An 8 year old boy is brought to your ED by his mum. The mum complains that her son has developed a cough and high temperature for the last two days. She also states that he is breathing rapidly and has been off his food.
On examination he is unwell with a few scattered crepitations in his chest.
Vital signs:
BP 90/60
PR 120/min
RR 35/min
T 39 degrees celcius
His blood tests show:
Hb 135 (112-145 g/l)
Plt 270 (140-400)
WCC 7 (4-11)
Neutrophils 4.1 (2-7)
The red cells show moderate cold agglutination. There are several
reactive lymphocytes. Platelet morphology is normal.
CRP 1
Urea and Electrolytes – normal
Questions:
- Describe and interpret?
- What are the differential diagnosis?
- What other tests are indicated?
- Give the causes of this condition in the different age groups in children
1. fever & tachycardia with respiratory symptoms
cold agglutinins, reactive lymphocytes
Hb 135 does not suggest anaemia (need to correlate with clinical volume status)
2 Mycoplasma pneumonia
differentials influenza, EBV, lymphoma
3. CXR, mycoplasma serology
if there was anaemia: retic count, coomb’s LFT. but I do not perceive indication here.
4. ?
mycoplasma common in primary school age
EBV more common in adolescence
flu and lymphoma.