- Email: [email protected]
Cough and Apnea in a Young Infant
CASE STUDY
Cough and Apnea in a Young Infant Bonnie M. Word, MD
A
previously healthy 11-week-old infant was well until 1 day before hospitalization in mid-March, 2005, when he developed nasal congestion. On the evening of admission, he had two episodes of choking and gasping, each lasting approximately 1 minute. He turned blue and became limp. After the second episode, he was transported by ambulance to the hospital for evaluation. In the Emergency Department, he was afebrile and in no distress with a respiratory rate of 44 per minute. The oxygen saturation in room air was 99 percent. The remainder of the physical examination was normal, except for a few fine erythematous papules seen on his chest. The infant was born at term after an uncomplicated pregnancy. He had transient tachypnea, but the neonatal course was uneventful otherwise. His immunizations were up to date for his age. The family denied that there were any ill contacts. He had no history of recent travel. The family lived Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX. Address reprint requests to Bonnie M. Word, MD, Texas Children’s Hospital, Clinical Care Center, Suite 1740.01, 6621 Fannin Street, Houston TX 77030. E-mail: [email protected]
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1045-1870/06/$-see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1053/j.spid.2006.04.007
in a rural area and had a dog that stayed outside; the patient had no exposures to animals. A chest radiograph revealed hyperinflation of the lungs. A nasal wash for respiratory syncytial virus was negative. The white blood cell count was 5900/mm3 (32% segmented neutrophils, 57% lymphocytes, 7% monocytes, and 4% eosinophils). A metabolic panel revealed a sodium of 138 mmol/L, potassium 4.7 mmol/L, chloride 106 mmol/L, bicarbonate 17 mmol/L, glucose 102 mg/dL, creatinine 0.3 mg/dL, and blood urea nitrogen 3 mg/dL. Antimicrobial therapy was initiated with ampicillin and cefotaxime. During the next several days, the patient’s cough worsened. He remained afebrile. An esophagram was performed and was normal. On the third day of hospitalization, a blood culture obtained at the time of hospital admission was reportedly growing a single organism.
What is the differential diagnosis? How does the positive blood culture alter your differential considerations? See page 105 for the denoument.
Cough and Apnea in a Young Infant Bonnie M. Word, MD
A
previously healthy 11-week-old infant was well until 1 day before hospitalization in mid-March, 2005, when he developed nasal congestion. On the evening of admission, he had two episodes of choking and gasping, each lasting approximately 1 minute. He turned blue and became limp. After the second episode, he was transported by ambulance to the hospital for evaluation. In the Emergency Department, he was afebrile and in no distress with a respiratory rate of 44 per minute. The oxygen saturation in room air was 99 percent. The remainder of the physical examination was normal, except for a few fine erythematous papules seen on his chest. The infant was born at term after an uncomplicated pregnancy. He had transient tachypnea, but the neonatal course was uneventful otherwise. His immunizations were up to date for his age. The family denied that there were any ill contacts. He had no history of recent travel. The family lived Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX. Address reprint requests to Bonnie M. Word, MD, Texas Children’s Hospital, Clinical Care Center, Suite 1740.01, 6621 Fannin Street, Houston TX 77030. E-mail: [email protected]
54
1045-1870/06/$-see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1053/j.spid.2006.04.007
in a rural area and had a dog that stayed outside; the patient had no exposures to animals. A chest radiograph revealed hyperinflation of the lungs. A nasal wash for respiratory syncytial virus was negative. The white blood cell count was 5900/mm3 (32% segmented neutrophils, 57% lymphocytes, 7% monocytes, and 4% eosinophils). A metabolic panel revealed a sodium of 138 mmol/L, potassium 4.7 mmol/L, chloride 106 mmol/L, bicarbonate 17 mmol/L, glucose 102 mg/dL, creatinine 0.3 mg/dL, and blood urea nitrogen 3 mg/dL. Antimicrobial therapy was initiated with ampicillin and cefotaxime. During the next several days, the patient’s cough worsened. He remained afebrile. An esophagram was performed and was normal. On the third day of hospitalization, a blood culture obtained at the time of hospital admission was reportedly growing a single organism.
What is the differential diagnosis? How does the positive blood culture alter your differential considerations? See page 105 for the denoument.