Multiple Lung Infection

My age is 45 years. I reside in India. Weight is 75 kg. Height is 172 cm. I have acute problem of breathlessness since birth. I was treated for Tuberculosis when I was 10 years old. I was frequently treated for Pneumonia once in at least four to five years. I was treated with the treatment of Tuberculosis in SEPT 2007 for four months with RIFAMPICIN and combination. I am patient of HYPOGLYCEMIA. My fasting sugar never crosses 70 and PP2 sugar never crosses 90. I am also a patient of PSORIASIS of scalp. And I have observed that when I was treated for lungs, the scalp psoriasis starts aggravating and when I was treated for scalp psoriasis, the problem of infection in lungs appear again. I have no habit of smoking or drinking wine or any other addiction.

RECENT PROBLEM - I have a problem of continuous fever (99 to 100 F) for more than two months with mild headache and frequent mild chest pain. No freshness and have weakness in the body with perspiration and sweating feelings more during night. PULSE RATE is ranging between 100 to 135. I have been admitted to the hospital for IV treatment (CEFTUM, CLINCIN and OMEZ).

CULTURE REPORT – Coagulase Positive Staphylococcous - Moderate Growth,  Few pus cells seen. Moderate number of Gram Positive Cocci in pairs and short chains and clusters seen. Occasional Gram Negative Bacilli seen.

CT SCAN REMARK - Small calcific opacity in apical segment of left upper lobe – posterior segment of right upper lobe and posterior basal segment of right lower lobe. Minimal FIBROTIC OPACITY in inferior lingular segment of left lung. Bilateral minimal pleural thickening along posterior aspect.

SERUM REPORT
SERUM IgG 965 (Reference Range 751-1560), SERUM IgA 170 (Reference Range 82-453)
SERUM IgM   72 (Reference Range 46-304), SERUM IgE        126 (Reference Range 0-100)
Anti TB IgA POSITIVE (Reference Range – Negative),
Anti TB IgM Doubtful Weak (Reference Range – Negative)

I need expert opinion as what shall I do now?

[National Jewish Health]

The coagulase positive staph, presumably in your sputum, is worrisome but much less worrisome than it would be in the presence of chest x-ray evidence of pneumonia.  Staph in your sputum, in the absence of evidence of pneumonia, is also not likely to be the source of the persistent, but relatively low-grade fever, especially without an elevation of the white blood cell count.

It is more likely that active tuberculosis would be the cause of fever, “weakness in the body”, tachycardia and night sweats.  The x-ray/CT scan findings do not suggest active pulmonary tuberculosis (TB), but nevertheless your sputum should be cultured for TB.  In addition, pulmonary miliary TB may not be radiologically evident in the early stages, although CT scanning is much more sensitive in the detection of miliary TB than is a conventional chest x-ray.  What should be considered is the possibility of endobronchial TB and extra-pulmonary tuberculosis:  lymphatic especially cervical, bone and joint, genitourinary and meningeal, a potential cause of headache.  With endobronchial TB, the organisms are usually readily detectable on smear and culture.

The anti-TB immunoglobulin tests are not very sensitive; only in the range of 3% (IgM) and 34% (IgG) so that the negative results do not rule out the possibility of extra-pulmonary TB.

My suggestions are that your doctors 1) obtain a number of sputum samples for TB culture, 2) that they consider the possibility of extra-pulmonary TB and 3) evaluate you for it.

Good luck.