RELAPSE?

[mme]

I was diagnosed with left pneumonia 5 weeks ago and slowly recovered with help of levoquin.  I also had pleurisy with this and was on percoset for the horrible pain.  Last week I developed a cold with sinus and cough.  Today I awoke and felt similar to when i developed the pneumonia, achey (achy) etc.  I went to a medicentre (its the weekend) and the Dr. said it is not common to relapse and that it appears as though I just have a cold (viral) He did not rx antibiotics and said that i could become resistant and end up in ICU if he prescribed them.  I am to go for a cxr and lab tomorrow.

I of course am petrified and paranoid that it is back and am looking for advise as to what more I can do to prevent recurrence.  I am taking multivits and cold fx and vitc and advil cold and sinus for the cold.  I am also wondering if recurrence is common or not and what do they do if it happens?  Can they rx more levoquin?

thanks, michelle

[National Jewish]

Pneumonia is inflammation of the lung.  This is most commonly due to an infection.  Antibiotics will help a bacterial infection, but will not help a viral infection.  Over time your body's natural defenses will clear a viral infection.  Pneumonia is generally best diagnosed by chest x-ray in addition to a thorough examination.

The question is whether this is just a cold or pneumonia that has relapsed or recurred.  The chest x-ray and lab work should help decide.  If you are coughing up any sputum, a smear and culture of the sputum may also help decide.  These tests will also help determine the most effective treatment.  The medicentre doctor was wise not to just start you on another antibiotic without having further testing done. This can cause the germ to become resistant to the antibiotic making it more difficult to completely eliminate.  Your doctors will need to determine what it was that kept your initial bout of pneumonia from completely clearing or if this is a true recurrence.

Sometimes this can be a complex circumstance.  You should seek care from an infectious disease specialist to determine what's going on and to get the most effective treatment.

[AndyRRT]

Michelle,

Your doctor couldnt be anymore correct. Treating a viral infection with antibiotics (ABX) is useless. They simply don't work. Prescribing ABX over and over throughout ones lifetime can result in infections becoming resistant to treatment. Thats the problem with todays medicine. Doctors just keep throwing pills at patients "just for coverage". This is why we are seeing more and more resistant viral strains in the hospital.


I totally agree that it sucks to get sick. And yes, reoccurance is common. What you are doing now is absolutely fine. Vitamins and Advil Cold/Flu formula are safe. Just treat your symptoms as they appear. Asperin/Tylenol for fever, aches and pains. Sinus meds for the drippies, and dont forget to DRINK lots and lots of fluid.

<< AAAACHOOO! >>

...uh-oh.


-Andy, RRT, CPFT

[mme]

Thanks for your reply.  I am  a nurse and agree that things are over prescribed.  I just get anxious about going through the infection that I had b/c it was 5 days of high fever, chills and pain (felt like i was dying).  It also drives me nuts when i go to work and my fellow workers are on antibiotics for what appears to be a minor cold so I wonder why am I not on antibiotics.  You are however probably correct in this being viral.  I will drink lots and thanks again.

One more question, if the pneumonia comes back and the previous one was bacterial could the relapse be viral?  How do you know the difference?

michelle

[AndyRRT]

When most people think of pneumonia, they think of bacterial pneumonia, but it is not always possible to distinguish viral from bacterial pneumonia based on the patient's signs and symptoms. Both illnesses can be severe, and even fatal, depending on the specific pathogen (disease-causing organism) involved. If there is significant sputum production, pleural effusion (fluid around the lung) and a dense, localized infiltrate (shadow) on X-ray, then bacterial pneumonia is usually present. If none of these are seen, then it could be either viral or bacterial. In essentially all cases of pneumonia, a chest X-ray confirms the diagnosis. You were diagnosed with a left sided pneumonia about 5 weeks ago. Pneumonia of any kind often develops a few days after a flu-like illness. When viruses cause pneumonia, the illness starts like any viral respiratory infection. The patient simply keeps getting worse. Bacterial pneumonia also commonly follows an initial viral infection. In fact, the viral infection predisposes to bacterial pneumonia, by damaging some of the lung's defenses against infection. One important clue to this diagnosis is deterioration after initial improvement. You can have severe pneumonia on the first day of illness.

I think it would be impossible for a physician to be certain that you had viral pneumonia. Therefore, antibiotics are almost always given to a patient with respiratory complaints and an X-ray suggestive of pneumonia because not giving antibiotics is risky. In the very rare case that viral pneumonia is definitively diagnosed, then antibiotics are not helpful and should not be given.

I hope that wasnt too confusing. Its usually a **** shoot when it comes to treating pnuemonia (pneumonia). The "oh-so-crappy-feeling" has been endured for a while before treatment takes effect.

Stay well and keep in touch!

-Andy, RRT, CPFT