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Suggest Treatment For Recurrent Tonsillitis

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Posted on Sat, 4 Apr 2015
Question: Hi, I am a 25 year old female and I have asthma, allergies, and early rheumatoid arthritis (I do not take any medications for RA at this time). I have a tendency to get sick somewhat easily. I have been sick since the beginning of January with what they first said was bacterial tonsillitis (but not strep). After no improvement from steroids or antibiotics, they suggested a possible relapse of mono, which I had been diagnosed with in July (but ultimately ruled it out). Three months later, I still have large swollen glands in my neck, swollen tonsils, intermittent throat pain, post nasal drip, nausea, fatigue, and regular low grade fevers. Since then, I've seen an oncologist that ran a bit of bloodwork and said I needed to be 'observed' but that I probably actually had an infection. They also performed a CT Scan that indicated enlarged bilateral jugulodigastric lymph nodes measuring up to 2 cm in diameter, small bilateral posterior triangle lymph nodes, numerous thyroid nodules measuring up to 5mm in diameter, and "maxillary sinuses revealing mild nodular mucosal thickening". No conclusions have been made at this point but a biopsy has been considered. The CT scan was evaluated by an infectious disease doctor that, while swabbing my nose for staph due to a staph skin infection in my ears, discovered C. Freundii Complex on my nasal swab (and no staph). She has prescribed Levofloxacin which I began last night. This antibiotic is very hard for me to tolerate so far, and I'm wondering what it means to have this specific bacteria in my nose and if it could in any way be related to the mysterious, undiagnosed sickness I've dealt with since XXXXXXX 6th.
doctor
Answered by Dr. Abubakar Siddiqh (50 minutes later)
Brief Answer:
Possible relation between the tonsillitis, continue Levofloxacin

Detailed Answer:

Hi,


I had gone through your question and understand your concerns that you are having recurrent tonsillitis.


Based on your clinical details, it (recurrent tonsillitis) occurs to due to post nasal drip of sinusitis secondary to allergic rhinitis.


As such, Citrobacter freundii is a rare but potentially aggressive cause of pharyngo tonsillitis, occurs as a opportunistic infection and may progress into retro pharyngeal abscess.


Lymphadenopathy could be due to tonsillitis and sinusitis. Thyroid nodules requires ultrasound neck and thyroid profile.

Tab. Levofloxacin best works on these organisms. Kindly follow your treating doctor and have a regular follow up.

Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Abubakar Siddiqh (2 hours later)
What you are suggesting makes a lot of sense. I am wanting to stick with the Levofloxacin but I've had an allergic reaction with swelling along my jawline and pain. I have since taken Benadryl. I contacted the doctor's office and my doctor is out of the office until Monday and I was advised not to take the antibiotic again. I'm wondering if I may have other options to treat this issue so that I can know what to expect when I talk to my Infectious Disease doctor on Monday.
doctor
Answered by Dr. Abubakar Siddiqh (11 hours later)
Brief Answer:
continue Levofloxacin.

Detailed Answer:


Hello again,


Thanks for considering my answer and for your follow up.


Pain and swelling indicates infection. You need to continue same antibiotic (best works for enterobacteriaceae group (Citrobacter freundii).


With that, start over the counter anti allergic medication tab. citrizine 10mg one tab at bed time (allergic reaction). Do steam inhalation for sinusitis and salt water gargling for tonsillar infection.


Hope, I have answered your query.

Take care.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Abubakar Siddiqh

ENT Specialist

Practicing since :1994

Answered : 2038 Questions

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Suggest Treatment For Recurrent Tonsillitis

Brief Answer: Possible relation between the tonsillitis, continue Levofloxacin Detailed Answer: Hi, I had gone through your question and understand your concerns that you are having recurrent tonsillitis. Based on your clinical details, it (recurrent tonsillitis) occurs to due to post nasal drip of sinusitis secondary to allergic rhinitis. As such, Citrobacter freundii is a rare but potentially aggressive cause of pharyngo tonsillitis, occurs as a opportunistic infection and may progress into retro pharyngeal abscess. Lymphadenopathy could be due to tonsillitis and sinusitis. Thyroid nodules requires ultrasound neck and thyroid profile. Tab. Levofloxacin best works on these organisms. Kindly follow your treating doctor and have a regular follow up. Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions. Wishing you good health.