Diagnostic Dilemma

Gastroenteritis, pleural effusion

A 1 year 8 months old boy presented with fever and diarrhea for 3 days and vomiting for 1 day. On examination, he had dry mucosa with delayed skin turgor. Vital parameters and systemic examination was normal. He was diagnosed as gastroenteritis with some dehydration and treated with intravenous fluids and zinc supplements to which he responded. Subsequently he developed cough and chest X-Ray showed right lower zone pneumonia and minimal pleural effusion within 3 days of the gastroenteritis. His hemogram showed hemoglobin of 12.2 mg/dl, WBC count of 14,900/cumm (30% neutrophils and 69% lymphocytes) with normal platelet count. Mantoux test was negative.

Are antibiotics indicated? If yes, which antibiotic?
Expert Opinion :
This child has presented with diarrhea that was self limiting. He has cough without fever and even hemogram shows lymphocytic predominance that is suggestive of non-bacterial etiology either viral or atypical organisms. Since the Chest X-Ray shows right lower zone pneumonia and minimal pleural effusion, atypical organism seems to be more likely. Bacterial pneumonia with pleural effusion will lead to fever, more toxicity and ill child. Viral pneumonia will lead to usually interstitial pneumonia, though pleural effusion is known. However, it would not lead to a localised pneumonia.
Thus, this child should be treated for atypical organism like mycoplasma. A macrolide group of antibiotic is recommended. This child was given a 5 day course of azithromycin following which a repeat chest X-Ray was normal.
Answer Discussion :
Meena Ghosh
No, consistent with viral picture..can follow up and wait. No hurry to start antibiotic
1 year ago
DrHesham Kordi
Yes.. Cefotaxime
1 year ago

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