Unformatted Preview CLINICAL CASE: My baby has a high fever and a bad cough Lee, a six-month-old infant, is brought to the pediatric emergency room (ER) by his mother at about 8 AM on a Saturday. She tells you that Lee was well until two days ago, when he developed a cough and seems lethargic. At that time, she called her family physician. He advised her that it was probably a cold, to keep him well hydrated, and to administer one baby acetaminophen every 6 h if Lee develops a fever. Lee slept poorly that night and the next day was noted to have a low-grade fever of about 38 C. Since he seemed to be getting worse, the family physician was called again, but he continued to think Lee merely had a cold and should be treated symptomatically. Over the course of the day Lee s cough became more frequent, and by the evening he was breathing more rapidly than usual (tachypneic). These symptoms became more intense during the night and prompted the mother s visit to the ER with the baby. Your physical examination of Lee discloses a child of appropriate length and weight (normal growth) who has a normal overall appearance, that is, no dysmorphic facial features or bone abnormalities. He has an elevated temperature of 38.5 C and obvious respiratory symptoms (coughing and rapid breathing) but no meningeal signs such as neck rigidity or inconsolable irritability. Auscultation of his chest reveals coarse breath sounds but no bronchospasm or evidence of pulmonary consolidation. Examination of the pharynx reveals no evidence of pharyngitis or tonsillitis (inflammation of the phyarynx and tonsils); in fact, the tonsils seem reduced in size. You surmise that the patient has a pulmonary infection (probably a bacterial pneumonia) and have him admitted to the pediatric ICU (PICU). You also order a chest X ray, blood cultures, and a complete blood count (CBC). The chest X-ray result is available shortly after admission to the PICU (Pediatric ICU) and reveals the presence of bilateral perihilar infiltration. A complete blood count shows an increased white blood cell (WBC) count (15,500 cells/ L, reference rang
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