Background:
A 6-year-old male child was admitted to the PICU with a high-grade fever, altered mental status, and respiratory distress. The symptoms began two days prior with fever, lethargy, and irritability, progressively worsening despite initial treatment with oral antibiotics. The child had no significant past medical history.
Initial Assessment:
- Vitals: Heart rate: 145 bpm, Respiratory rate: 32/min, SpO₂: 88% on room air, Blood pressure: 85/50 mmHg, Temperature: 39.5°C.
- Physical Examination:
- Cyanosis and nasal flaring indicative of respiratory distress.
- Neurological: Glasgow Coma Scale (GCS) score of 10/15.
- Evidence of petechial rash over the lower extremities.
- Initial Diagnosis: Suspected bacterial meningitis with septic shock.
Investigations:
- Blood Work:
- CBC: Elevated WBC count (20,000/μL), CRP: 45 mg/L.
- Blood cultures: Positive for Streptococcus pneumoniae.
- Arterial Blood Gas: Metabolic acidosis with a pH of 7.25.
- Imaging:
- Chest X-ray: No pulmonary infiltrates.
- CT Brain: Signs of cerebral edema.
- Lumbar Puncture:
- Elevated protein and decreased glucose levels in cerebrospinal fluid (CSF).
Management Plan:
- Airway and Breathing:
- Immediate intubation and mechanical ventilation to stabilize oxygenation.
- Close monitoring of blood gases and respiratory parameters.
- Infection Control:
- Empiric broad-spectrum antibiotics (Ceftriaxone and Vancomycin) initiated, later narrowed to specific therapy based on culture sensitivity.
- Septic Shock Management:
- Intravenous fluid boluses to address hypovolemia.
- Vasopressors (Dopamine) initiated for persistent hypotension.
- Neurological Support:
- Administration of Mannitol to reduce cerebral edema.
- Continuous GCS monitoring and neurology consultations.
- Nutritional and Supportive Care:
- Total parenteral nutrition (TPN) initiated due to feeding intolerance.
- Strict asepsis to prevent secondary infections.
Outcome:
- Over 10 days, the child’s condition stabilized with improved oxygenation, hemodynamics, and neurological status.
- Antibiotic therapy was continued for 21 days.
- Follow-up brain imaging showed resolution of cerebral edema.
- Gradual weaning off ventilatory support, with full recovery of respiratory function.
Discharge Plan:
- Parents educated on home care, recognizing early warning signs, and follow-up visits.
- Regular check-ups scheduled for neurological and developmental assessments.
- Vaccination against Streptococcus pneumoniae and Haemophilus influenzae recommended to prevent recurrence.
Conclusion:
This case demonstrates the importance of timely intervention, multidisciplinary care, and the use of advanced PICU facilities in managing life-threatening conditions like meningitis with septic shock. The child made a full recovery, highlighting the success of a structured and evidence-based approach.