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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17995
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My son has been unwell weeks now and I am concerned

Resolved Question:

My son has been unwell for several weeks now and I am concerned as things are not progressing quick enough with the NHS.
His main symptoms are pain in joints (knee and hip), a rash which comes and goes, fever, high temperature and just generally not feeling 100%.
Our first visit to the GP the doctor was going down the route of an arthritic condition and requested an ASOT blood test
We then took him to the hospital where a routine blood test was performed and they said he had an infection, and prescribed antibiotics.
As things did not improve and the blood test was 2 weeks away we took him for a private blood test where the following was revealed.
“There is evidence of significant infection - high white cell count, raised platelet number high CRP and high ferritin. The high antistreptolysin titre is suggestive of recent infection with Haemophilus A, the bacteria responsible for scarlet and rheumatic fever. The ASO level was 800.
There is also evidence of significant iron deficiency. The reduced transferrin saturation and iron level are signs of iron lack. The low haemoglobin and HCT are also diagnostic of anaemia (anaemia is a deficiency in or lack of red blood cells) - which is often the first sign of a significant lack of iron in the body”.
Our GP said that he had tonsillitis and also wanted to refer us to a Paediatrician for further test re the joint pain.
I am really concerned as he is just not getting better, and when you read about these types of symptoms, the work Leukemia jumps out at you. The appointment is 2 weeks off which to my mind is too far away if there is an underlying serious issue.
Any advice you can give would be much appreciated?
Submitted: 10 months ago.
Category: Medical
Customer: replied 10 months ago.
Please see attached
Expert:  Dr. D. Love replied 10 months ago.
Hello from JustAnswer.The antistreptolysin O titre is actually indicative of infection by Streptococcus, not Haemophilus.Which antibiotic was prescribed?
Customer: replied 10 months ago.
I don't know the details of that. I would need to check with the GP. You are correct, it is the Streptococcus that was advised by the GP. The statement re Haemophilus was mentioned following the blood test, though we were advised to follow this up with the GP.
Expert:  Dr. D. Love replied 10 months ago.
The primary concern in this situation is rheumatic fever. Rheumatic fever is an inflammatory reaction to a recent Streptococcus infection. The inflammation can affect various organs in the body, but an arthritis is one of the major manifestations of the disease. The other major manifestations that can occur includes the heart, brain, and skin. The first step is to assure eradication of the Streptococcus, and I asked about the antibiotic to assure that it would treat the germ. The antibiotic course is usually relatively straightforward, but in cases of tonsillitis, it may require higher doses or longer courses to fully eradicate the germ. It is worth noting that the inflammatory reaction will continue even after the germ is eradicated, but if there is still evidence of tonsillitis, it likely will need additional antibiotics. For treatment of the inflammatory arthritis, the usual first-line treatment is aspirin or another anti-inflammatory medicine. The other major issue in this situation would be monitoring for any evidence of other manifestations of rheumatic fever. I would not be concerned about leukemia in this situation. First, infections are far more common. Second, there is no evidence of abnormal white blood cells on the lab blood count. There is a rare form of leukemia that has a normal blood count, but it is much less likely and would not be a concern until the infection and inflammatory condition is addressed and there are any persistent symptoms. If I can provide any additional information, please let me know.
Customer: replied 10 months ago.
Thank you for the response. Just to check with you, from what you have observed with the blood work there are no abnormalities in your opinion? That is of course with the exception of the high ASOT. I was concerned because the WBC was quite high, accompanied with the joint pain, fever etc...which when you read up on these symptoms point to some nasty illnesses. Not being a medical professional I should probably not read up too much on these things and try to self diagnose.
Expert:  Dr. D. Love replied 10 months ago.
The WBC is high, as is the platelet count, but that is not surprising when there is an infection. The elevated C-reactive protein and ferritin are non-specific markers of inflammation, but are also not surprising in this situation. The elevated WBC that is seen in someone with leukemia typically contains cells that are not normally seen in normal blood, and none of these cells were seen on the lab test, which is one of the reasons that I noted above that leukemia is not much of a concern. The other abnormality of the blood work is the anaemia and the evidence of iron deficiency, but this is typically not related to the acute illness. It is one of the issues that can arise in growing children and will need to be addressed, but the acute illness should be addressed first.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17995
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer: replied 10 months ago.
Thank you very much for your help.

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