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What Causes Intermittent Shortness Of Breath And Weakness While Treating Dengue Fever?
Question: My wife aged 45 yrs suffered from Dengue on 22.08.15. She has 103-104 fever for 2 days and then fever came down to 100. she was kept hydrated, hence no vomiting etc and could take food, water orally. She was feeling very weak, hence admitted in local Hospital at XXXXXXX (UP). Her platlet count came down to 95000 & TLC came down to 1.85 L. She had no bleeding, only few 5-6 red spots on arms etc. She was discharged on 29.08.15 with TLC of 2.64 L & Platlets of 97,000 & BP of 110/70. Since then, she is taking lot of fluids and complete bed rest at home. However she feels very weak and after walking from one room to another feels tired. The TLC on 01.09.15 (after 3 days) was 4900 with 2.09 Lakh platlets. On 09.09.15, the TLC was 10,200 & platlets was 3.62 Lakhs.
She had following complains on and off - (1). She starts heavy breathing after some physical activity and in between even lying down on bed, this remains for 0.5 to 1 hr or so and then she is OK. (2). She was feeling very weak and was feeling drained out completely once or twice a day occasionally. However almost in middle of night regularly after sleeping for 2-3 hrs. After eating few biscuits, Electrol, she will feel better and sleep off. (3). She had to get up for going to toilet atleast once / twice in night daily (4). Her Legs and arms will feel cold upon touching, but sole of foot and palm will be warm, she will feel no strength in legs and slight discomfort (not pain, little burning sort of), after rubbing her legs and arms, she feels better. (5). Her BP during these weakness is about 97/60. Doctor's were continously saying, it is post dengue weakness and will take 6 weeks.
On 13.09.15 i.e after 15 days of coming from Hospital, she had about 99 fever and felt very weak. We got Blood test done and TLC was 11,800 with platlets of 3.51 Lakhs and RBC of 4.11. Thinking that some infection in body, got Urine culture & Blood Culture on 15.09.15 and started Maha Flox from 15 th onwards, 1 tablet/day, took 4 tablets till 18.09.15. However, after getting Urine Culture report on 19.09.15, growth of E Coli found, colony count more than 1 lakh/ml. The report showed Resistant to Moxifloxacin. From 19 th morning, started taking Levoflox 500, 1 tablet daily. After taking first dose, there was considerable improvement in weakness of legs, Only on 19.09.15, she felt some burning sensation after passing urine, had felt the same while in hospital occasionally. But urine routine test was normal then.
After 19.09.15, she is feeling better, but the weakness, occassional shiver for a minute while changing clothes and in general not feeling well, not able to walk / stand etc is continuing. However, after 20.09.15, she is not getting up for toilets in night and no need to eat some thing in middle of night like earlier.
However, since today morning, she is unable to catch her breath and continously breathing uneasy for almost 8-9 hrs now. In between, she feels better for 1/2 hr os so and then it starts. Today she has taken 4 rth dose of Levoflox 500, want to know the reason for such weakness, heavy breathing and why is not able to recover fully. In between, doctors had advised Chest X Ray, ECG and 2 D Eco, all tests were normal. Whether she should stop taking Levoflox 500 after completing 5 days course, Got Urine culture tested again on 19.09.15 i.e after taking one dose of Levoflox 500, report is -ve.
We are worried about infection in Kidney and Sipses after reading on internet...pl advise....
She had following complains on and off - (1). She starts heavy breathing after some physical activity and in between even lying down on bed, this remains for 0.5 to 1 hr or so and then she is OK. (2). She was feeling very weak and was feeling drained out completely once or twice a day occasionally. However almost in middle of night regularly after sleeping for 2-3 hrs. After eating few biscuits, Electrol, she will feel better and sleep off. (3). She had to get up for going to toilet atleast once / twice in night daily (4). Her Legs and arms will feel cold upon touching, but sole of foot and palm will be warm, she will feel no strength in legs and slight discomfort (not pain, little burning sort of), after rubbing her legs and arms, she feels better. (5). Her BP during these weakness is about 97/60. Doctor's were continously saying, it is post dengue weakness and will take 6 weeks.
On 13.09.15 i.e after 15 days of coming from Hospital, she had about 99 fever and felt very weak. We got Blood test done and TLC was 11,800 with platlets of 3.51 Lakhs and RBC of 4.11. Thinking that some infection in body, got Urine culture & Blood Culture on 15.09.15 and started Maha Flox from 15 th onwards, 1 tablet/day, took 4 tablets till 18.09.15. However, after getting Urine Culture report on 19.09.15, growth of E Coli found, colony count more than 1 lakh/ml. The report showed Resistant to Moxifloxacin. From 19 th morning, started taking Levoflox 500, 1 tablet daily. After taking first dose, there was considerable improvement in weakness of legs, Only on 19.09.15, she felt some burning sensation after passing urine, had felt the same while in hospital occasionally. But urine routine test was normal then.
After 19.09.15, she is feeling better, but the weakness, occassional shiver for a minute while changing clothes and in general not feeling well, not able to walk / stand etc is continuing. However, after 20.09.15, she is not getting up for toilets in night and no need to eat some thing in middle of night like earlier.
However, since today morning, she is unable to catch her breath and continously breathing uneasy for almost 8-9 hrs now. In between, she feels better for 1/2 hr os so and then it starts. Today she has taken 4 rth dose of Levoflox 500, want to know the reason for such weakness, heavy breathing and why is not able to recover fully. In between, doctors had advised Chest X Ray, ECG and 2 D Eco, all tests were normal. Whether she should stop taking Levoflox 500 after completing 5 days course, Got Urine culture tested again on 19.09.15 i.e after taking one dose of Levoflox 500, report is -ve.
We are worried about infection in Kidney and Sipses after reading on internet...pl advise....
Brief Answer:
Better get some more investigation
Detailed Answer:
Dear XXXX,
Welcome to healthcare magic.
The prolonged intermittent shortness of breath and weakness indicates either the post viral fever fatigue which resolves slowly over weeks.
But meanwhile infection must be searched for and treated. She has grown E.Coli in urine so she should receive suitable antibiotics. Get repeat CBC, Chest Xray, Urine routine and culture, blood culture, ultrasound abdomen, procalcitonin and CRP to get exact idea of possibility and severity of the infection.
Treatment is needed till 3days after patient becomes a febrile, symptoms resolve and TLC resolve below 11000/mm3.
It is also advisable that she should be reviewed by a local MD Internal Medicine doctor.
I hope the advise will be helpful for you.
Better get some more investigation
Detailed Answer:
Dear XXXX,
Welcome to healthcare magic.
The prolonged intermittent shortness of breath and weakness indicates either the post viral fever fatigue which resolves slowly over weeks.
But meanwhile infection must be searched for and treated. She has grown E.Coli in urine so she should receive suitable antibiotics. Get repeat CBC, Chest Xray, Urine routine and culture, blood culture, ultrasound abdomen, procalcitonin and CRP to get exact idea of possibility and severity of the infection.
Treatment is needed till 3days after patient becomes a febrile, symptoms resolve and TLC resolve below 11000/mm3.
It is also advisable that she should be reviewed by a local MD Internal Medicine doctor.
I hope the advise will be helpful for you.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
As blood culture done on 15.09.15 is sterile and Urine Culture shows infection, is there any other infection over the UTI, which needs investigation. Chest X Ray done on 09.09.15 is OK, just now consulted MD Medicine and he has given Lonazep 0.5 mg 1/2 tablet now at 8 PM and 1 tablet before sleeping tonight. He has also advised to get her admitted in hospital in case breathing problem increases, pl suggest what is the actual cause if UTI is being treated, chest is clear, Blood Culture is strile, then where the infection could be
For UTI she is taking Levoflox 500 mg and today is the 4 rth tablet she has taken, tomorrow will be the last dose. Can short breath be because of side effects of Levoflox ?
Tomorrow is her cycle date, can short breath be because of this ?
For UTI she is taking Levoflox 500 mg and today is the 4 rth tablet she has taken, tomorrow will be the last dose. Can short breath be because of side effects of Levoflox ?
Tomorrow is her cycle date, can short breath be because of this ?
Brief Answer:
Investigations should give new clues
Detailed Answer:
Hi
Welcome back.
Repeating investigations is needed to see if the problems we are dealing with have resolved or not. Chest Xray ECHO and culture are normal but there is no doubt that patient is having problem, so relook investigations are needed.
Levoflox should be continued for 7 days and if anything crops up in new investigations then may extend to longer course or modify the regimen.
Menses can not be a reason because patient has been having the problem much before a premenstrual syndrome could cause it.
I hope the advise will guide you through.
Take care.
Investigations should give new clues
Detailed Answer:
Hi
Welcome back.
Repeating investigations is needed to see if the problems we are dealing with have resolved or not. Chest Xray ECHO and culture are normal but there is no doubt that patient is having problem, so relook investigations are needed.
Levoflox should be continued for 7 days and if anything crops up in new investigations then may extend to longer course or modify the regimen.
Menses can not be a reason because patient has been having the problem much before a premenstrual syndrome could cause it.
I hope the advise will guide you through.
Take care.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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