Doctors Lounge - Pulmonology AnswersBack to Pulmonology Answers List
If you think you may have a medical emergency, call your doctor or 911 immediately. Doctors Lounge (www.doctorslounge.com) does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site.
DISCLAIMER: The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Please read our 'Terms and Conditions of Use' carefully before using this site.
Date of last update: 10/19/2017.
Forum Name: Pneumonia
|Shazinoz - Sun Jul 18, 2010 7:39 am|
I am a 39yr old female as you can see from my profile has a complicated Medical and family history.
In May I woke with a sore throat one morning and the next day I woke with a VERY HEAVY Chest and the beginning of more than 2 months of he!!
I was diagnosed with Pneumonia by my Dr after a clinical examination (listening to my chest, tapping on my chest etc) and history (shortness of breath, heavy lung feeling, infection taste when breathing, night sweats, fatigue, lack of appetite, low grade fever (37-38C), headaches, sore throat at beginning etc I didn't have a cough although I felt I needed to cough and this was put down to a side effect of medication (MsContin in HIGH dose) I take to help combat my Chronic pain condition (RSD) and did get one later for a short time.
I was put on Amoxicillin for 2 boxes worth, after 3 days I ended up in the ER with shortness of breath (my O2 saturations were said to be normal) and an x-ray was take and said to be mostly clear with "something" in the middle, I was subsequently diagnosed with Bronchitis or possibly Mycoplasma pneumonia, and given Doxycycline just in case as well as the other Antibiotic I was taking (I am allergic to Cephalosporin and Roxithromycin antibiotics as you can see in my profile).
10 days or so later back at my GP I was no better (in fact I was worse) and she was getting concerned, she sent me for another chest x-ray and an ECG to rule out heart problems (I have pre-existing trivial mitral and tricuspid valve regurgitation) and to the ER with a letter and the hopes that I would be admitted.
I was admitted (by this time I had been sick for more than 3 weeks) to hospital (and spend three weeks (21 days) in there), and put on IV amoxicillin every 4 hours, for 4 days and back on the Doxycycline as well. I also had/ have the occasional fast/funny heartbeat but this was not picked up on any of the ECG's I have had about 5 in the last 2 months. After 4 days I was transferred under a different Dr and continued on the Doxy for another 2 weeks or so. I was coughing up green gunk by this stage (Dr had me taking a (Bisolvin Chesty Forte) Bromhexine hydrochloride cough mixture (8mg/5ml) to help) and the hospital took sputum samples, and blood tests too (not sure of results, except the ones taken in the ER showed increased inflammation and white blood count).
While in-patient I was seen by a pulmonary specialist as I was having severe chest pains (eventually diagnosed as Costochondritis and possible pleurisy as well), I was changed from Doxycyline to Moxifloxin for about 7-10 days and had NSAIDS (firstly Voltaren and then Indomethacin) added to the mix to treat the supposed Costo/ Pleurisy. Got results of one of my blood tests that said I had Mycoplasma (or had had it) and was kept in an extra week after this.
I was sent home after 21 days in patient as they said everything that was being done for me could be done at home.
It is now 3 weeks since i was discharged and I still have shortness of breath (although all the time in hospital they said my O2 levels (by pulse oxymeter) were fine - about 95% or above), chest pains (especially if I lean forward, move about too much, and riding in the car hurts too), slight heaviness in my lungs, fatigue, I get cold too, normal temp to low grade fever (36-38C), night sweats (mostly on my lower half (not sure what that is about)), wheezing, and other odd breathing noises. I spend most of my days in/on bed sitting at a 45 degree angle (I sleep at this angle as well).
I am seeing my GP again in a week (she is away at present and has been since I got discharged), but until then am concerned about what is going on with my body, why after more than 10 weeks I am still not better/ well (I thought Mycoplasma was supposed to be a mild illness).
I am also seeing a Cardiologist on 28th August for a check up as I have not had my 2 yearly Echo to check my heart murmurs and also because one of the Dr's said she heard an Aortic valve murmur as well (and this is new). Although none of the above stuff is/was thought to be cardiac, I had multiple ECG's and blood tests including checking my heart stuff.
I am worried it was/ is more than Pneumonia/ Bronchitis/ Upper Respiratory Tract infection (All things I have been told it is). I am wondering if I should ask my GP to refer me for a Chest CT scan to see if this shows more? or what else could be going on or if this is simply normal???
Sorry for the length of this and congratulations if you made it all the way to the end
ANY help would be greatly appreciated.
|Dr.M.Aroon kamath - Tue Jul 20, 2010 12:55 am|
Thank you for the very detailed post. Seems you had overlooked mentioning a few conditions which i feel certain your doctors must have been very concerned about (given the history of trivial mitral/tricuspid valve regurgitation, the appearance of a new aortic murmur, occasional fast/funny heartbeats, chest pain on leaning forward)- and they are,
- an infective endocarditis(IE): very rarely caused by mycoplasma spp.,
- myocarditis, and
- pericarditis due to mycoplasma spp.
Mycoplasmal infecions are one of the causes of culture-negative IE.
The vast majority of organisms that cause infective endocarditis are readily isolated from blood cultures. However, in a small minority of patients with infective endocarditis, no organism is isolated. This may occurdue to certain factors, such as,
- either because previous antimicrobial therapy has partially cured the infection,
- or because the infection is due to an unusually fastidious microbe,
- or due to a slow-growing organism.
Broad-range eubacterial polymerase chain reaction (PCR) amplification is a method available for detection of mycoplasma spp.
PCR-based method has both advantages and disadvantages. The advantages lie in its high sensitivity and quick turnaround time. A notable limitation is that it cannot provide antibiotic susceptibility data or minimal inhibitory concentrations, as is possible with conventional culture methods.
I guess these possibilities were entertained during your recent hospitalization apart from the possible mycoplasma pneumonia.
I feel that you should consult a chest physician or a cardiologist at the earliest.
|Shazinoz - Tue Jul 20, 2010 1:32 am|
Thank you Dr.M.Aroon kamath,
As far as I know none of these conditions were looked into.
I had some ECG's to check my heart rhythms etc but they were all normal.
I had multiple blood tests but I think they were testing for normal things like FBC etc.
I think they checked cardiac enzymes at one stage after a bad episode that scared both myself and many of the nurses etc who came running (they thought I might have had a small collapse in my lung but the x-ray was clear).
I am seeing my GP on Thursday and am thinking of asking her if I should have CT Scan for a better check of my chest etc, as my X-rays have been pretty clear all the way through this.
What exactly should I ask her to test for regarding these heart issues ( infectious endocarditis, myocarditis and pericarditis) you mentioned? Should I be having specific blood tests, x-rays, scans etc to rule these conditions in or out?
I am also seeing a Cardiologist at the end of August but that is more than a month away yet (and the earliest I can get in).
I have been feeling a bit heavy chested again lately and coughing up small amounts of white/ clearish stuff when I can cough but again am having a lot of trouble coughing properly (thought to be caused by the high doses of morphine I take for my RSD). I also have the night sweats again/ still and my temp last night got up to 37.9C (100F)
I was seeing a pulminologist while in-patient but no one ever mentioned my heart except to say it wasn't cardiac because my ECG's were clear. and to mention the possibility of the new aortic murmur.
I have had all of my Pathology results (blood tests and sputum tests) sent to my GP so she will have these when I get there, I also have all of the Chest X-rays that were done as well.
I don't know what method was used to diagnose the Mycoplasma except that it took about 4 days to get the results of the blood test.
Again THANK YOU for your answer and I will bring this up with my GP when I see her on Thursday.
|Dr.M.Aroon kamath - Wed Jul 21, 2010 7:24 am|
Thank you for your update.My reply to your question was based purely on the basis of the information you had supplied(without the opportunity of a first-hand clinical examination!).
It is quite possible that your treating doctor might have 'entertained' the possibility of an infective endocarditis, but might not have divulged it under those circumstances,
- possibly because the evidence for it was not compelling or
- for concern regarding precipitating unnecessary anxiety.
The comforting aspect is that you were on the necessary antibiotic therapy at that time.
The chest pain apparently developed AFTER you were discharged home. Mycoplasmal infections are not always mild illnesses. They can cause serious complications in some individuals.It is good that you responded fairly well.
I suggest that you may voice your concerns with your doctor and get investigated. A repeat ECG and chest X-ray may be useful. An echocardiographic examination also may help to exclude any vegetations on the heart valves.
Hope this information is helpful to you.
|Shazinoz - Thu Jul 22, 2010 1:57 am|
Thanx again Dr. M. Aroon Kamath
I am back from my GP and have an appointment to see the pulminologist (I was seeing while I was inpatient) Next Thursday (a near miracle to get in this early).
We also got a full copy of one of my blood tests from my hospital stay and it turns out I am only Mycoplasma Pneumoniae positive (Total Ab Titre 1: 160), but also Chlamydia Pneumoniae positive as well (IgA - Detected, AU/ml: 51; IgG - Detected, AU/ml: 195).
So hopefully we will get to the bottom of things when I see the Pulmonologist again next week and the cardiologist is still on for the 12 August.
Thanks so much for all your help and I will continue to update this as news comes to hand in the hopes of helping others who read this as well...
|Dr.M.Aroon kamath - Mon Jul 26, 2010 1:57 pm|
Than you keeping me posted. Hope that you get well and i am also as concerned as you are and by the way, how's your cough?- and the chest pain. Hope these have subsided by now. Best wishes!
|Shazinoz - Mon Jul 26, 2010 9:01 pm|
I still can't cough properly (have had this issue the whole time - they think it is due to the large doses of Morphine sulphate I take for my chronic pain), but still feel the need to cough.
The chest pain is still there but comes and goes. It is not as bad as when I was inpatient, but it is still there.
My GP says costochronditis and pleurisy can take more than 6 weeks to get better. It is no where near as bad as it was and isn't constant any more but is now intermittent, but the pain is still very severe when it is there.
I am seeing the lung specialist in 2 more days and hopefully he will have some more answers as to what is going on with this body of mine.
Thank you very very much for all of your help. It has given me other avenues to check/ get checked to make sure this is gotten to the bottom of.
|Dr.M.Aroon kamath - Sat Aug 07, 2010 2:38 pm|
As i indicated earlier, my reply to your post was solely based on the information provided and i had to analyze and come forward with all the possible diagnoses that i could muster.
However, in practice, "common" things always occur "commonly"! Going by this dictum, i sincerely hope that the chest pain turns out to be due to costochondritis rather than something else. Hope you will get better soon. Good luck!
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.