A Child with Recurrent Pneumonia: A case study

In children, recurrent pneumonia is defined as the occurrence of more than one episode of pneumonia within a single year, or greater than three episodes within any duration; with radiographically documented clearing between episodes. Study in Journal of Postgraduate Medicine, Education and Research describes a study of a young girl.

An 11-year-old girl presented with history of recurrent episodes of fever, cough, and rapid breathing since the age of 5 years. Each episode had a similar pattern with moderate-grade fever, wet cough, fast breathing, and requirement of oral antibiotics for resolution. The frequency and severity of these episodes increased over time. There was no history of coughing up blood or pain in the chest. There was associated breathlessness, initially during the episodes, but later in between episodes as well. It progressed in recent years, such that at the time of presentation, the child was breathless even on minimal exertion.

These episodes were managed with antibiotics but did not correlate temporally with the episodes of respiratory symptoms. The family reported that the child's growth had faltered in recent years, and she was not gaining any weight for the past 2 years. Investigations for Allergic Bronchopulmonary Aspergillus was done. Sputum fungal smear and culture yielded yeast on three occasions. Oral prednisolone and broad-spectrum antifungal IV amphotericin were added. On day 17 of hospitalization, her sensorium deteriorated suddenly.

So the researchers concluded that a step-wise clinical approach confirmed the diagnosis of underlying chronic granulomatous disease with bronchiectasis, with disseminated tuberculosis involving the lungs and central nervous systems, complicated by Allergic Bronchopulmonary Aspergillus.

To emphasize- General physical examination is focused toward identifying dysmorphic features, growth pattern, and neurodevelopmental status of the child. so if there is presence and grade of digital clubbing pointing to an underlying chronic suppurative lung disease – that must be a keep point in directing towards further examination and investigations.

Reference:

Anvesh Reddy, Sachin Singh, Ketan Kumar; A Child with Recurrent Pneumonia: Approach to Diagnosis and Management Journal of Postgraduate Medicine, Education and Research, Volume 56 Issue 2 (April–June 2022).