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Lung diseases

Pneumonia

09/24/2009

Question:

Hello, My husband started complaining of upper back and chest pain 4 months back (April 2009). After about twenty days of incorrect diagnosis, he took a sputum culture & sensitivity test that revealed the presence of Klebesiella Pneumoniae. It was a secondary infection in his lung on a TB scar. (He had tuberculosis 10 years ago.) He was treated with antibiotics for about 15 days and a repeat sputum test showed no presence of Klebesiella Pneumoniae but there were a few short chains of gram positive cocci. He was given broncho-dilators but his sputum was still yellowish with black specks. So, another sputum test was done which showed long chains of gram positive cocci. In the next sputum test over one lakh(100000) gram positive cocci were isolated in culture. He was put on antibiotics two more times by now. After the completion of the last course of antibiotics, another sputum test was done. It showed the presence of over 50000(50k) gram negative E coli isolated. Four months have passed, the infection doesn`t seem to get over. During this period two CT Scans of the thorax have been done. He has two lesions (cured TB scars) in the lower lobe of his right lung. their size was reduced in the second CT scan. His pain has come down by a huge margin. It is very little now. He is more active now. But the infection hasn`t subsided. Please give your opinion. Is the period of infection too long?

Answer:

Sputum cultures can be inaccurate and just because a bacteria is cultured from the sputum doesn't mean that it necessarily is infecting the lung - it could simply be growing in the mouth. If there really is on-going infection, then the duration is too long for simple pneumonia. Some of the conditions that can cause recurrent or repeated infections in the lung include immunodeficiency (for example, low levels of the antibody IgG), bronchiectasis (which can occur after TB and usually requires a "high resolution" chest CT to identify, aspiration (when food or saliva goes down the wrong tube and gets into the lung), parasite infection (such as strongyloides), or a lung abscess. Conditions like lung abscess can take many weeks of antibiotics to eliminate.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University