This case presentation summarizes the medical history and examination of a 1 year old female patient presenting with fever and cough for 4 days. On examination, the patient had normal vital signs with bilateral crepitations on lung examination. Chest X-ray and lab tests were performed. Differential diagnoses of acute bronchiolitis and pneumonia were considered. The patient was treated with nebulizers, antibiotics, antipyretics and IV fluids. Acute bronchiolitis was concluded as the likely diagnosis based on symptoms, examination and test results.

1. CASE
PRESENTATION
BY DR SARAH SIDDIQUI

2. PRESENTING COMPLAINTS
1 year old female baby, having weight of 8 kg , resident of lyari ,
with admitted through OPD with complaints of
• Fever – for 4 days
• Cough and chest congestion – for 4 days

3. HISTORY OF PRESENTING COMPLAINTS
According to patient’s mother, she was alright 4 days
back than she develop fever which is high grade,
undocumented, continuous, gradual in onset, not
aggravated by anything but relieved by medication,
associated with rigors and chills. She also has cough
which is dry, more at night associated with SOB. No
history of weight loss.

4. Past medical and surgical history:
She has history of multiple episodes of cough and SOB for which she visited clinics
many times and was advised to admit the baby but the mother refused. No history
of blood transfusion or any surgical procedure.
Birth history:
It was a booked case. mother had history of HTN but no history GDM and any
infection during gestation. Baby was born by SVD at term and at home.There were
no complication during labor.After birth baby has cried immediately. She has history
of respiratory distress at 1st day of life for which she has taken cefotaxime and
amikacin for 1 week. No history of cyanosis or fits after birth.
Feeding history:
She was on EBF till 1.5 months than she started giving bottle feed than prelacteal
was given 9 month after birth.
Vaccination history:
She is vaccinated up to the date.

5. Developmental history:
All milestones are achieved on appropriate time.
Family history:
Patient has no siblings. Mother and Father are also healthy and there
is no chronic illness running in family.
Socioeconomic history:
Patient lives in own house. Father is teacher . They drinks filter water
and goats in home.

6. ON EXAMINATION
On examination baby was looking active, lying comfortably on
bed and has following vitals
HR=112 bpm
RR= 64 breathmin
Temp=98.6F
SpO2=96
She has no pallor, jaundice, cyanosis, dehydration, edema, JVP is
not raised and lymph nodes are palpable.

7. On respiratory examination:
Normal shaped chest, with symmetrical chest expansion of about 2cm. Trachea is
centrally placed. Percussion note is resonant.There are bilateral crept. No
intercoastal ressestion or chest indrawing.
On CVS examination:
S1 and S2 are audible in all cardiac areas no added sounds are present.
On abdominal examination:
Normal shaped abdomen. Soft non tender no visceromegaly is appreciated. Gut
sounds are audible.
On CNS examination:
Is intact and unremarkable.

8. Investigation
• CBC
1. Hb: 11.2
2. TLC: 13500
3. Neutrophil: 65
4. Lymphocytes: 45
5. Platelet: 299000
• UCE
1. Urea: 21
2. Cr: 0.7
3. Na: 136
4. K: 4.6
5. Cl: 99

9. Chest X-ray

10. Treatment Given
• Inj Augmentatin 240mg /IV /8 hrly
• Inj Provas 8ml / IV/ SOS
• Syp brufen 1TSF 6hrly
• Syp Today 1 TSF /OD
• Nebs e atom+ clenil * 8H
• All D drops / 2 drops *OD
• Tab folic acid 1/4 tab OD
• Syp zinc 1TSF OD
• Norsaline P drops 2 hrly

11. DIFFERNTIAL DIAGNOSIS
•Acute bronchiolitis
•Pneumonia

12. ACUTE BRONCIOLITIS
Acute bronchiolitis is a sudden swelling in the
minor airways into your lungs, called bronchiole.
It is usually caused by a virus, but it can also be
caused by breathing in things that irritate your
lungs, such as tobacco smoke, fumes, dust, and
air pollution. Bacteria sometimes cause acute
bronchitis.

13. Symptoms
The most common symptoms of acute bronchitis are
• Cough ( dry or productive)
• Runny and stuffy nose starting a few days before chest
congestion
• Sore ribs from long periods of coughing
• Not being able to be as active
• Wheezing or a whistling sound while breathing

14. Diagnosis
• bronchiolitis is usually diagnosed on the history and physical
examination of the child.
• Chest X-ray
• Complete blood picture
• Pulse oximetry
• Saliva or spit cultures

15. Treatment
• Management is usually symptomatic
• A pain medication, such as acetaminophen (for fever and discomfort)
• Cough medicine
• Increased fluid intake ( IV or Oral)to prevent dehydration
• Bronchodilator may help in short term improvement.
• Antihistamines (benadryl / zyrtec, etc.) should be avoided, in most cases,
because they dry up the secretions and can make the cough worse.
• Antibiotics are recommended in severe cases with superadded bacterial
infection otherwise not indicated.

16. Pneumonia
It is defined as inflammation of lung parenchyma along
with consolidation of air spaces. It may be caused by
bacteria, viruses, protozoa, fungi or toxic substances.

17. Symptoms
• Chest pain when you breathe or cough.
• Cough, which may be productive.
• Fever, sweating and shaking chills.
• Nausea, vomiting or diarrhea.

18. Diagnosis
• Clinically in children less than 5 years pneumonia is
diagnosed by respiratory rate and chest in drawing.
• Complete blood picture
• Chest X-ray
• Pulse oximetry
• Saliva or spit test

19. Treatment
• Oxygen inhalation
• Antipyretics
• Adequate water intake
• Antibiotics
• Hospitalization is recommended only for severe cases of pneumonia.

20. THANKS