A Five Year Old with High Fever, Aches, Pain and Poor Fluid Intake

1/22/2008

I saw a five year old with fever that began four days ago along with poor fluid intake and cough. The fever resolved for 24 hours but returned soon after. No other family members are sick. She is not sleeping well and does not feel like playing.

On examination she appears to be very unhappy and uncomfortable. She has an inflamed throat and appears very congested. There is no rash and no signs of dehydration. Her temperature in the office is 104 degrees Fahrenheit.

I performed a throat culture which was negative as well as a clinical blood count (CBC). The reason that I ordered a CBC was that I was concerned about the possibility of a secondary bacterial pneumonia especially in view of the 24 hour improvement and then return of the fever. The white blood cell count in the CBC revealed a very low count of 3.8. This is a classical finding with an influenza infection. This young girl indeed has the flu. The chest x-ray revealed a lobar or bacterial pneumonia which is a common complication of the flu. The child was treated with an injection of ceftriaxone (Rocephin). She will return for a follow up in 24 hours to asses whether an oral antibiotic will be given or another dose of antibiotic injection. I rarely use injectable antibiotics except in the case of bacterial pneumonias in very sick looking children.

      

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