Cough in 4 month old girl

Symptoms

  • winter
  • 3 days
    • runny nose
    • loss appetite
    • non-productive cough
      • waking at night
  • 24 hours
    • cough more pronounced

Examination

  • restless and distressed
  • temp 38.4
  • pulse 160
  • respiratory rate 70
  • visible indrawing of chest wall on inspiration
  • diffuse wheezes and crackles in both lung fields

Investigation

  • Chest X-ray
    • hyperinflation
    • increased peribronchial markings
  • O2 saturation 82%

Diagnosis

  • lower respiratory tract infection
    • bronchiolotis
    • pneumonitis

Cause

  • Respiratory syncitial virus (RSV)
    • children <2, especially <6 months
    • peaks October to March
    • hyperinflation
  • influenza / parainfluenza - commonest causes in adults
  • adenovirus

Further tests

  • Nasopharyngeal aspirate
    • direct immunofluorescence - result can be same day
    • viral culture - needs storage at 4°C, result in 8-14 days
  • throat swab - 50% negative

Treatment

  • ribivarine - nebulised or IV
  • hospital for 24 hours of oxygen
 

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