Dear Doctor,

I had a cough recently and was given amoxyl. My health improved, but I developed chest pain two days ago. A family member said I might have TB. I am worried, what should I do?

Emily

Dear Emily,

You have not specified the duration of cough and whether there was associated expectoration, fever, sweating and / or loss of appetite. What is the site of pain in the chest? Is it burning or pressure like, does it occur with breathing? Cough can be due to infections which may be bacterial, viral or mycobacterial. It can also be due to allergy to something present in the atmosphere or something eaten or used over the body. Cough due to bacterial infections can produce expectoration which may be mucoid or purulent depending on type of infection and fever.

Chest pain can simply occur with cough due to the stress put on muscles. It can occur due to inflammation of the cover of lungs, as sequel to T.B. or bacterial infections. Bacterial pneumonia causes inflammation and solidification of part of lung tissue and there can be residual chest pain, even after the pneumonia is resolved.

But all these conditions would be associated with fever, sweats, anorexia, one or more of these complaints.

Herpes zoster (a viral infection) can produce severe excruciating burning pain on the affected side of the body including the chest. Dyspepsia can produce pain either in the middle or the left side of the chest. This would be burning in character, commonly aggravated by food and associated with nausea and or vomiting. Chronic constipation can also cause a sense of heaviness over the chest, which may be perceived as pain.

Angina pectoris can also produce left sided chest pain, which is pressure like and occurs on movement and exertion and stops with rest.

Participating in active sports can lead to a muscle pull and / or soft tissue injury which manifests as pain over the affected part, i.e. the chest if muscles of chest are involved. Mental stress and anxiety can as well lead to chest pain on the middle of the chest bone, which even pains on touching. It is advisable that complete blood count is done to exclude any infection. X-ray of the chest can show some lung pathology. Taking small frequent meals with fresh vegetables and fruits, drinking more water and avoiding alcohol helps to prevent dyspepsia and constipation. If the pain is troublesome, taking analgesics would be helpful.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital