Muhammad Haris, a 1-year old boy, presented with 7 days of fever and 1 day of cough. On examination, he had a temperature of 101F, fine crackles in both lungs, and a chest X-ray showed bilateral scattered lung infiltrates. He was diagnosed with pneumonia based on his symptoms and examination findings. He was treated with intravenous ceftriaxone, paracetamol, vitamins, and other supportive medications. His condition improved and he was discharged after 5 days of treatment.

1. CASE PESENTATION
By; Dr Veer vikram Singh(HO)
Paeds department

2. BIO DATA AND PRESENTING COMPLAIN
My patient M.Haris 1 year old ,7 kg weight ,R/O Shershah
admitted through OPD in our Pediatric ward Room#2 ,
Bed#11 ,CR#11895 on 19 september 2020 with C/O;
Fever ----------7 days
Cough---------1 day

3. HOPC
• According to attendent of my patient, baby was in usual state of
health 7 days back then he develops Fever which is
• Gradual on onset
• moderate to high grade (102 F -104F)
• Intermittent
• spikes at night with Rigors , chills ,night sweat ,no fits ,no neck
rigidity
• No aggravating factor ,Relieved by Paracetemol
• Associated with vomiting( 2-3 times a day ,on and off during
this period ,no blood staining,no foul smelling ,quantity about
half cup,contain food contents,has relation with food intake )

4. • sudden in onset
• occurs more at night
• no relationship with feeding
• no whooping or brassing sound
• No any triggering factor or aggravating factor,
• not nebulised

5. PAST HISTORY
• When child was 3 months of age he was admitted in CLF lyari
,according to attendent he was diagnosed pneumonia and got treated
,attendent dont know about what treatment given ,neither old
radiographic evidences available nor discharge card available.
• When child was 5 months he had measles ,for which he was also
admitted in CLF Lyari for which patient was admitted for 10 days then
discharged.
• On 13/8/2020 he again got admitted in CLF lyari for Fever got treated
there and discharged on 19/8/20.Antibiotics and antipyretics given .
• No any blood transfusion history .

6. Birth History (Antenatal ,Natal ,Post natal)
• Booked case ,No maternal DM ,Hypertension ,TB or any
other illness ,US done 2 times .
• Baby was delivered by Normal vaginal delivery on 9
months gestation at LGH with no any maternal and fetal
complications.
• Baby cries immediately ,no jaundice , no paleness , birth
weight was 3 kg .

7. Feeding history
• First breast feeding was given after 1 hr of Birth
• Exclusive breast feeding was given for 6 months
• Weaning started after 6 months but baby had low apetite ,
• Apetite before illnes and after illness are both low
,whatever the food is given he doesnt show any urge to
eat ,swallow only half or one spoon of khichri,
• Breast feeding is still continuous .

8. Vaccination history
• Vaccination history is upto Date but there was no
vaccination card available .
• Acc to the mother, baby's last vaccination was 3 months
ago when he was 9 months ,

9. Developmental history
• All development milestones are upto age
• on Gross motor he can walk when holded by one hand
• on hearing and speech ,he also says few words.
• Previous milestones were all almost upto the date.

10. Family history
5
year 1 yr
Consanguineous marriage , 2 children , elder child is healthy.
No Tuberclosis or other infectious ,chronic or genetic illness in
family.

11. Socioecnomic hx
• Living in own house , 7 persons are living in 2 rooms
,drinking tape water , ventilation is not well enough
• only one member is earning,
• poor socioecnomic status

12. Personal
• General ;loss of weight from 7.5 to 7 kg in month ,
decreased apetite,No allergy history.
• Low sleep and low appetite

13. General physical examination;
• child was sitting comfortably on bed with mother ,he looks mild Pale ,
• no clubbing,no koilonchychia ,no cynosis ,
• no ulcers or any congenital deformity in mouth,
• No Bitot spots seen on lateral bulbar conjuctiva,
• lymphnodes were not palpable and pedal and sacral edema were also absent.
• Vitals APM SD= MEDIAN
HR; 108bpm FOC; 46 cm
RR;40 MUAC;13cm
temp;101F length ;65 cm
weight ;7kg

14. Respiratory Examination
• On Inspection ;shape of chest looks normal,symmetrical
,Respitory rate is 40 breath per minute .
• type of respiration is abdominothoracic , no sign of
respiratory distress ,No stridor.
• On palpation trachea is centrally placed,apex beat is in
4th intercostal space midaxillary line ,movements looks
normal .
• On percussion;Resonant all over chest field,
• on Auscultation;Vesicular breathing ,added sounds ;
Fine Crackles were present on both sides,

15. Abdominal Examinations;
• On Inspection; abdomen looks mild distended with
umblicus everted ,respiration is abdominothoracic ,no
scar ,no pigmentation .
• On palpation; abdomen is soft ,non tender ,no mass and
no visceromegaly
• percussion ;Resonant note all over ,No shifting dullness.
• Auscultation;bowel sound audible 1/min

16. CNS ,CVS
• CNS is conscious and oriented ,GCS 15/15
• CVS =Apex beat is in 4th ic space midaxillary line
• auscultation; s1+s2+ 0

17. • Pneumonia ( Acute cough ,fever with rigors and
chills,Reluctant to feeding ,RR is 40,HR to RR ratio is
just bove 2:1, fine crackles on auscultation? but no
any Dullness to percussion)
• Bronchiolitis(fever ,feeding difficulty ,vomiting but No
subcostal ,intercostal retractions ,no initial rhinitis sx ,nor
cough is increasing ,no family member is ill.)
• Tuberclosis (young age(1yr),weight loss, but fever has
not much duration and cough is also acute ,no history of
contact with TB and also immunized by BCG vaccine)

18. DDX
• Enteric Fever (High grade Fever,vomiting associated
,but fever is not continuous nor worsening ,no
visceomegaly ,no other GIT symptoms ,No Rose spots.
• Reactive airway disease (Male gender,repeated chest
infections,cough is more at night? no allergy hx ,No
SOB ,No chest pain ,Expiration is also not prolonged .)

19. CBC
Hb 7.8
T LC 12900
Neutrophils 46
lymphocytes 49
eosinophils 02
monocytes 02
platelates 95000
Urea and
Creatinine
Urea 17
creatinine 0.6

20. CXR of child M haris, AP view ,
nor trachea is deviated ,CT ratio
is quite normal .
shows Bilateral scattered
infilitration of both lungs.
no any fracture
cardiophrenic angle intact

21. • BLOOD CULTURE Report was AWAITED, but patient
discharged before that.
• URINE DR DONE ,no any pus cells ,ph ,color and specfic
gravity all were normal.

22. Pneumonia

23. Managment
IV line maintained
watched for TPR charting 8 hourly
Inj Ceftriaxone given 75mg/kg/day
Inj Provas 7 ml IV SOS given
Syp; Calpol 1/2 Tsp SOS given
Syp; Calcium P 1Tst OD
Syp Vidalyn ,Syp Zyncate OD given
Inj Vit D3 3 lac orally stat given
Inj Vit A lac orally stat given
Tablet folate gven

24. Progress
• Muhammad Haris got treated and discharged on
24/9/20 from Pediatric ward ,

25. Pneumonia
• Inflammation of lung
Parenchyma and is
associated with
consolidation of alveolar
spaces.

26. Types of pneumonia
• Bronchopneumonia; scattered
inflammation around
bronchioles causing patchy
involvement.
• Lobar
pneumonia;consolidation of
one or more lobes of lung.
• Interstitial
pneumonia;Inflammation of
interstitial tissue(walls of
alveoli,sacs,duct and
bronchioles)

27. Bacterial Pneumonia
• Etiology:depends on age
Newborn E.Coli ,group B strept cocci ,Klebsiella ,
pseudomonas
Infancy and early childhood Pneumococcus, strept A, H influenza B
,Staph aureus ,Mycoplasma ,Ecoli
older child Pneumococcus ,H influenza B , Strept A,
Staph aureus ,Mycoplasma

28. BACTERIA SPECFIC CHARACTERS
Pneumococcus 90% ,classically causes Lobar pneumonia
Streptococcus few cases ,causes empyema in 25%
cases.
Staphylococcus aureus common in 1st year of life ,skin lesions
associations,rapidly progressive
Hemophilus influenza type b Gradual onset ,usually lobar ,associated
with bacteremia , meningitis ,cellulitis or
arthritis ,complicated to P effusion or
empyema.

29. Typical Findings ,DX ,Rx
Clinical Findings Diagnosis Managment
High garde Fever with shaking
chills
Tachypnea
Dry Cough
flaring of alae nasi ,expiratory
grunting
intercostal , subcostal
recessions
cynosis
chest pain , abdominal pain
diminished movement on
affected side
bronchial breathing
increased vocal fermitus
WBC Count Raised (15000-
40,000) neutrophil
predominant, WBC less than
5,000 =fatal.
Xray=lobar or diffuse
infilitration
Blood culture
ASO
Bed rest ,good diet
Oxygen 2-4 litres
Antipyretics
Adequate fluid intake
Specfic=
Pneumococcus=Benzyl
P/Cephalosporin
Streptococcus=Benzyl P,
Erythromycin
Staph aureus=cephalosporins
,Cloxacillin
H influenza .2nd ,3rd
cephalosporin ,
chloramphenicol
Ecoli = Amikacin.Gentamicin
Mycoplasma=Erythromycin

30. Goal is to treat adequately By recognizing the Cause
and prevent complications

31. .