Background:
A 4-year-old female child was brought to the emergency department with a 3-day history of fever, persistent cough, rapid breathing, and decreased appetite. The parents reported worsening symptoms, including lethargy and difficulty breathing.
Initial Assessment:
- Vitals:
- Temperature: 39.2°C
- Respiratory Rate: 50/min (tachypnea)
- Heart Rate: 130 bpm
- SpO₂: 88% on room air
- Physical Examination:
- Audible wheezing and crackles on auscultation.
- Use of accessory muscles for breathing and nasal flaring.
- Mild cyanosis around lips.
Investigations:
- Blood Tests:
- Complete Blood Count (CBC): Elevated WBC count (16,500/μL) with neutrophilia.
- CRP: Elevated at 58 mg/L, indicating inflammation.
- Procalcitonin: Elevated, suggestive of bacterial infection.
- Imaging:
- Chest X-ray: Consolidation in the right lower lobe with air bronchograms.
- Microbiology:
- Blood culture: Positive for Streptococcus pneumoniae.
- Sputum culture: Confirmed bacterial pneumonia.
Diagnosis:
Community-acquired bacterial pneumonia, likely caused by Streptococcus pneumoniae.
Management Plan:
- Respiratory Support:
- Oxygen therapy via nasal cannula to maintain SpO₂ above 92%.
- Nebulized bronchodilators for wheezing and airway clearance.
- Antibiotic Therapy:
- Intravenous Ceftriaxone initiated based on likely pathogens.
- Transitioned to oral antibiotics (Amoxicillin-Clavulanate) after clinical improvement.
- Symptomatic Management:
- Antipyretics (Paracetamol) for fever.
- Adequate hydration and nutritional support to enhance recovery.
- Monitoring:
- Regular assessment of respiratory rate, oxygen saturation, and temperature.
- Chest physiotherapy to improve lung clearance.
Outcome:
- Significant clinical improvement was observed within 48 hours of initiating treatment.
- Fever resolved by Day 3, and oxygen saturation stabilized without supplemental oxygen by Day 5.
- The child was discharged on oral antibiotics after 7 days of hospitalization, with advice for a follow-up chest X-ray to ensure resolution of consolidation.
Discharge Plan:
- Education for parents on signs of recurrence (e.g., increased coughing, fever, or difficulty breathing).
- Completion of the antibiotic course as prescribed.
- Emphasis on preventive measures, including pneumococcal and influenza vaccinations.
Conclusion:
This case highlights the importance of early diagnosis and prompt management of bacterial pneumonia. The patient responded well to evidence-based interventions, resulting in full recovery without complications.