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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is an ESR level of 77 a cause for concern?

Answered by
Dr.
Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2881 Questions

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Posted on Wed, 14 Sep 2016 in Medicines and Side Effects
Question: My father is having high fever from couple of days, Post analysis and blood reports it is observed that ESR count is 77. He had earlier TB in 2007, are there any chances of recurrence. Also he is a diabetic with fasting 235 , post meal 301.
doctor
Answered by Dr. Saumya Mittal 23 minutes later
Brief Answer:
Needs more details. Needs to upload the reports again

Detailed Answer:
Hello.
I am Dr Mittal.
I have read your message.
I would like to help you out.

However, your reports are quite unreadable except for ADA.
Please upload the reports again- WA0012 is cut in between, and WA0014 is exceedingly hazy.

As for the questions, yes TB can recur specially in diabetics.
The possibility increases if the treatment was not completed the first time around. It also depends on the type and location of the TB.

As for the sugars, they are both high and not at all under control.
I would like to know what medicines and what diet he takes regularly.

As for ESR, that just indicates that there is an infection going on. It does not specifically suggest TB, and it can be raised in other chronic diseases as well, including diabetes.

I would also like to know what are the other comorbidities/diseases he has? What are the medicines he is on regularly? I need the details on the TB last time? I need the medicines taken, the dose and the duration of those medicines? I also need to know if there are any other symptoms as of now besides fever.

Please let me know the information requested, and I will try to help you further.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Saumya Mittal 3 hours later
Hi Dr,
I have updated new files,
He is having gluconorm G2 twice daily after meal for diabetes,

Symptoms : Only Fever during some time in a day and diabetes. Body Ache
doctor
Answered by Dr. Saumya Mittal 1 hour later
Brief Answer:
suggestions

Detailed Answer:
Hi
Thanks for your response.
The response is still deficient regarding the prior TB and the treatment details.
I am assuming that this was a TB of lung, and was treated for full 6 months and was proven to be TB negative after sputum test three times,
If any of the fact does not add up, do let me know.
The sugar tablet is obviously not sufficient. However, one reading should not be taken into consideration for changing the medicines. I therefore suggest testing HbA1C test.
These tests would probably have been ordered by a local physician. I would like to know what were his comments after the examination of the patient, since there are not too many symptoms to go by.
Now the reports you have uploaded are not really conclusive towards or against TB. In the absence of the other symptoms, it is quite difficult to say that this is due to TB. However since TB is very very common in XXXXXXX and since he already has had TB once, one cannot rule out TB either.
I therefore suggest the following tests - tests for other causes of fever. I suggest testing them as well-
Typhi Dot,
Blood culture,
Urine culture,
HbA1C (as already discussed),
Vitamin D,
Sputum culture and sputum AFB.
I think, since he is already on antibiotics (the query does not tell me how long he has been on it) which I assume have been started on opd basis to be taken at home, I would suggest admitting him to the hospital for detailed evaluation and treatment.
He also seems to be developing some anemia, by the looks of the blood indices in CBC, possible iron deficiency anemia. In view of his diabetes status, I suggest testing
1. renal profile
2. iron
3. ferritin
4. TIBC.
Let me know the reports as soon as possible.
And as suggested, please consider admitting him to a hospital for further evaluation,
Best of luck,
Dr Mittal
Above answer was peer-reviewed by : Dr. Prasad
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