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Prepared by.... .Kraison Pongwilairat
M.D.
Meijinee Densriwiwat M.D.
Thanyawee Puthanakit M.D
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Pertussis with secondary bacterial pneumonia
Differential diagnosis
1. Viral pneumonia ( adenovirus, parainfluenza, influenza, respiratory
syncytial virus)
2. Bacterial pneumonia (S.pneumoniae, H. influenza type B)
3. C. trachomatis infection, C. pneumoniae
4. Mycoplasma infection
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Treatment
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1.
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Ventilatory support: He developed paroxysmal cough, dyspnea,
and cyanosis after admission. Therefore, he was intubated and received
ventilator support for 5 days. |
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2.
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Antibiotics: |
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> Erythromycin estolate 40 MKD in four divided dose
for 14 days
> Ampicillin (100MKDay) 150mg iv q 6 hrs (for secondary bacterial
infection) for 7 days |
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Other investigations:
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> ESR 6 mm/hr
> Hemoculture for bacteria: no growth
> Sputum culture for bacteria: no growth
> Complete blood count during clinical course were |
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Day1
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Day4
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Day5
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Day10
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| Hb
g/dl |
11.6 |
12.3 |
10.7 |
10 |
| Hct
%, |
38.8 |
39.9 |
35.1 |
32.5 |
| WBC
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62,100 |
42,600 |
34,400 |
17,000 |
| Neutrophil (%)
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38 |
41 |
56 |
44 |
| Lymphocyte(%) |
57 |
46 |
38 |
45 |
| Monocyte
(%) |
0 |
12 |
6 |
7 |
| Eosinophil
(%) |
4 |
1 |
0 |
0 |
| Basophil
(%) |
1 |
1 |
0 |
1 |
| Platelet |
885,000 |
617,000 |
439,000 |
338,000 |
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Outcome:
> He was hospitalized for 20 days and was discharged without sequelae.
He was referred
to community hospital for catch-up immunization.
> His family members also received erythromycin for 14 days. |
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