How is lower respiratory tract infection managed?

Question

Hello doctor,

My 54-year-old uncle has been diagnosed with rheumatoid arthritis and is currently taking Prednisone and Methotrexate. Recently, he traveled for one week, and after returning home, he has been experiencing a persistent cough, chills, and extreme difficulty breathing. Additionally, he has very low energy.

Could this be a sign of a serious infection?
Can you suggest any additional tests he should undergo to confirm the diagnosis?
I also want to know whether he should stop his current medications or if any changes are needed in his treatment plan. Lastly, how can we manage his condition to prevent it from spreading to his wife and children?
Should they take any precautions or preventive treatments?

Kindly provide your guidance.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

The symptoms may suggest a lower respiratory tract infection, such as pneumonia, or opportunistic infections, which pose a risk to immunosuppressed individuals taking medications like Methotrexate and Prednisone. These drugs suppress the immune system, making him more vulnerable to infections.

He needs to plan for a consultation and possibly an admission to the hospital. I suggest he undergo the below-mentioned investigations:

Chest X-ray.
Complete blood count (CBC).
Sputum culture.
Polymerase chain reaction (PCR) to confirm the infection.
Blood gas analysis to assess oxygen levels.

Stopping or modifying his rheumatoid arthritis medications should only be done under a doctor’s supervision, as abrupt changes can exacerbate his condition. The physician may temporarily adjust or pause his immunosuppressive therapy while addressing the infection.

I suggest they practice strict hygiene measures to protect his wife and children, avoid close contact during his active illness, and stay current with vaccinations, including influenza and pneumococcal vaccines. They may not need preventive treatment unless exposed to a contagious infection.

Recovery involves prompt treatment of the infection, which may include antibiotics, antifungal medications, or antiviral medications based on the diagnosis.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.