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Q. My father has CT severity score of 8/25 and negative RT-PCR test. What does it mean?

Answered by
Dr. Muhammad Zubayer Alam
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jun 25, 2021

Hi doctor,

My father got a fever ten days back and his fever got subsided after using medications and injections prescribed by the local doctor. He was advised to take Doxycycline, Cetirizine, Dolo, cough syrup, and vitamin C. His fever came back at night after two days. After taking tablets, his fever got reduced. After that, he became normal without any problem after three days. But he had a burning sensation in the chest. His energy levels are very low in the last four days. On the previous three days, he had dizziness and cough while trying to get his phlegm. He had some itching in his throat with a cough. He took Azithromycin, Allegra M, and Dexamethasone. He did an HRCT scan which shows CO-RADS of 5 and a severity score of 8 out of 25. Can he have a severe issue? How to resolve it?

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Hi,

Welcome to icliniq.com.

I understand your concern. According to your statement, your father is suffering from a burning sensation in the chest, dry cough, and lack of energy for four days. I have gone through the attached report (attachment removed to protect patient identity). There are multiple patchy sub-pleural ground glassing are seen in both lungs predominantly in the peripheral and subpleural regions. It shows that he has a moderately atypical viral pneumonia caused by COVID-19. Your father has infections due to COVID-19.

His CO-RADS (COVID-19 reporting and data system) shows a value of 5. It highly suggests COVID pneumonia. It can be confirmed by doing RT-PCR (reverse transcription-polymerase chain reaction). He has a CT (computed tomography) severity score of 8/25. It indicates that he has a moderate type of pneumonia and below eight indicates mild pneumonia. Having fatigue or lack of energy is a common complication of a viral infection. It usually takes some time to subside.

Burning sensation in the chest can occur due to various reasons like gastric irritation, constipation, respiratory problems, and many more. Your father can take tablet Montelukast, tablet Levosalbutamol, and tablet Doxophylline along with his current medications for dry cough. As his HRCT of the chest shows COVID pneumonia, then it is good to take antiviral drugs to reduce viral load. If your father is free from diabetes mellitus, then you can give him glucose mixed water. It gives instant energy by increasing oxygen circulation in the blood. In case of gastric irritation, he can take anti-ulcerants. He can take syrup Lactulose in case of constipation.

Thank you doctor,

As advised by the chest doctor, we did a blood test to check the severity. I have attached the reports and prescription of medications. So kindly suggest whether he needs to get admitted to the hospital or he can go for home isolation to avoid having other complications.

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Hi,

Welcome back to icliniq.com.

I have gone through the investigation reports of your father. He has a CRP (C-reactive protein) of 20 mg/L, LDH (lactic acid dehydrogenase) of 686 IU/L, ALT (alanine transaminase) of 103 IU/L. These values are above normal levels and his hemoglobin is below average at 11.5 g/dL. As LDH is present in lung tissue, so higher LDH levels are found in COVID-19 positive patients having COVID pneumonia. Higher LDH levels in the blood indicate the presence of COVID pneumonia.

CRP is an acute-phase protein and so raised CRP levels indicate any ongoing infections or inflammation like COVID infections in the body. But raised CRP levels can remain linked to excess production of inflammatory cytokines. It helps to fight against any infections in the body. Higher SGPT levels in COVID-19 positive patients can indicate a liver injury.

But other health conditions can also raise SGPT levels. Low hemoglobin levels indicate the presence of anemia caused due to chronic blood loss. Blood loss occurs due to constipation caused by defecation. Monitor your father's oxygen saturation level routinely. If his oxygen saturation level declines up to 90% or below 90%, then he needs to get admitted to the hospital for oxygen inhalation therapy. At present, his blood marker levels are not high. As of now, he does not require any admission to the hospital.

Thank you doctor,

My father has a COVID-19 infection and it was confirmed by taking a CT scan. Yesterday, all the four members of my family and my father did an RT-PCT test. It came negative for all of us. What does it mean? Is there any infection? Does his infection got decreased?

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Hi,

Welcome back to icliniq.com.

HRCT of the chest of your father was taken before three days. It suggests COVID pneumonia with moderate severity. But on the RT-PCR test taken yesterday, he has a negative result. If 14 days are passed after being infected by COVID-19, then your father can become negative. In some cases, RT-PCR test can show a false negative result. Duration is important to know in this condition. If your father was tested COVID positive before 14 days, his RT-PCR may become hostile and it can suggest a subsiding COVID-19 infection. As your father had a COVID positive result recently, his RT-PCT report can show a false negative result. As your father was tested positive before 14 days and so pneumonia has developed as a complication of COVID-19 infections. His primary source of infection can subside soon but pneumonia can persist for some time.

Thank you doctor,

Can we follow the medication prescribed by a local chest physician? I have attached it. Kindly guide me. From yesterday night, we are taking it. My father's weakness has got reduced. His chest tightness, pain, and cough have some slight reduction. Now, he is feeling comfortable for the last two days. His oxygen saturation lies between 94% to 96%. I have a doubt whether CT scan and RT-PCR are only used for coronavirus detection. CT scan of lungs shows any inflammation or complexity in the lungs. But it does not tell the cause of infection. How can we know whether it was caused only by the virus? There can be other causes for having inflammation or infection. KIndly clarify and suggest me.

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Hi,

Welcome back to icliniq.com.

I have gone through the attachment. It covers both viral and bacterial infections. You can continue taking it as your father is feeling better. His oxygen saturation level persists at 95%. It is a piece of good news and it indicates the overall well-being of his health condition. As mentioned earlier, duration is a significant factor in detecting the cause of his pneumonia. If your father was tested positive for COVID-19 before 14 days, then his present pneumonia results from COVID-19 infections and your father is free from COVID-19 infection now. But, RT-PCR test for COVID-19 can show false negative results despite having COVID infection. While having ongoing viral infections like COVID-19, patients are more vulnerable to develop secondary opportunistic infections like pneumonia. So your father's present pneumonia can also occur due to bacterial or fungal infections also. Taking a CT (computed tomography) guided FNAC (fine needle aspiration cytology) or biopsy from lung lesions or pneumonic consolidation helps to confirm the exact cause of his current pneumonia. From my point of view, your father's overall condition is getting better day by day. He can continue taking his current medications.

Thank you doctor,

My father is feeling better. But he has a slight dry cough. His oxygen saturation remains around 96%. What to do to have complete recovery? Does he need to do RT-PCR or HRCT or any other test? Kindly suggest.

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Hi,

Welcome back to icliniq.com.

Your father is feeling better now. He has an oxygen level of 96%. It indicates that he has an improvement in his respiratory function. He does not require to do RT-PCR as your father has become COVID-19 negative already. As he has pneumonia, he can undergo HRCT of the chest to know the present status of his condition. His dry cough will subside over time without taking medications. If it persists for a long time, then he can take cough-relieving medications. Otherwise, no medication is needed.

Thank you doctor,

My father is fine. I am asking for me now. I took Covi-shield vaccine day before yesterday. I have gone loose motions two times today. I have mild asthma. I am not taking any regular medicine for asthma to avoid having any vaccine side effects. Can I take an anti-motion tablet? Can I go for COVID test now? Kindly suggest.

#

Hi,

Welcome back to icliniq.com.

Covishield vaccine has some side effects. The side effects are pain, tenderness at the site of administration, headache, tiredness, muscle pain, joint pain, fever, chills, nausea, and diarrhea. There is no known interaction found between Covishield vaccine and any type of asthma medications. If you want to take any asthma medications, you can take them without any fear as Covishield will never interact with your asthma medications and it will not produce any unpleasant side effects.

Your diarrhea can occur due to side effects of Covishield vaccine, indigestion, food poisoning, or any other cause. As you have only two episodes of diarrhea, so you do not need to take any medications for now. You can take oral rehydration salts (ORS) and plenty of fluids after each loose motion. If your diarrhea persists for a long time, then you can take Loperamide, Metronidazole, or Ciprofloxacin along with ORS.

If you develop nausea or vomiting, you should not take Metronidazole as it aggravates it. You just have diarrhea without any other symptoms of COVID-19 infections like cough, fever, respiratory difficulties, weakness, loss of taste, anosmia or loss of smell, headache, and body ache. So you do not need to do RT-PCR for COVID-19.


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