Case #1 The patient was an 18-day-old female who at initial presentation was bro

Question

Case #1 The patient was an 18-day-old female who at initial presentation was brought to the emergency department by her mother after a 3-day bout of coughing. Her mother also reported that her daughter had been "spitting up" more than usual and had episodes of tachypnea. During the initial exam, a rapid respiratory syncytial virus test was obtained with negative results. A review of systems was notable only for a nonproductive cough. Her pulse was 168 beats/min, her respiratory rate was 32 inspirations per minute, and oxygen saturation was 92 to 95% on room ir. Her complete blood count was significant for a white blood cell of 15,300 cell/ul with an absolute lymphocyte count of 10,900 cels/ul. The mother had a chronic cough of 4 weeks' duration but had been afebrile. Six weeks before this patient's admission, her 10-year-old brother also had a prolonged coughing illness that responded to breathing treatments and inhaled steroids. After initial exam, the child was admitted to the hospital, Her initial hospital course was uneventful, and she was discharged after 2 days. However, she was readmitted the following day with worsening respiratory symptoms. Over the next several days she had increasing difficulty breathing, tachypnea up to 100 breaths per minute, and oxygen saturation in the low 80s during episodes. She was admitted to the pediatric intensive care unit for respiratory support. She had an extremely complicated and prolonged intensive care unit course that included pulmonary hypertension, acute respiratory distress syndrome, and health care- associated pneumonia. After a 10-week hospital stay, she was eventually discharged to return home where her recovery was uneventful. Nucleic acid amplification testing (NAAT) was performed on a nasopharyngeal swab. The amplified DNA was screened for a particular agent with positive results, and the patient was begun on azithromycin. What was the etiologic agent infecting this patient? What findings in this case support this conclusion? Why is a nasopharyngeal specimen superior to any other clinical specimen f diagnosing this infection? Why has NAAT replaced culture for the diagnosis of this pathogen? 1. 2. 3 Describe the clinical course of this disease. Why didn't the patient respond to the antimicrobial she was given?

Explanation / Answer

1. The patient is probably suffering from Pneumonia (There is a slight chance that it may be Tuberculosis as well). Since she has low oxygen saturation, tachypnea, rapid breathing rates and breathing issues (spitting up). The presence of Pneumonia is further confirmed when both the Mother as well as the patients brother also have the prolonged coughing illness.

2. Nasopharyngeal specimen is superior for the following reasons -

NAAT has replaced Culture for diagnosis because NAAT can identify the causative agent even before the disease enteres its infective state. NAAT utilises DNA amplification techniques like PCR to determine the causative agent within hours. Whereas culturing the agent from a sample inoculation can take almost 3-6 days to develop thereby delaying treatment.

3. The patient did not rerspond to the antimicrobial she was given because there is a very high possibility that the infection had developed resistance to it. It may be possible that the mother and the brother consumed antimicrobials to treat their cconditions, but did not complete the full course of treatment leading to the development of resistant microbes in the process which then infeccted all the three family members. It ccould also be that they used anti microbials to treat all the simple infections that they had thereby allowing the microbes to become resistant.

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