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Dr. Andrew Rynne

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Xray showed fluid in lower lung. Is R -cinex, pyzadine, combutol and wyeslone safe to take?

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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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Posted on Fri, 28 Dec 2012 in Environmental and Occupational Hazards
Question: Hello Dr. My chest X XXXXXXX indicated some fluid in the lower lobe of left lung. Some qty. Of the fluid was tabbed and taken out for lab testing. Lab report indicated myco bacterium infection other than T.B. But still I have been put on same medicines as that of T B i.e. R -cinex 600,pyzadine 750 & combutol 800 & wyeslone 20 mg ( for 15 days )Are the medicines prescribed by my Dr O. K ? Some fluid is still there in my lungs even after taking above medicine for 30 days. Shall the remaining fluid be also taken out by tabbing ?
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Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. You seem to have been diagnosed as a case of left pleural effusion (?MOTT).

2. The treatment you are receiving is of TB. MOTT responds to most of the anti tb drugs.

3. Remember that MOTT diagnosis requires a very high quality lab and chances of environmental contamination are high. MOTT pleural effusions are rare.

4. Was a pleural fluid ADA done at the beginning? If you could let me know the initial reports then I could advice in detail.

5. MOTT infections require individualized treatment. It is a possibility that the MOTT was a contaminant and hence you are being treated for tubercular pleural effusion.

6. Also all the fluid needs to be tapped at the start. If the remaining fluid is minimal then it gets resorbed by the medications.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Gyanshankar Mishra 14 hours later
Thanks for your reply. The report of fluid is as under:
RBC. 40 -50/hpf
PUS cells. 10-15/hpf
TLC 900
POLY. 44
LYMPHO. 56
PRotein. 5.3
Glucose. 104
AFB. Not seen
Malignant cell Not seen
ADA. 94 u/L (positive)

Result for mycobacterium genus. Detected
Result for mycobacterium tb complex. Not detected
(above molecular biology test done by vimta labs, Hyderabad

Report of ct scan chest

Shows evidence of large left pleural effusion occupying most of the posterior hemithorax.superiorly the effusion is extending upto the apex. No XXXXXXX septa or solid component seen in the effusion.there is compression collapse of lower lobe of LT lung. The ct value of effusion is +35 hu.
No rib destruction seen.
The LT upper lobe is normal
No mediastinal mass or lymphadenopathy seen.
No mass lesion seen. No honecombing seen.


My follow up queries are:
Is the medicine taken by me appropriate
About 200 ml of fluid was tabbed initially and the balance (reported to be almost 200 ml was left )Will the fluid be resorbed by medicines taken by me.because after 35 days of anti tb medicines( including 15 days of wyeslone)the chest x XXXXXXX was done and it still shows presence of fluid(though less than the one in first x rayi.e. Before tabbing)
I am getting fever of almost 99 F after every 3/4 days.I am not taking anymedicine separately for fever. When will this fever stop coming?
Whenever I take adeep breathe while exhaling out I experience some sort of friction in the left lung alongwith bout of cough. Otherwise cough is occasional why is it so?
Are there any side effects of the medicines taken or shall we take any diet supplements for the same.
I shall be extremely thankful to you if you can advise me on the above.thanks
I will be extremely thankful to you if you can advise me on the above
doctor
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,

Thanks for the follow up query and info.

1. Your reports seem to be suggestive of tubercular pleural effusion. The PCR based test is not that reliable since species identification has not been done.

2. All the fluid should be tapped and if any tappable fluid is present then it should be confirmed with a sonography first and then tapped if possible.

3. You are currently experiencing pleural friction rub which is seen in resolution phase of pleural effusion. You can take an analgesic like tab. voveran for the pain if any.

4. Steroids need to be tapered over a duration of 2 months every 2 weekly.

5. Please check if you are taking Tb pyridoxine (b long) 100 mg twice weekly (eg. on tuesday and thursday). If not then please take it.

6. Increase your protein intake in diet.

7. Anti tb drugs normally do not cause major side effects. Please take all anti tb drugs at the same time daily after light breakfast.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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