(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: In this case, the parents brought the child to the hospital one month after the child had developed cough and low-grade fever, during which the parents used medication to relieve the low-grade fever but the cough and other symptoms were gradually worsening. The child was diagnosed as having whooping cough through relevant examinations and combined with the child’s symptoms, and was treated with intravenous fluids and nebulized inhalation.
Basic information】Female, 6 years old
Disease Type】Pertussis
Hospital】Qilu Hospital of Shandong University
Date of consultation】May 2019
Treatment plan】Intravenous infusion (azithromycin lactate for injection) + nebulized inhalation drug therapy (budesonide suspension for inhalation, ipratropium bromide solution for inhalation)
[Treatment period] 1 week of hospitalization, regular outpatient review
Effectiveness】The child’s condition is basically stable now.
I. Initial consultation
When the parents brought the child to the clinic, they complained that the child had been coughing for more than a month, accompanied by symptoms such as low-grade fever and a stuffy, runny nose, etc. Although the low-grade fever improved after self-medication, the cough gradually worsened. The child visited the clinic at noon and was observed to be in good spirits, while no coughing occurred during the visit. A physical examination at the outpatient clinic did not reveal any obvious positive signs, and the child was initially considered to have pertussis, while mycoplasma infection could not be excluded.
II. Treatment
The child was given relevant tests, including nucleic acid test for pertussis and routine blood tests. The test results indicated that the nucleic acid test for pertussis was positive, while the routine blood count was significantly higher, with a value of 15.51×10^9/L and a significantly higher lymphocyte ratio. The parents were informed that the child needed to be treated in isolation to avoid excessive worry, and at the same time explained to the parents that pertussis could be recovered with timely treatment.
After communication with the parents, we decided to use azithromycin lactobionate for injection as an anti-inflammatory treatment, and to give budesonide suspension for inhalation and ipratropium bromide solution for inhalation as a nebulized inhalation to stop coughing and calm asthma. During the treatment process, the dosage of the corresponding drugs should be reduced as the child’s symptoms gradually resolved.
Treatment effect
After 1 week of treatment, the child’s body temperature and other basic signs had returned to normal, and the cough had improved significantly, especially the spasmodic cough at night had basically disappeared. When the child’s blood tests were repeated, the results showed that the child’s leukocytes decreased to 11.45×10^9/L and the nucleic acid test for pertussis was negative, which proved that the treatment was effective, and the child was discharged from the hospital. Half a month after discharge, the child’s condition had become more stable and there was no sign of recurrence.
IV. Notes
I was relieved to see the gradual reduction of the child’s symptoms, but I still need to remind the child and his parents to pay attention to the following points in their daily life.
1. try to provide the child with a quiet living environment, not only with appropriate temperature and humidity, but also with fresh air to avoid inducing spasmodic cough.
2. It is recommended that children with no contraindications be vaccinated against pertussis as soon as possible. Although the pertussis vaccine does not guarantee 100% that the child will not become infected, the vaccination will prevent the child from contracting the disease to the greatest extent possible.
3. Diet is recommended to be light, nutritious and easy to digest, such as soft rice, rice porridge and mashed vegetables, and more fresh vegetables and fruits, while avoiding oily, spicy and stimulating foods.
V. Personal insight
Usually, pertussis is a respiratory infection caused by Bordetella pertussis, but in this case, the child was vaccinated but still contracted pertussis, suggesting that not all children will have the corresponding protective effect after vaccination. In addition, as children age, their antibody titers to pertussis gradually decrease, which also contributes to the onset of pertussis.
Since the nocturnal paroxysmal spasmodic cough seen in the child in this case is the main clinical manifestation of pertussis, families are reminded that pertussis also needs to be considered when they find their own children with nocturnal paroxysmal spasmodic cough, and that they should seek medical attention and treatment at the hospital in a timely manner.