MONDAY PRESENTATION

Paediatric 2

8 MONTH OLD BOY

Previously well
Fever x 8 days Chesty cough 7 days

a/w difficulty breathing & occasional audible wheeze No rash/ post tussive vomiting/ fits Went to GP on D2 and given oral antibiotics (augmentin for 1 week) + sick contact- father had URTI

Examination showed minimal subcostal recession, afebrile Throat & ears: unremarkable Lungs good breath sounds, equal bilaterally, no crepitations or rhonchi.

FBC: WCC 12.3 (lymphocyte predominance 78%, neutrophil 11%), CRP <0.4

CHEST X-RAY

Opacity seen in the right upper zone A well defined thin wall lucent lesion measuring 2.7cm in R MZ, suggestive of pneumatocoele No pleural effusion/ cardiomegaly Suggestive of pneumonia with pneumatocoele of the R lung (Staph pneumonia is possible)

NPS

Staph aureus (mod growth) s:methicillin S. pneumoniae, s: erythromycin, ceftriaxone, penicillin & cotrimoxazole
Treated with iv Augmentin 240mg tds x 3/7 and oral Augmentin x 11/7 TCA respi clinic 1/12 with repeat CXR

PARTIALLY TREATED PNEUMONIA WITH PNEUMATOCOELE

PULMONARY PNEUMATOCOELE
Thin-walled, air-filled cysts that develop within lung parenchyma Single emphysematous lesions/ multiple thin walled, air filled, cystlike cavities Sequela to acute pneumonia

Commonly Staph aureus Others: Strep pneumoniae, H. influenzae, E. Coli, Gp A Strep, Kleb pneumoniae, Tuberculosis Non-infectious: hydrocarbon ingestion, trauma, positive pressure ventilation

Asymptomatic, no need surgical tx Treat pneumonia with antibiotics Periodic f/up care until resolution of pneumatocoele Slow resolution, no further clinical sequelae