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Fever, persistent cough, crashed rapidly. Diagnosis, treatment.

Resolved Question:

This consultation is for my Father (age 62) who is currently admitted in an ICU and in CRITICAL condition. He is in Kuwait (Middle east).



Main Concerns: Looking for Diagnostic help, Prognosis and Treatment options




First, below is the timeline of the events.
Oct 28th: Returned from a 1-month trip to India (one of the many regular visits to the family)
Nov 15th: Started complaining of Low-Grade Fever. Constantly between 37.4 to 38 degree celcius. There was some basic dry cough with no other major symptoms. Otherwise felt good and went to office (Desk job)
Nov 15-20th: Tried to ride it out with self-medicated Paracetamol (Panadol) but no change in above symptoms.
Nov 20th: First doctor visit: Flu like symptoms perceived but also given a 5 day course of antibiotics.
Nov 20th to 25th: Complete the antibiotics course with no change in Low grade fever (NOT EVEN ONCE it went down). Meanwhile, cough increased a bit.
Nov 26th: Second doctor visit, this time different doctor. Allergies or wrong antibiotics thought to be a problem. A second course of different antibiotics prescribed along with paracetamol. Multiple blood tests done (WBC elevated but no other abnormal result - blood test was basic one)
Nov 26th to Dec 3rd: Completed antibiotics course. No change in Low-Grade fever (Remained constant even with medication). Got very concerned.
Dec 6th: Went to another doctor. More tests later still no result but was asked to get admitted to the hospital. Was told he has Bronchitis (severe case and on Dec 10th recommended for hospital admission). Upton Dec 10th he was moving around very well.
Dec 11th (night): Admitted to hospital A with following symptoms: Low-Grade fever, persistent heavy cough, severe loss of appetite, tiredness. Side note: He could drive himself easily to hospital (family was tag along)
Dec 11 - Dec 13th: Condition CRASHED RAPIDLY. Symptoms: Blood in cough, Fever still contant and low grade, anxiety, lost appetite, headaches. Blood oxygen saturation at 74%. TB, Typhoid ruled out. Chest X-ray on first two days showed nothing - clean. Then suddenly on last day at Hospital A a final X-ray showed Pneumonia. Lungs filled with fluid. He also fainted for 10 mins (First time ever). Doctor at Hospital A got nervous and recommeded moving to an ICU in a different Hospital (Hospital B - a better facility).
Dec 14th: Admitted straight into ICU. Diagnosed with ARDS. Put on 100% ventilator support (could not breathe himself).

Facts from Hospital B (daily breakdown) - Based on what we were told - we don’t have written reports. Dec 14th - Dec 19th (Today):
Dec 14th: Started with 100% Oxygen and 16 pressure on Ventilator. Broad Spectrum antibiotics, some antivirals. Had fluctuating fever which was not getting controlled with basic medication. BP controlled via medicine. Completely sedated. Fluid in the lungs was removed.
Dec 15th evening: Condition started to stabilize. Still on 100% ventilation but blood oxygen saturation was holding above 90%. Other vitals stable and controlled via medication. Bronchiactmy done to get infection cultures tested. Fluid in lungs under control.
Dec 16th: Ventilator oxygen level reduced to 60% but still on 16 pressure. Other vitals holding stead on medication.
Dec 17th: Put in Prone position for first time. In this position, ventilator oxygen level reduced to 50% with 16 pressure (max limit). X-ray of lungs showed uniformly spread white areas in both lungs; which according to the doctor are indicative of viral infection and not bacterial. Influenza A suspected (Not confirmed).
Dec 18th: Prone and Spine position rotated. Ventilator steady at 50 and 60% respectively with everything else remaining the same as above.

Basic Health info.
Age: 62. Ethinicity: Indian
Built: Medium. Lifestyle medium active.
General health: Very good except for conditions below.
Conditions: 1) Borderline Diabetes: Controlled using diet and exercise only - no medication required 2) High Blood Pressure: Required a tablet every day.
Annual or Once in two years a flu affected week.
Tonsil inflammation not-infrequent (once or twice a year).
NO SMOKING, NO ALCOHOL, VEGITARIAN.


Category: OBGYN

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,
Thanks for posting your query at DoctorSpring.com
What she mentions is normal.
That is the normal pH of seminal fluid, and it is alkaline, while vaginal pH is acidic.
So the two fluids have different pH , and it is normal, because that is physiological.
There is nothing to worry about, nor does that cause any discomfort to the female partner in any manner.
If she is having any symptoms of discomfort in the private parts, the beginning of an infection should be suspected and ruled out by a gynecologist.
Your hydration is vital for your health, and not otherwise.
All the best
Please feel free to discuss further.
Regards.


Patient replied :

It's not a painful discomfort but more so a odor. She said that it used to last a day after sex but now it is lasting longer. She did have a recent yeast infection. Is there any chance that I got it and that is the odor


Expert:  Dr. Aarti Vazirani replied 3 Days.

If you had it, you would have itching, redness etc.
It is more likely just the smell of normal seminal fluid, that might linger on , if not thoroughly cleaned.
To be sure, why dont both of you get tested for infections?
Regards.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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