Case Study 2
The patient was a 4-month-old female who was admitted to the hospital in March with severe
The patient was a 4-month-old female who was admitted to the hospital in March with severe respiratory distress. Five days prior to admission she had developed a cough and rhinitis. Two days later she began wheezing and was noted to have a fever. She was brought to the emergency room when she became lethargic.
One sibling was reported to be coughing, and her father had a “cold”. On examination she was agitated and coughing. She had a fever of 38.9°C, tachycardia with a pulse rate of 220 beats/min., tachypnea with a respiratory rate of 80/min., and blood pressure of 90/58 mm Hg. Her fontanelles were open, soft and flat. Her throat was clear. She had subcostal retractions and nasal flaring. On auscultation of her lungs, there were rhonchi as well as inspiratory and expiratory wheezes.
A chest radiograph revealed interstitial infiltrates and hyperexpansion. Arterial blood gasses on supplemental oxygen revealed a respiratory acidosis with relative hypoxemia. She was put in respiratory isolation in the pediatric intensive care unit and was subsequently intubated. Blood and nasopharyngeal cultures were obtained and sent to the bacteriology and virology laboratories. A rapid diagnostic test for RSV was positive and specific antiviral therapy was begun. She was also given the bronchodilator aminophylline to treat the bronchospasm that was resulting in her wheezing. She was extubated 5 days later and was discharged on day 8.
- What is the differential diagnosis for this patient’s pneumonia, and which of the possible viral agents is the most likely etiology?
- Described the epidemiology of the agent causing her infection.
- Describe diagnostic strategies available for detection of the agent. Why is it important to establish this diagnosis quickly?
- What treatment strategies are available for this infection?
- What are the hospital’s infection control issues related to this patient’s diagnosis?
- Besides infection control measures, what strategies are available for prevention of this infection?
- Describe the patho-physiologic basis for wheezing?