Concluded Case

5 yrs old female c/o rhinitis ,cough ,off and on fever with normal apetite since last 8days. clinical examination insignificant wt 15 kg. Rv neg ,ESR 93, creat 0.84, urine nil. BSL 46. plz comment on approach to this case.

(Edited)

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Concluded answer

Child is improved Clinicoradiologicaly with inj. amoxyclav. Wbc came down to 13300 today. Afebrile.cough subsided markedly. Thanks everyone.

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Agreed with @Dr. Mayuri Johari Phadnis The mentioned symptoms directing towards SWINE FLU. THROAT SWAB EXAMINATION IS MANDATORY IT CAN DEFINITELY AFFECT LOWER RESPIRATORY TRACT AS WELL. AS THE LEUCOCYTE COUNT IS SO HIGH, BACTERIAL INFECTION SHOULD BE TAKEN INTO CONSIDERATION. BASICALLY THE THING IS, THE CHILD MUST BE HAVING LOW IMMUNITY AND AGAIN ?SWINE FLU VIRAL INFECTION HAMPERED IT. SO CHILD MAY HAVE BECOME SUSCEPTIBLE TO THE BACTERIAL INFECTION AS WELL SEND BLOOD AND SPUTUM CULTURE. THE CHILD NEED BROAD SPECTRUM ANTIBIOTIC BLOOD SUGAR LEVEL IS ALSO VERY LESS.. 46. EXPERT PAEDIATRICIAN OPINION NEEDED SIR

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Bilateral upper lobe dense consolidation..should be bacterial given the high neutrophilic TLC..but the prodromal symptoms are of viral flu...one can still send H1N1 swab.. Likely to be viral flu with superadded bacterial infection...give adequate cover for pneumococcus and staph aureus..watch for pneumatocoele/ abscess formation/effusion

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Patch of pneumonitis at left lower and right mid zone.

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Pneumonitic patch on mid Rt zone And left basal. Leucocytosis present Start with piperacillin tazobactum a/c to body weight and amikacin Nebulization with asthalin Mucolytics and expectorant

Thanks@Dr. Gayatri Surya
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Consolidation both lungs Double pneumonia Leucocytisis with polymorph predominance. Acute sepsis, Bacterial Strep, staph, Hemophilus, Regionella pneumonia to be considered

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CBCsuggestive of Acute Bacterial infection and Xray chest Rt middle lobe consolidation So also inCT. with Iron deficiency Anaemia.

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Hazziness , very much round shape in lf lower lobe & in rt middle lobe with obstructive bronchiactasis . This process has to be chronic with acute secondary bacterial infection . Possibility of hydatid cyst or ? Lung cyst with secondary bacterial infection .

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Infiltrative opacities in b/l lung zones.. Seems to be Right UZ/MZ with left LZ pneumonitis..

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Child is improved Clinicoradiologicaly with inj. amoxyclav. Wbc came down to 13300 today. Afebrile.cough subsided markedly. Thanks everyone.

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