A 6-week baby presents with cough and cold for the past 3 days. Respiratory rate is 48/min. On examination, patient is febrile with wheezing but no chest indrawing. Which of the following is not true?(AIIMS May 2014, Nov 2013)
Correct Answer: Child has pneumonia
Description: Ans. a. Child has pneumonia (Ref: Nelson 19/e p1459)A 6 weeks old baby presents with cough and cold for the last three days. Respiratory rate is 48/min. Patient is febrile, there are no chest retractions but wheezing is present. This child is not suffering from pneumonia, as respiratory rate is < 60/minute without chest indrawing. The child is most probably suffering from bronchiolitis.Acute BronchiolitisCommon serious acute lower respiratory infection of infantsQ, mainly affecting 1-6 monthsQ oldUsually occurs in winter and springQRespiratory syncytial virusQ is implicated in most casesProtection against RSV is mediated by antibodies of IgG3 subclassQ. These antibodies have shorter half life and do not cross the placenta in substantial amount so as to offer protection to the infant.Pathogenesis:Resistance to the airflow is increased both during inspiration and expirationQTrapping of air inside the alveoli causes emphysematous changesQThe presence of eosinophils in the blood and respiratory secretions suggest that the virus infection initiates the wheezing attack in a child who is already sensitized.Clinical Features:Respiratory distressQ is out of proportion to the physical signs in the lung.Air is trapped in the lung leading to emphysemaQ.Prognosis:Self-limiting illness, symptoms subside in 3-7 daysQ.Treatment:Essentially symptomatic , oxygen remains the mainstayQ of treatment. It is administered continuously even in the absence of cyanosisQ.Antibiotics have no role.Ribavirin, an antiviral agent has no role in infants who were previously healthy.Ribavirin shortens the course of illness in infants with underlying congenital heart disease, chronic lung disease and immunodeficiencyQ.Beta 2 adrenergic drugs and ipratropium are not recommended for infants less than 6 monthsQ.
Category:
Pediatrics
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