she also has purplish patches over skin suggestive of bleeding below the skin then it is very serious to consider immediate treatment. Also checking renal (kidney) functions and blood pressure is of immediate importance. In case she has any sepsis or renal failure again she'll need 2 to 3 weeks to recover. But honestly I cannot comment with confidence over this period unless the patient is seen clinically by myself. You can discuss these questions with the treating doctor.
Take care.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 1 hour later
Hi Doctor, so just to recheck on sepsis, its curable right nothing that we should be worried about . Also, does it mean that she will need to stay in hospital till she completely recovers i.e. 2-3 weeks tentative. Also she is not having any more bleeding it was just once night before yesterday.
the report from the blood culture says :

"haematology says leucocyte count 90k, dlc test polymorph lymphocyts n monocyts r 10 n 0 % lower than usual all other r higher, cml
cml referon a pyrigesic coblex"

could you help decipher what does this mean.

Regards,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 4 hours later
XXXXXXX the report which says Leucocyte count is 90,000 is itself suggestive that she might be having sepsis. Yes, tentatively she might need 2/3 weeks to recover from what you have described here.
We are not talking about possibility of sepsis only on the basis of one time bleeding from nose, but we are suspecting it on the basis of various conditions you have described here.
If you or her close family members take care of her and take her to hospital right away for treatment then she'll recover fast. there is no point in wasting 24 hours of questioning over this. I hope if not you, at least her other family members have taken her to the hospital and she's already been started on proper treatment by now. Good luck. Get back for any further query.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 11 minutes later
Hi Doctor, her parents have already admitted her to the hospital but am trying to get opinion at my end as well. Before I ask any further, like to thank you for helping find answers and kindly bear with me as I may ask few more or in between. Just also wanted to check what does CML referon a pyrigesic coblex indicate or its likely to be sepasis and not anything else.
Regards,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 3 hours later
Oh good, XXXXXXX that she's been taken care by somebody. The blood investigation can be of blood malignancy (cancer) nature as you have written here polymorphs are lower but other white cells are in higher percentage. To be XXXXXXX it may not be just sepsis as the Total Leucocyte count is also too high, the picture is said to be suggestive of Chronic Myeloid Leukemia.
Do not worry about your questions. You can ask as many questions as you want. I was wondering if you were still waiting for an online consultant to answer your doubts before taking her for treatment to an actual physician.
The CML referon is Interferon alpha used in the treatment of Chronic Myeloid Leukemia (a cancer of blood cells).
I understand your concern may be likely because she's your fiancee and not your wife yet, but please make sure you are supportive to her during her treatment, irrespective of your future relationship with her. You can talk to the physician about her prognosis as he/ she would be able to comment better after seeing her personally and judging clinically.
Get back for any related query. Take care.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 19 minutes later
thanks a lot for your information doctor, so can we still assume it can be a possible case of sepsis and not cml since you said CML referon is interferon alpha used in treatment of cml. frankly this might not be a place to express emotions but she means the world to me and want her to be fit :). another question is even if its cml what are the treatments that she might have to undergo and how long would it take to be cured. while the physician would be able to comment as he is seeing her personally would get back to you incase of any other query apart from the above.
 
 
Answered by Dr. Madhuri Patil 1 hour later
No, XXXXXXX I said it is mostly CML as the count is too high to call it only a sepsis case. I really cannot say anything on her prognosis. The prognosis depends on how she responds to the treatment and if she suffers from the untoward side-effects too much. Unfortunately CML has bad prognosis compared to other types of leukemias. You can hope for miracles because they do happen. It is your duty to do your best you can as per the medical advice and as per your faith on the almighty.
wish all the best.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 2 hours later
Thanks doctor, will get back to you with any follow up queries.
Regards,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 8 hours later
You are welcome, XXXXXXX Get back for any related query. Take care.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 6 hours later
another thing doctor, based on the information I have given you so far, is it possible for you to suggest which stage CML might be if thats the case whether chronic, accelarated or blast phase or what could be probability of each of these phases.
Thanks,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 1 hour later
She's got infections incidently when she met with an accident and couldn't recover normally but the infection lead her to sepsis, subsequent renal failure and need of dialysis. Then she got infection of Malaria. If she's from Bangalore, this area is very less prone for P. Malaria infection, but she got it due to very less immunity. and now headache, bleeding with fever of unknown origin. This means she's got 'blast form' of CML where very few normal cells (polymorphs) are functioning against the infection and she's having very low immunity. The Polymorphs you mentioned are 10% and rest of the cells, or in fact, blast cells are more than 50% and this stage is honestly bad. I am very sorry to say this.
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Follow-up: Have headache, leg pain, bleeding nose and tested positive for malaria. Any thoughts? 47 minutes later
Actually I am based out of Bangalore and she is based out of Delhi. So doctor historically whats the possibility of prognosis in blast cases. Its fine you can tell me as frankly as you have been so far, the idea of me having a parallel conversation with you is exactly this.
Regards,
XXXXXXX
 
 
Answered by Dr. Madhuri Patil 1 hour later
Blast cell form is, as I told you, the worst. Certainly the doctor treating her will do Oncologist control it to make it look like a chronic form. If they can then there are medications to keep this kind patients survival as high as 95% for minimum five years. But if this form can be treated to make it clinically and histologically look like chronic form is unknown to me and the answer you will get only from the Hemat-oncologist treating her.
Thanks.
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