Can You Help This Child Breathe?

November 1st, 2012 by INMED

Can You Treat This Child’s Respiratory Distress?

 

You are volunteering in Honduras by providing vacation coverage for the clinicians whom you met at the INMED Exploring Medical Missions Conference. A young mother approaches your health center carrying a one-year old child. He is febrile and breathing rapidly with shallow chest excursions. You are alarmed to observe that his sputum is mixed with blood and his limbs are cyanotic.

 

You immediately call for oxygen to be administered, but learn that the tank is all but empty. You also request a chest X-ray, but find the technician has left for the day. You next consider initiating empiric therapy for pneumonia. Regarding pneumonia management in low-resource communities which ONE of the following statements is TRUE?

 

A  Most deaths from pneumonia occur in elderly persons.
B  Treatment against pneumonia should be immediate and based on observations regarding a cough, fever, respiratory rate and chest retractions.
C  H. influenzae and pneumoccal vaccines are routinely administered.
D  Treatment with an antibiotic must be initiated only after obtaining bacteriological cultures.
E  Upper respiratory tract infections also cause severe health consequences.

 

Consider carefully before you respond. The correct answer is B. Medical care providers of all levels, particularly community health workers, must be trained to appropriately diagnose and treat pneumonia based on observations regarding a cough, fever, respiratory rate and chest retractions. Delay should never be made for further testing. Deaths from pneumonia are most common among children age 1 to 4 years. H. influenzae and pneumoccal vaccines are not routinely administered in low-resource nations. With the exception of streptococcal pharyngitis and subsequent rheumatic fever, upper respiratory tract infections rarely cause severe health consequences.

 

You initiate therapy with ampicillin. The following day you find that the child’s respirations have slowed. But, he continues to be febrile up to 40 degrees and the sputum is profuse and blood tinged. You take a specimen to the laboratory to make a Gram’s stain. As you approach the microscope slide to apply the chemical you are alarmed to notice that the sputum is moving. You place the slide under low power and observe hundreds of white worms of 4-8 mm in length. Of the following statements regarding Ascaris infection, the most common helminth to infect humans, which ONE is NOT true?

 

A  Periodic mass deworming of children improves their growth.
B  Complications may include intestinal obstruction and anemia.
C  Diagnosis is usually made when stool exam demonstrates eggs or larvae.
D  Migration through the lungs causes no symptoms.
E  Larvae undergo a period of migration to the alveoli to the esophagus.

 

Take you time in selecting your answer. The correct response is D. Ascaris infection (ascariasis) is acquired through ingestion of eggs, that mature into larvae in the gastrointestinal tract. Larvae undergo a period of migration by penetrating the gut and traveling via blood stream to the alveoli. Larvae next ascend the bronchial tree to the pharynx. They are again swallowed into the gut, where they mature to adult worms and release eggs into the stool. Manifestations of the lung migration phase of ascariasis may include fever, cough, wheezing, blood-tinged sputum, rales, dyspnea and pulmonary infiltrates. These findings may be difficulty to distinguish from typical pneumonia or bronchitis.

 

Based on this startling observation, you add the helminticide mebendazol to your child’s treatment. Over the ensuing days his breathing improves and his mother expresses sighs of relief. Do you want to sharpen your skills in diseases of poverty? Take advantage of the INMED International Medicine & Public Health Intensive Course. Next time you’ll even better manage a young child’s respiratory distress.

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