Dear Doctor, I have had cough for the past two months and I’m currently recovering from a second chest infection. Ever since I completed a dose of amoxicillin and doxycycline antibiotics, I’ve had a productive cough. I also have pain in the right side of my back which is very painful especially when I cough, sneeze or lie down on that side. Sometimes I cough up blood. I barely sleep at night and when it’s cold, it gets worse. I had a chest x-ray, saw white patches across the site where I have pain. However, my doctor said that I had nothing to worry about although I’m still congested and coughing up phlegm and blood? I’m wondering what to do next. Rita Dear Rita, Dr. Rachna Pande Coughing up phlegm and blood is really a serious problem which needs attention. Is the chest infection associated with high fever? Do you sweat at night, lose appetite and get low grade fever in the evening? Have you been in contact with somebody having pulmonary tuberculosis? The diagnosis of the underlying cause of your symptoms depends on the answer to these questions. Cough with phlegm and blood, associated with pain can be due to acute bacterial pneumonia (solidification and inflammation of a part of a lung tissue). Backache can be due to site of congestion in the lungs on the posterior aspect. If the causative microbe is resistant to amoxicillin and doxycycline, the symptoms may persist or relapse. In case of reduced resistance of the body like the case of diabetes, HIV/AIDS, etc. the infection takes longer to resolve. Bacterial pneumonia is easily diagnosed by clinical examination, blood test and X-ray chest. Culture of the blood or sputum done helps to identify germs and the antibiotic which would be useful to destroy them, hence aiding to cure the infection. Tuberculosis of the lungs is yet another infection which can cause such symptoms. Spread of the infection to the covering of lungs can cause local inflammation and pain at that site, whether at the back or front part of the chest. Diagnosis of the condition can be made clinically with complete blood count and X-ray of the chest. Blood count will show preponderance of the type of cells suggestive of non-bacterial infection, whereas x-ray of the chest may show small opacities. Examination of the sputum for TB bacilli and sensitive tests like gene expert help to confirm diagnosis of tuberculosis. If diagnosed, it is a curable condition. Cancer of the lungs can cause similar symptoms. Smoking, chronic exposure to dust of any kind, are risk factors for chronic lung disease and cancer can occur as a sequel. Rarely cancer of some other parts in the body can metastasize to the lung causing such symptoms and spots in the lungs. Common cancer of the liver, backbone or breast can spread to the lungs. It is diagnosed by imaging techniques like X-ray chest and C.T scan of chest and confirmed by biopsy. In case of cancer, treatment depends on the type of cancer and clinical stage, i.e how much it has spread in the body. Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.
