Fever, Irritability and Refusal to Feed

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question
4 months old male child came with fever, irritability since 2 days. Infant was feeding well till then. There was history of third dose of DPT/Polio given 2 days back. He was given Paracetamol. Next day fever & irritability continued coupled with refusal to feed. On examination : Temp. 99degF, Heart rate 110 per min., RR 40, AF being narrow could not be well appreciated. ENT was Normal, Per abdomen Soft, Liver 1cm palpable firm, Spleen not palpable. Baby was then admitted & put on maintenance I.V. fluids. CBC showed : Hb 11.3, WBC 10100, N49, E2, L49, Low Platelets of 63000.Smear for Malaria parasite negative. Fever subsided but irritability & refusal to feed continued for next day. CBC was repeated on second day of admission showed Hb 11.1, WBC 8300, N36, E5, L56, M3, Platelets dropping further to 55000, Serum Proteins 7.9 with albumin 3.6 , SGPT 385, PT 14 with control 14, PTT 39 with control 29, Serum Electrolytes : Na 145, K 5.2, Cl 109. Child is haemodynamically stable with good urine output. What is the probable diagnosis and further line of treatment?
Answer
Rule out dengue, malaria, leptospirosis and septicemia since the child has thrombocytopenia with hepatitis and deranged PTT. Do serum ammonia and blood sugar. Treatment would be according to the causative agent. Back to All Questions

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