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What Causes Bronchiectasis, Fever And Cough When Diagnosed With Chronic Pulmonary Tuberculosis?

Posted on Sat, 8 Aug 2015

Question: sir, i am consultant radiologist in XXXXXXX m.p., my mother is suffering from bronchiectasis (cystic) in right upper and mid lung ( as diagnosed by hrct chest). she had past history of chronic pulmonary tuberculosis since 1970 ., irregularly taking drugs . get cured also in between , her age is 80 years , thin built , mildly raised b.p. . non diabetic. now she is having cough since last 6 months and developed fever since last 10 days with raised wbc
+12130, poly more . not getting relieved with antibiotics . kindly let me know about role of lobectomy in bronchiectasis . will she be cured after lobectomy - thank in anticipation - dr XXXXXXX kulshrestha , 0000 , YYYY@YYYY .

Answered by Dr. Drkaushal85 (45 minutes later)

Brief Answer:
Lobectomy is not advisable at her age.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Lobectomy is major Cardio Thoracic surgery. It has its own complications and dangers.
Usually lobectomy is indicated in patients with isolated bronchiectesis which is causing recurrent and chronic infection. And it is indicated in young individuals where life expectancy is good and cost benefit ratio is high. Someone attention the age of 20 years will be more benefitted by lobectomy than your 80 years old mother.
Old age itself is risk factor for such major surgery.
I doubt she can be medically fit for the same.
Better to get done sputum culture or bronchoscopy and XXXXXXX (bronchoalveolar lavage) analysis for the identification of causative organism and sensitivity report for guidance of antibiotic treatment.
Also give her mucolytic, expectorant and antioxidants drugs.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (24 hours later)

sir thanks for your quick reply .at present , she is having main problem of fever since last 15 days , not responding to 2 antibiotics , clindamycin and cefuroxime and antimalarial . beside this , she is also having dry cough and weakness . her temperature becomes normal after taking antipyretic , but she regains fever after effects of paracetamol is over. i shall be highly thankful if you suggest your line of treatment / prescription , like any other better antibiotic , anti tussive for dry cough , mucolytic drug, antioxidants , any vitamin + diet supplement , iron tonic / protein powder etc . kindly suggest name of XXXXXXX pulmonologist in NCR/ NEW XXXXXXX REGION FOR SECOND OPINION if she does not relief from local chest physcian from XXXXXXX M.P. thanks and regards dr XXXXXXX kulshrestha +0000

Answered by Dr. Drkaushal85 (11 hours later)

Brief Answer:
Better to consult RML hospital or XXXXXXX

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
In XXXXXXX RML hospital and XXXXXXX hospital has very good Pulmonary department with XXXXXXX pulmonologists. So you can consult them.
My advice for her
1. Tablet levofloxacin 500mg OD
2. Tablet azithromycin 500mg OD
3. Tablet Mucinac 600mg Thrice daily
4. Tablet Picnovit 50 micrograms twice daily
5. Tablet ABphyllin Sr 200mg OD at night
6. Pulmocare or pulmofit protein powder twice daily with milk
7. Bronchovit OD for lung specific vitamin and nutrients.
8. Don't give anti tussive in bronchiectesis patient. Expectorant and mucolytic drugs should be given. So give her brozodex syrup thrice daily.
Please let me know
1. Have you ever checked for 2d echo?
2. Have you ever checked for sputum culture and sensitivity?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wishing good health to your mother. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar