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Symptomless chest infection

Right now I'm on azithromycin for bacterial infections for the third time in four months. All three times accompanied asthma flares. Two (the one in may and the one now) were discovered solely by blood tests (CBC with elevated neutrophils and low leucocytes) were completely symptomless unless one counts the accompanying asthma exacerbation as a symptom: no fever, no feeling sick, no colored phlegm, no physical sign of infection anywhere in my body, X-ray clear except for hyperinflation. strange.

Any thoughts about this? Your own experiences of a pattern of asthma flared accpsnied by signs of bacterial infection on CBC?

7 Replies

Could be viral? Research shows that its viral rather than bacterial infections which cause the majority of asthma exacerbations. And viral infections can still cause raised neutrophils and WBC.

Or are you on long term steroids? Steroids can cause raised neutrophils and WBC without evidence of infection. My neutrophils and WBC are always higher than normal, however when I have an infection they go really high and crp is also raised.

Usually mine are viral infections, but I often get some doxycycline abx to cover me 'just in case' when I have a bacterial infection I feel terrible and have fevers and green sputum etc etc!

B x


I may be wrong, but i thought pred made it look like you had a cxray in your bloods?? Ive had A&E diagnose a chest infection from bloods a few times, once i rang cons as they'd given me antiBs that interact with uniphyllin and cons said it wasnt a chest infection unless i was also getting symptoms, it was just pred messing with my bloods. not sure if the bloods you got are also doing what pred does, or whetherfor example pred only raises neutrophils but doesnt lower leuocytes?? Im not sure - just a thought :-)


Not quite the same but ive had a symptomless chest infection but only showed up on chest xray in hospital... also was having attacks (2 in 10 days is a lot for me!) but I'd be going about as normal apart from that, no fever, no phlegm


I think I'm mostly wondering if one can have a symptomless infection.

It was also my understanding that viruses are a more common trigger. The reason on this case for assuming bacterial infection was the neutrophil/leucocyte ratio was very high: doesn't guarantee bacterial but increases the probability significantly.

I've actually had 4 infections since may: the one before this was most likely viral. Oddly that was the only one where I felt sick in the usual way. It wasn't respiratory though: just a high fever, headache, feeling achy and sick when the fever was high and some temporarily high liver enzymes. (but not hepatitis, mono, or cmv)

Pred is certainly a possibility. I've been on various doses for 9 months. But in each case there is something that says maybe not. In may, I lost a lot of hemoglobin and red blood cells literally overnight which isn't normally part of a pred response. In June, I had a cough with yellow phlegm and a high band count. It was my understanding that whilst pred can mess up counts it doesn't normally increase band (immature neutrophils) counts.

This most recent ""infection"" the neutrophils have been gradually rising over the course of three weeks. The levels of pred weren't rising and falling in concert. I was going down on pred while the neutrophils are rising. During the first two tests where neutrophils were rising, i was actually going down on pred and was nearly at zero. The week before the third test i was completely off pred for five days (yeah!) and the had to go back up to 40. Only the rise in week 3 matches a rise in pred. Also the rise started with a high band count.


Hiya, been meaning to post on here for a bit! The last time I was admitted (2 weeks ago today for 4 days) I'd visited the gp in the week saying that my lungs felt yucky and painful and my temp was raised. As usual the gp listened to my chest and as usual said it was clear, no infection, no wheeze and other than the fact I was using my accessories there was no objective evidence that I had a chest infection or that my asthma was playing up.

It had to get to a crisis point where my asthma became too bad to manage and had to go to A&E. where I needed the usual treatment I get during an attack - hydro, mag, the works etc. it took the usual blood tests and chest X-ray to see that I had a really bad chest infection and the bottom of my lungs was *interesting* on the cxr.

I know this doesn't really answer your question as I was having symptoms that I experience during a chest infection, but then medics haven't picked it up. B frustrating it has to get to a crisis to get treatment, when I feel as though that admission could have been avoided!

Laura x


Laurs, sorry i missed your response and thank you for taking the time to share your experience. For me too often the only initial sign that I'm having a problem is that I'm overusing accessories. Some doctors do take note, but others don't.

Some form of asthma exacerbation has been going on for literally a year by now. I know that because my niece was born Oct 10 and I went into a long debate about whether or not to come see her the day she was born because I was coughing a lot at that point. If the cough was asthma there was no problem, but if it was a virus or infection then the last thing in the world I wanted to do was get her sick.

Sometimes I wonder if all of this is just a long series of viral or bacterial infections that somebody missed or treated with the wrong antibiotics. But all of the presumed infections in the last 6 months have had different signs on the test results, so it doesn't seem likely there is just one thing. CT scan in March and four chest x-rays didn't find any signs of some sort of hidden infection either. Nor was there evidence of something like bronchiectasis that would make me more prone to infection.

A more likely explanation for all these infections I suppose would be that pred depresses the immune system so all of us chronic pred users are at higher risk for for various infections?

Then again, when infections are symptomless and have no evidence except for raised neutrophils and lowered, I wonder if the asthma itself is not being given due credit for what is going on. Although none of the chest x-rays showed signs of infection, three of the four had evidence of hyperinflation which can be associated with asthma.

I am glad that people look at things other than asthma when I show up for a walk-in, urgent care, or A&E visit. On the other hand, pinning the tail on the infection donkey is an easy alternate, but possibly wrong, diagnosis if the one and only sign is an elevated neutrophil count and a low lymphocyte count. Pred can cause that all on its own as many of you have noted above.

Also, it turns out from a BMJ best practice article (http://bestpractice.bmj.com/best-practice/monograph/1023/overview/aetiology.html) that sudden onset anemia/destruction of red blood cells (such as happened when I was hospitalized in May) can cause raised total leukocytes, neutrophils and platelets --- which is exactly the pattern that was on my hospital CBC's. - so a non-asthma diagnosis can be missed as well if doctors fixate on ""infection"" as the cause.

I don't mind taking antibiotics if I need them, but I'd rather not be taking them if I don't.

How are things going for you now, Laurs, now that the infection has been treated? (I know your reply is nearly four weeks old, but sometimes these things don't always clear up right away).


This isnt 100% relevant but here seems to be the best place for it.

For a couple of months Ive had a sense of something just 'not being right'. Its coincided with this last exaserbation but blood tests have been okay, not coughing up gunk, no fever etc. It has gradually got worse and now diagnosed as pleurisy after the pain became very severe, but bloods etc still normal. Id say, we know our own bodies, and if you think something is wrong keep asking, it might not be the most obvious problem.


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