A 14-month-old infant suddenly develops a fever of 40.2°C (104.4°F). Physical examination shows an

Discussion in 'MRCPCH forum' started by samuel, Sep 19, 2014.

  1. samuel

    samuel New Member

    A 14-month-old infant suddenly develops a fever of 40.2°C (104.4°F).
    Physical examination shows an alert, active infant who drinks milk eagerly.
    No physical abnormalities are noted. The WBC count is 22,000/μL with
    78% polymorphonuclear leukocytes, 18% of which are band forms. Which
    of the following is the most likely diagnosis?
    a. Pneumococcal bacteremia
    b. Roseola
    c. Streptococcosis
    d. Typhoid fever
    e. Diphtheria
  2. samuel

    samuel New Member

    Ans A
    In an infant who appears otherwise normal, the sudden onset of high fever, together with a marked elevation and shift to the left of the WBC count, suggests pneumococcal bacteremia. The incidence of pneumococcal disease producing this picture may be decreasing with the widespread use of a pneumococcal vaccine. Viral infections such as roseola occasionally can present in a similar fashion but without such profound shifts in the blood leukocyte count. Streptococcosis refers to prolonged, low-grade, insidious nasopharyngitis that sometimes occurs in infants infected with group A β-hemolytic streptococci. Neither typhoid fever nor diphtheria produces markedly high WBC counts; both are characterized by headache, malaise, and other systemic signs. Other bacteria that should be considered in a child with this presentation include H influenzaetype B (rare in the vaccinated child) and meningococcus.

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