Case 079: Upper Respiratory Infection

PATIENT PRESENTATION

Chief Complaint

“My son’s cold is getting worse. He is so congested that he isn’t sleeping well, he says his right ear hurts, and he has a fever today.”

History of Present Illness

An 8-year-old boy presents with his mother to his pediatrician’s office with a 7-day history of cold symptoms (rhinorrhea, nasal congestion, and postnasal drainage) that are worsening. His signs and symptoms are consistent with acute bacterial rhinosinusitis and acute otitis media.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of acute bacterial rhinosinusitis (ABRS) does this patient have?

   Hint: See Sinusitis in PPP

2. What signs and symptoms of acute otitis media (AOM) does this patient have?

   Hint: See Otitis Media in PPP

3. Should this patient be treated with an antibiotic? If yes, what is the drug of choice for this patient?

   Hint: See Otitis Media, Sinusitis, and Figures 75-1, 75-2, and 75-3 in PPP

4. What adjunctive treatments could be considered for this patient?

   Hint: A viral upper respiratory tract infection may have preceded ABRS and AOM, and concurrent allergic rhinitis is a likely contributor to the development of these infections in this patient. See Otitis Media, Sinusitis, Common Cold and Table 75-6 in PPP.

5. What counseling points regarding treatment would you discuss with this patient’s mother?

   Hint: See Otitis Media and Sinusitis in PPP.

FOLLOW-UP

Three days later, the patient’s mother calls the pediatrician’s office because her son is experiencing “diarrhea”. She is worried that he is allergic to the antibiotic that was prescribed. After asking her to describe the appearance of his stool, she states that some are formed but that some are “mushy”. Her son has been taking the antibiotic as prescribed and he has not missed any doses. His other symptoms have improved, and he has been afebrile for more than 24 hours. He is eating and drinking normal amounts. What actions, if any, would you take?

Hint: See Problematic Drug Classes and Treatment Options in PPP to help determine if this is an actual allergic reaction

CASE SUMMARY

Global Perspective

AOM is a common childhood infection worldwide with an increased incidence in high-risk populations, such as Native Americans, Inuit, and aboriginal Australians. Complications such as mastoiditis and hearing impairment are more common in these high-risk groups, in children with lower socioeconomic status or who live in crowded conditions, and in developing countries. ABRS is also common worldwide and associated with allergic rhinitis, asthma, cystic fibrosis, gastroesophageal reflux, ...