Diagnostic Dilemma

Irritability in a one and a half years old boy

A 1½ years old boy presented with fever and cough for 4 days. He had similar complaints 1 month ago for which he was hospitalized and treated with intravenous antibiotics for 7 days. He was admitted for febrile convulsion at the age of 1 year during which lumbar puncture was done which was normal. There was no breathlessness, altered sensorium and convulsion presently. On examination, he was febrile and had tonsillitis. There were no meningeal signs and systemic examination was normal. The resident doctor noticed excessive irritability of the child on rounds. However, the child continued to remain normal during the rest of the time. A central nervous system (CNS) infection was suspected thus.

What is the cause of irritability in this child?
Expert Opinion :
This child seems to be irritable only when the doctor is coming for examination, otherwise, the child seems to be normal. That makes one suspect that the child is anxious and is scared of doctors. The reason why the child is scared of doctors may be due to repeated hospitalizations, needle pricks; intravenous antibiotics (which may be painful) and even a lumbar puncture (again done by a doctor) which has made the child realize that a doctor leads to pain. As a result, the child is anxious when he sees the doctor and starts crying. This should not be taken as a sign of CNS infection and just observation is required. This child was observed for next 2 days and remained normal.
Answer Discussion :
Abhishek Janjale
Basically irritable only during rounds so fear or phobia.
4 years ago
May be bc of IRTI but one should Rule out meningitis
4 years ago

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