Seeking Transfer for Advanced Treatment of Pneumonia and Suspected Tuberculosis

Q: Seeking Transfer for Advanced Treatment of Pneumonia and Suspected Tuberculosis

Hello： Pneumonia and pulmonary tuberculosis cannot be distinguished from X-ray images, and the presence of pulmonary edema further complicates the differentiation between inflammation and fluid accumulation. <br>This is also why it is challenging for clinicians to make a definiti

Can I transfer to another hospital for treatment by Director Yang for tuberculosis and pulmonary inflammation? Thank you?

Dear Director Yang,
My grandfather is 89 years old.
He was hospitalized on May 4 due to a fever, and tests indicated pneumonia with an inflammatory marker of over 7.
His hemoglobin level was 7.8.
He has been hospitalized since then (in a general ward) for treatment, which seems to include intravenous antibiotics.
The inflammatory marker decreased to 6.7 at one point but later rose again to over 7 and has not dropped since.
During his time in the general ward, my grandfather was still able to eat, bathe, and use the restroom independently.
On May 23, tests indicated suspected tuberculosis (the doctor estimated a 50-60% likelihood), with an inflammatory marker over 7 and a white blood cell count of 11,000.
He was moved to an isolation room, and after medication was administered, he experienced nausea and vomiting, making it difficult for him to eat.
The doctor later adjusted his medication and provided intravenous fluids for improvement.
It is possible that his heart and kidney functions are poor, leading to edema in his legs, for which a diuretic was added.
This resulted in him needing to urinate frequently, going to the restroom over 20 times from afternoon to evening, which caused weakness in his legs.
The doctor recommended transferring him to the intensive care unit for better rest.
He was admitted to the ICU at midnight on May 30.
Since then, he has been in a deep sleep, but when called loudly or spoken to, he shows awareness by responding with "uh-huh" and nodding or shaking his head, although he has not opened his eyes.
He has a nasogastric tube in place, and the inflammatory marker has not decreased.
Given that his condition is worsening in this hospital, I would like to know if it is possible to transfer him to your hospital for your assistance in diagnosis and treatment.
Would it be necessary for me to bring his medical records for your review? Currently, his health insurance card is with the hospital, and I am unsure how to handle this situation.
I sincerely appreciate your help.
Thank you very much.

Liu Xiaojie, 30~39 year old female. Ask Date: 2017/06/05

Dr. Yang Wenda reply Pulmonology

Hello: Pneumonia and pulmonary tuberculosis cannot be distinguished from X-ray images, and the presence of pulmonary edema further complicates the differentiation between inflammation and fluid accumulation.
This is also why it is challenging for clinicians to make a definitive diagnosis of pulmonary tuberculosis in the absence of evidence of mycobacterial infection (though it cannot be ruled out), as they are still waiting for the results of mycobacterial cultures, which take 2 to 8 weeks.
It is recommended to first listen to the attending physician's explanation of the condition.
If you wish to hear other opinions from pulmonologists, you can obtain copies of the X-ray and medical summary and schedule a consultation at your own expense to hear their interpretations!

Reply Date: 2017/06/05

More Info

Dear Sir/Madam,
I understand that your grandfather is facing a challenging medical situation, and I appreciate your concern for his health. Given his age and the complexity of his condition, it is crucial to approach this matter with careful consideration.

Your grandfather's recent hospitalization due to pneumonia and the subsequent suspicion of tuberculosis (TB) raises several important points. First, pneumonia can be caused by various pathogens, including bacteria, viruses, and fungi, and in older adults, it can lead to significant complications, especially if there are underlying health issues such as heart or kidney problems. The elevated inflammatory markers and white blood cell count indicate an ongoing infection, which needs to be addressed promptly.

The suspicion of tuberculosis is particularly concerning, especially given the age of your grandfather. TB can present in various forms, including pulmonary and extrapulmonary, and it often requires a prolonged course of treatment, typically lasting six months or longer. The fact that he has been experiencing nausea and vomiting could be a side effect of the medications used to treat TB, which can sometimes be harsh on the gastrointestinal system, especially in older patients with compromised organ function.

Regarding the transfer to a different hospital, it is essential to ensure that the new facility has the appropriate resources and specialists to manage both pneumonia and suspected TB. Transferring a patient in critical condition, especially one who has been moved to the intensive care unit (ICU), should be done with caution. The new hospital must be equipped to handle his specific needs, including monitoring and managing any complications that may arise from his existing conditions.

Before considering a transfer, it would be prudent to gather all relevant medical records, including lab results, imaging studies, and treatment plans. This information will be vital for the new medical team to understand your grandfather's current condition and history. If the current hospital is reluctant to release the medical records due to the health insurance card being held there, you may need to discuss this with the hospital administration to facilitate the transfer.

In terms of urgency, the decision to transfer should be based on your grandfather's current stability and the level of care he is receiving. If his condition is deteriorating and the current facility is unable to provide the necessary care, then a transfer may be warranted. However, if he is stable enough to be moved, it may be beneficial to wait until he is in a more stable condition to minimize the risks associated with transportation.

Lastly, I recommend discussing your concerns with the current medical team. They can provide insights into your grandfather's prognosis and whether a transfer is advisable at this time. They may also assist in coordinating the transfer if it is deemed necessary.

In summary, while transferring your grandfather to a different hospital may be beneficial, it is crucial to ensure that the new facility can provide the necessary care for his complex condition. Gather all relevant medical records, consult with the current medical team, and make an informed decision based on his stability and the resources available at the potential new hospital.

Best wishes for your grandfather's recovery, and I hope he receives the care he needs.

Sincerely,
Doctor Q&A Teams

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