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12 Cards in this Set
- Front
- Back
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Eight weeks after her birth, L. was taken to her family doctor for a checkup and her first baby shot. The immunization was postponed for a month because she had a slight cold and a runny nose. The baby may have acquired her cold from one of her three siblings or a grandfather living with the family, who all had colds recently. Subsequently, L. began sneezing and coughing. Any loud noise would bring on a coughing spell. L’s mother became concerned when the baby turned blue after a series of coughing spells that ended with vomiting. Later, during an examination of the infant by a physician, L. had a series of "barky" coughs, after which she vomited and could not catch her breath
As L.'s physician, what is your initial diagnosis? Why? |
Dx: Whooping cough due to B. pertussis
- "barky" cough - in contact with someone with cough / cold - cyanosis - vomiting after coughing |
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How would you diagnose whooping cough in baby L.?
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- cough! (prolonged, paroxysmal)
- contact with someone with chronic cough - lymphocytosis - lab confirmation (with PCR) |
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How might baby L. have acquired whooping cough?
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Probably the grandfather (or other members of her household) who was symptomatic from pertussis.
(Will look like a cold in adults) |
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What host factors would lead to increased severity of pertussis?
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- non-immune individuals (unvaccinated)
- young infants (because they are non-immune and have narrow airways) |
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Lab results for B. pertussis would show an ________ WBC count, primarily because of _______________
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elevated; increased lymphocytes
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How would you confirm the initial lab results of lymphocytosis on CBC?
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PCR for B. pertussis, sample obtained from nasopharyngeal swab
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Would you recommend antibiotic treatment for baby L? Why? Which antibiotic
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Yes
- macrolides recommended in order to prevent the spread of disease - will NOT impact the disease in the patient because the toxin has already affected the cells |
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What treatments are recommended for management of this patient (besides antibiotics)?
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Symptomatic management
- fluids - oxygen - mechanical ventilation - close monitoring for apnea |
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Should baby L. still be vaccinated despite already having the disease?
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Yes, she should still be vaccinated with DTaP
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What complications might arise from whooping cough?
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- bacterial pneumonia
- cerebral hypoxia with seizures - vomiting and dehydration - apnea (in babies) - rib fractures - conjunctival hemorrhage |
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Mrs. R, a 59 yo school teacher, was admitted to hospital with high fever and altered mental status. Eight days earlier she had developed a “flulike” illness with fever, anorexia, malaise, headache, muscle aches. These symptoms were followed by a cough that became progressively worse but was productive of only scanty, clear sputum. Five days before admission, she went to a local phsycian who ordered a chest radiograph. The ratiograph showed a small left upper lobe infiltrate, consistent with pneumonia. She was treated with an oral cephalosporin. In spite of the antibiotic treatment, her fever and chills increased steadily, she developd watery diarrhea, and she becamse confused and lethargic. Mrs. R’s past medical history was unremarkable, but she had smoked one pack of cigs a day for 40 years. Two weeks earlier, Mrs. R had returned from a 2-week holiday at a resort in southern Florida. None of Mrs. R.’s family members, coworkers or students had a simlar illness.
On admission to the hospital, her temperature was 40C her heart rate was 88bpm. The patient was severly hypoxic, and her white cell count was not remarkable. A gram stain of the sputum showed numerous neutrophils but no bacteria. A chest radiograph showed extension of her left upper lobe infiltrate and a new right middle loble infiltrate. As Mrs. R's physician, what is your initial diagnosis? Why? |
Legionnaire's disease (Legionella pneumonia)
- cough with minimal sputum - no bacteria on gram stain - cephalosporin didn't work... - hx of smoking - infiltrate in multiple lobes on cxr etc. |
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How did Mrs. R acquire L. pneumophila, and why wasn't anyone in her family or workplace infected?
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- Probably got it from her trip to southern Florida (hanging out in the hot tub)
- other water sources - other people not infected b/c bug does NOT travel person to person |
