Question: On 28th July 2014, Blood report of my niece shows following values:
Symptoms: Low grade fever with chills, weakness. This is happening for two months especially during the time of her periods. She is 13 years old.
Widal slide tests:
Salmonella Typhi O is 1: 80
Salmonella Typhi H is 1: 80
Salmonella Para Typhi AH and BH are both negative.
Malaria parasites not detected.
RBC Parameters:
Haemoglobin – 10.7 gm/dl
PCV/HCT – 32.1%
MCH – 25.5 pg
RDW – 16.2%
Platelet count – 113000 per cubic mm
ESR – 40 mm
SGOT – 58 iu/l
SGPT – 50 u/l
Dengue IgG – Positive
Dengue IgM – Positive
Method used rapid immunocromotography assay.
Urine examination: S. Hazy (see below)
Puss cells – 4-5 hpf
Rbc – 1 -2 hpf
Proteins – Trace
Ocult blood – Trace (she has her periods)
I understand that from this test that she has Dengue, However I want to know is that it or is there anything else. Please note, last month when she was hospitalised, the dengue test was negative.
Please could you tell me what is she suffering from and the appropriate treatment?
Doctor XXXXXXX XXXXXXX (Radiologiist, Healthcaremagic.com) reply to my question above...
Brief Answer:
She is suffering from dengue fever.
Detailed Answer:
Hello XXXX
Thanks for writing to HCM
She is suffering from dengue fever with low hemoglobin,low platelet level and slightly raised SGOT,SGPT.
Low hemoglobin,low platelet and slightly raised SGOT,SGPT are complications of dengue fever.She need periodic assessment of hemoglobin and platelet level.
There is no specific treatment for dengue fever. Patient only need supportive therapy.Your doctor may recommend to take plenty of fluids to avoid dehydration.
Blood and its component like platelet may be transfused depending upon condition.
Don't worry,her present condition is easily manageable and she will be fine.
She is getting right medicines and she should continue it.
Other findings are within normal limit.
Her urine report can be considered as normal.
Up to 5 pus cells in urine are normal.
Few RBC may be due to contamination during menstruation.
Widal test and malaria parasite test are also negative.
Get well soon.
Hope I have answered your question.
Further queries are most welcome.
Take Care
Dr XXXXXXX XXXXXXX
Replied by Dr. XXXXXXX XXXXXXX , 1 day ago     
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.


My follow up question for today,
As of yesterday 29 July 2014, she was been given the following medication:

Syrup tixylix cough linctus
becosule forte
tab Augmentin 375
septilin
Inj cefotaxime
inj zanocin
inj ondem
inj dexona
inj aciloc
(Injections thru IV)
At home, we gave her one teaspoon of papaya leaf juice extract to increase her platelet count.

On 30 July (today) early morning, blood sample showed the following:
Haemoglobin: 9.9 gm/dl
Total WBC Count: 4700 per cumm
Platelet - 126000 per cu. mm
SGOT - 44
SGPT - 40
When compared to the blood report of 28th July (sent to you earlier), the Haemoglobin and WBC count was better. The present result shows deteriorated counts.

As of today, 30 July 2014, she has been given the following medication:
inj zanocin
inj Taxim
inj ondem
inj dexona
inj aciloc
syrup Tonoferon

We are very tensed because of the decreased count in Haemoglobin and WBC. Although platelets have increased and SGOT and SGPT counts have decreased.
Please advise your suggestion and necessary action.

Thank you.

Dear Doctor,

Thank you for your reply. It indeed is very helpful. We have got the urine culture report. I am attaching the same. The name of the file is 30 Jun Report 1, 30 Jun Report 2 and 30 Jun Report 3.

The report shows bacterial infection. I have questions below:

1. What is the 30 Jun Report 2 all about? I haven't understood what this report is trying to tell us.

2. Does her medication need to change due to the urine infection?

3. Blue nails when shivering after which there is fever. What is the reason of blue nails? I understand it is due to lack of oxygen through the constricted arteries, but I want to know why is this happening with her? It has not happened before (Just last month when she was admitted). At present her nails are normal however during the shivering episode this and last month, her nails have had turned blue.

Awaiting your reply.

Dear Doctor,
Thank you for your quick response. I totally understand that you have work and you also need to rest.
We are a little perplexed with today’s report. I have written yesterday and today’s report.
Please find yesterday’s report details below:
•     5 ml of patient’s venous blood, injected into selective, enriched blood culture broth. At 48 hours of incubation, no growth was detected. No Microorganisms seen.
•     25 ml, yellow, slightly hazy specimen of clean catch, mid-stream urine received. Culture: SHEEP BLOOD AGAR, C.L.E.D., MAC CONKEY’S AGAR, 37 C/ 48 HRS/ AEROBIC. A pure moderate growth of Escherichia coli, G N bacilli, LF coliform, Biochem, typed. Remarks: Colony Counts: 40,000 C.F.U/ml
•     Investigation: Urine: - Routine Culture and Sensi tests
Organism/s isolated – E. Coli ( E S B L producing strain)
R – RESISTANT , I – INTERMEDIATE, S – SUSCEPTIBLE

ANTIBIOTIC – SUSCEPTIBILITY
o     AMPICILLIN – R
o     AMOXYCILLIN – R
o     PIPERACILLIN – R
o     AMOXY + CLAV – R
o     AMPI + SULBACT – R
o     NALIDIXIC ACID – I
o     LOMEFLOXACIN – I
o     PEFLOXACIN – I
o     NORFLOXACIN - I
o     CIPROFLOXACIN – S
o     OFLOXACIN – S
o     SPARFLOXACIN – S
o     LEVOFLXACIN – S
o     MOXIFLOXACIN – S
o     GATIFLOXACIN – S
o     PRULIFLOXCIN – S
o     NITROFURANTOIN – R
o     CHLORAMPHENICOL – S
o     AZTREONAM – R

o     CEPHALIXIN –R
o     CEPHALORODINE – R
o     CEFAZOLIN – R
o     CEFADROXIL – R
o     CEFUROXIME – R
o     CEFACLOR – R
o     CEFDINIR – R
o     CEFPODOXIME – R
o     CEFIXIME – R
o     CEFTRIAXONE-R
o     CEFTIZOXIME – R
o     CEFTAZIDIME – R
o     CEFOPARAZONE – R
o     CEFPIROME – R
o     CEFEPIME – S

o     TOBRAMICIN – R
o     GENTAMICIN – R
o     NETILMICIN – R
o     AMIKACIN – S
o     TETRACYCLINE – R
o     CO-TRIMAXAZOLE – R
o     MEROPENEM – S
o     IMIPENEM – S
o     IMIPENEM + CILASTATIN – S
o     CEFOPERAZONE + SULBACT – S
o     PIPERACILLIN + TAZOBACT – S
o     CEFTRIAXONE + SULBACT – S
o     TICARCILLIN + CLAV – R
o     CEFOTAXIME + SULBACTUM - S
{I don’t know why this was done. What I understand is that she is resistant to the above antibiotics. Is there anything else I should know from this chemical report?}

Today’s report from Metropolis has a new story to tell us. Please find the details below:
Dengue IgM – Negative (5.01) PanBio Units
Dengue IgG – Negative (4.41) PanBio Units
Remarks:
1.     False negative Dengue IgM antibody may be observed in case the blood is collected earlier than 5th day of fever
2.     Dengue NS1 antigen test is available for very early detection – Day 0 to 4
3.     Dengue Real Time PCR Test is available for early detection
4.     Dengue IgM antibodies can persist for more than 60 days. False positive can be seen as cross reactivity to other flavi viruses (west nile, yellow fever, Japanese encephalitis), malaria and Rheumatoid Arthritis

Please could you tell us the following:
1.     What is she really suffering from?
2.     With your experience, how would you treat her (in this case)?
3.     I understand that the above antibiotic susceptibility test is for antibiotic allergies.. Is it for anything else?
4.     Does her medication need to change due to the E. Coli bacteria in the Urine?
5.     I understood the answer you gave about her blue nails. It has only happened during the last two months. Is this an indication of a congenital heart disease? It hasn’t really been long term. Please advise.