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Thalassemia Minor.

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My son of five years old,
He is minor thalassemia minor.
Asthma allergic, on beudacot for a last one year, in cough takes livonin inhalers as well.

He has had the fever since last 30 days. This fever is going and coming back for remaining for a day after every 3rd day since then. Then we got his chest X-ray done, which is showing prominent vascular markings and bilateral hila prominent in the chest X ray.

His hemogram is also done the result of that is as under:
HB: 9.2
TLC: 18.2
RBC: 5.38
ESR; 44
Neutrophil: 74
Lymphocyte: 20
monocyte: 04
Eosinophil: 2
Basophil: 0

and CRP is 64.64
Sometimes, I feel he is having night sweats also, please advise is this is some critical situation we are in.

He had BCG injection initially thus chances of TB should be minimal. the blood reports are also attached herewih for your review.

His mother had breast cancer in 2011, done mastectomy, i do not know whether this information is relevant in this case.

please advise if i would need to take in to undergo certain other tests

Category: Pulmonologist

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Category: Allergy and Immunologist
 29 Doctors Online

Dear patient,
Regards from DoctorSpring.
All lab values are evaluated based on the trend of the different values, and not on a single absolute value. Hence I would like to know the trends of TLC and CRP rather than a single value.
The lab reports suggest a focus of infection, for which an active search has to be done.
I would like to get him admitted, do a repeat blood count, peripheral smear, urine routine, blood and urine culture, sputum gram stain and culture, sputum AFB, and a skin mantoux test , WIDAL test and a procalcitonin to start with. adding on other investigations later on.
This problem you are facing, I do believe, requires more intensive investigations and attention.
I think he requires a course of antibiotics, preferably to start with intravenous, later changing to oral antibiotics once he starts responding to treatment.
I don't think his asthma history has much to do with the present scenario, and you may continue to use budecort regularly, with levovin
BCG vaccine protects from serious forms of TB like TB meningitis and not from TB itself. SO we cannot sit back and relax assuming it won't be TB.
Please clarify all doubts you may feel. however I prefer to that you consult a pediatrician to closely observe, monitor and manage your sons symptoms and treatment.
Jacob George P

Patient replied :

Dear Sir,

I have consulted three pediaritic but feel they are very busy to give my specific questions and moreobver i do not want to ask question on my son in front of my wife as she is a cancer surviour thus requesting you to look into and advise.
Please find attached all the bloods, urine, radiology and montoex report as suggested by you. All reports are in one file only with 12 pages for your review.
The pediatrician has given him only the "augmentin duo" for 10 days (6 ml two times). I tell you since last 35 days we have visited these three doctors 18 times and now finally we are in chronic infection condition. even though now they advised to give this antibiotic only.

though i feel it is good that the fever is not returned since last 3 days as we are giving him augmentin duo, i though feel this is effective.

do adivse some more tests or we wait for another 7 days to get other observations done.

Please advise if some more test are to be done. I am visiting many sites but feel half knowledge is not bad as they indicate more stress on us. please advise me furher i am very worried.

thank you and best regards,
neeraj Tanwar

Dear sir,

I had gone through your reports in detail, they offer nothing new or of greater significance.

Ig M- is the body's first response to an infection. it is called immunoglobulin M. once the disease becomes sub acute / chronic, ig M values come down and Ig G starts to rise.
Here you have an Ig M thats coming down and an IgG thats high. This implies that the acute state is over and now chronic sttage has set in. - DOES that mean anything to you- it need not bother you at all.
IgA is produced by the areas that come in contact with external substances, and are again indicating that he is responding to an infection.

ESR and CRP are also highly volatile markers of infection. they shoot up rapidly, and fall rapidly once the infection is controlled. any persistantly high esr will make me wonder if i am missing something, so i might suggest a repeat esr after 2 weeks.

There is no focus of infection in chest x ray, urine or sputum. most common sight of infection in this age will be a tonsils. ask him to gargle twice a day with warm salt water, continue antibiotics, and good food.

I find no reason to be pressing the panic button now. its an excellent sign that the fever came down by now. I do hope and believe it will be sustained.

I suggest no further investigations. Complete a 5 day course of augmentin and he can remain tension free.
Suggest a hematology opinion later on for thalassemia and anemia.

Dr. Jacob George P

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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