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Fever, chillness with SPLEEN ABSCESS in CT. Treatment?

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Hi Doctor,

This is Asha, my husband - 38 yrs old suffering from fever since 2 months, we had approached physician and they had given antibiotics and paracitamol for 10 days, even then the fever did not come down.. later they diverted to gastroenteritis... he suggested to take blood samples and urine, USG, CT,.... in CT they came to know there is abscess in spleen... which might be causing fever and chillness... he underwent parcutanious drainage on 5th Jan 2015 and the pus was collected and sent for culture, even in culture it did not show any bacteria growth... on 10th Jan 2015 the pipe which was done in the drainage was removed.. he was under mild antibiotics and signoflame for the pain...

Even after this drainage, he was getting mild fever with chills fever was variying from 98.6 to 100.2.. so.. took him to doctor again, the uSG and Tc DC for blood done, so.. now doctor is suggesting to under to laparoscopic splenectomy... today he took vaccine - pneumococcal vaccine and doctor suggested to take signoflame if fever or pain comes and laviflox 500 mg 1-0-0 after food....

We are really worried to under go laproscopic splenectomy.. because it might lead to further more complecations..

Doctor please help us..

Regards,
Asha.J


Category: Gastroenterologist, Surgical

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Category: Gastroenterologist, Surgical
Dr. Lokesh HM is online now

Expert:  Dr. Lokesh HM replied 4 Days.

Hello,
Thank you for your query at Doctorspring.com
I understand your concern
Splenic abscess is best treated by laparoscopic splenectomy and percutaneous tube drainage will be used only in controlled settings.
Splenectomy surgery will not have many complications and it is a relatively safe surgery.
One thing I want to tell you is....
Usually splenic abscess will be secondary infection, means infection will be there in other sites of body and might have spread from there. This point is to be taken care with further tests like echo for heart infection. Again this may not true in all patients. That means spleen might have been infected primarily.
I think you go ahead with splenectomy
I hope that was helpful.
Feel free to discuss further,
Regards,
Dr. Lokesh HM


Patient replied :

Hi Doctor,
On saturday - 19th Jan 2015 - doctor gave him pneumococcal vaccine and asked to take Lavoflox - 500 mg for 2 weeks. After taking that vaccine.. he is getting fever every 2-4 hrs.. and he is taking signoflame 2 tablets a day.. the vaccine was given to left hand and his left hand is still sollen with pain....
Isnt there any other diagonisis for this doctor...!! If spleen is removed, will his infections goes.. and will he be free from this continuous fever..??

Please help us..

Regards,
Asha.J


Expert:  Dr. Lokesh HM replied 3 Days.

Yeah. ..His symptoms looks like that. ..even i think splenectomy will cure his symptoms. ..biopsy of spleen after surgery will give you a correct diagnosis. .as i have already told other infection has to be ruled out. ...
If he getting recurrent fever u can go for emergency splenectomy. ..
Dr. Lokesh


Patient replied :

Hi Doctor , sorry to distrub with lot of questions.. i was just checking on net aswell...
Points from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853043/
Out of various extrapulmonary tuberculous entities, splenic tuberculosis is extremely rare in
immunocompetent individuals and delays in diagnosis are frequent.
Few of the reasons for this undue delay being
? Nonspecific clinical presentation
? Difficulties in confirming the diagnosis and
? Prevalent concepts requiring the surgical intervention for confirmation of the disease and its
subsequent treatment
Splenic abscess should be considered in patients presenting with fever of undetermined origin and
abdominal pain; although splenic infarction can have a similar clinical appearance
The other features reported in splenic tuberculosis include splenomegaly, leucocytosis and raised
erythrocyte sedimentation rate (ESR)
The gold standard for diagnosis remains microbiological and histopathological confirmation of the
tuberculous lesion in the splenic specimen obtained by fine needle aspiration or biopsy or after
splenectomy
The first-line management of the splenic tuberculosis is considered to be anti-tubercular
chemotherapy with a significant number of the patients responding to it
Mail from Dr. Chayan Das (General Physician - Brother of my husband):
In our case tuberculosis is not confirmed. Colombia did abscess drainage but did not examine the
tissue under microscope. At this situation it will be very good if we can confirm the diagnosis first.
How can we confirm?
? We can do puncture again and collect some tissue and examine it under microscope. This will
not only confirm tuberculosis but also rule out any malignancy.
? Alternatively we can try to confirm diagnosis of tuberculosis non-invasively by mantoux test or
by DNA PCR.
I do feel doctors there are stressing more on splenectomy, kind of without considering alternatives.
But once the spleen is gone immunity becomes highly inefficient.
Regards,
Asha.J


Expert:  Dr. Lokesh HM replied 2 Days.

We can do puncture again and collect some tissue and examine it under microscope. This will
not only confirm tuberculosis but also rule out any malignancy.
A: Yeah. ..you can try this. ..but yield will be less. .because bacteria will be in the wall of cavity
? Alternatively we can try to confirm diagnosis of tuberculosis non-invasively by mantoux test or
by DNA PCR.
A: In India montoux test will be positive in all so not so specific
And yeah you can do DNA PCR
I do feel doctors there are stressing more on splenectomy, kind of without considering alternatives.
But once the spleen is gone immunity becomes highly inefficient.
A: what ever you do. ..but at the end you need to go for splenectomy after all the sufferings. ..
After removal of spleen there will not be much problems with immunity in this age group ..as compared to children. ..
Regards.


Patient replied :

Thanks Doctor for the inputs...!! we are just really scared if the spleen is removed... he will be prone to more infections after splenoctomy as the ages up...we dont want to loose him..... So that is why i was asking you so many questions...
Sorry to disburb doctor....
Regards,
Asha.J



Expert:  Dr. Lokesh HM replied 1 Day.

Hello,
I can understand why you're so scared.
But please do not worry, in his age spleen does not really matter that much, it is children who get affected if spleen is removed at an early age.
He will be fine.
God Bless.
Regards.


Dr. Lokesh HM
Category: Gastroenterologist, Surgical
Experience: 
Fellowship: Minimal Access Surgery (FMAS)
Fellowship: Pancreato-Biliary surgery (FPBS), SGPGI Lucknow, 2012
Senior Residency: MCh, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI) Lucknow, 2011
Junior Residency: MS, PGIMER, Chandigarh, 2008
Medical School: MBBS, MS from Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, 2007
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