Recurrent Bout of Illness

Casebank Counselling
1

Presentaion

  • 5Y/SON-GP
  • 3 events of flu
  • Reassured that it is viral infection
  • Presenting complaint: Baby is fine and well, up to date with jabs, eating and developments ware fine

Rule out

  • Red flags: Low intake, vigorous cough and Severe SOB
  • Cystic Fibrosis
  • Head to toe
  • BirdDD

Risk factor

  • Family hx of immunodeficiency
  • No Childhood Immunization
  • Seasonal Infection
  • Diet

Examination & Investigation

  • Observation + General Physical Examination
  • Throat +Ear +Chest Examination
  • Nil

Managment

  1. Why>lt happens in children in this age and gets better itself and it helps in the immunity getting better.
  2. She was reassured that it’s not serious just regular follow ups and good diet and fluid intake was needed ± saline nebs
  3. Advice : healthy diet, supplements, regular health check-ups.
  4. Taking Flu jabs yearly.>Intranasal Flu jab >Yearly.
  5. If these infections are >8Times/Year then we will refer. + Cough persistent more than 1 week.

Advice:

  1. Avoid cold weather
  2. Avoid travelling to adverse weather condition.
  3. Avoid all outside junk food
  4. Avoid dust exposure

Safety Netting

  • Regular follow
  • If severe ill > don’t send him school to avoid spread.
  • why this is happening?
  • Bad immune system?
  • Need any refer ?
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Patient Information

• Opening sentence : “My little Carl is always sick”
• Your son has had 6 episodes of infections in the last year.

Patient concerns

  • Why does he keep having these infections?
  • What do you think is wrong with him?
  • Will it affect him in the future (complications)?
  • Will he grow out of it?
  • Is my child immunocompromised?

History of presenting complaint

  • What symptoms does the child usually develop?
  • How frequent does he get the infections?
  • In the last one year, how many times would you say he has had an infection?
  • How is the child treated when he gets an infection? Do they need antibiotics?

Systemic review

  • Respiratory symptoms:
    – Ask about cough, shortness of breath, fever, running nose, sneezing.
    – How often does this happen?
    – Any wheezing
    – Coughing out phlegm?
  • GIT symptoms:
    – Any tummy pain?*
    – Diarrhoea and vomiting
    – Biliary disease: Any jaundice, Yellow eyes
    – Pancreatic: Pale, fatty stools
  • Genitourinary: Any water works infection in the past?
  • Musculoskeletal: Any joint pain?, Any rashes?
  • CVS: Any heart problems?, Any swelling of the legs?

Paediatric history

  1. Eating and drinking: is he eating and drinking well
  2. Other children:
    – Do you have any other children?
    – If yes, anyone with similar problems?
  3. Social skills
    – Playing with others well
    – Children with atopic disease seem more likely to develop recurrent and persistent upper respiratory infections
  4. Development:
    – Any concerns regarding his developmental milestones
    – Is he walking well?
    – What about his speech
    – Does he play with others
  5. Vaccinations
    – Is he up to date with all vaccinations?
  6. Pregnancy:
    – Any problems in the current pregnancy?
    – How many weeks was he when he was born?

Other histories:

  • DHx
    – Is he/she on any regular medication?
  • Allergies
    – Does the child have any allergies?
  • Effects of symptoms:
    – Do the infections stop the child from going to school?
    – Is the child going to nursery?

Differential diagnosis

  • Normal Situation,
  • Primary immunodeficiency
  • Cystic fibrosis
  • Any problems opening the bowels after he/she was born? (meconium ileus)
  • Any history of constipation?
  • Secondary immunodeficiency e.g. HIV infection, diabetes
  • Recurrent infection secondary to medication (e.g. steroids)

Management

  • Arrange a face to face appointment
  • Routine blood test: FBC, U&E, fasting glucose,LFTs,
  • Refer to a Paediatrician
  • Explain what a specialist would do: specialist investigations such
    – Immunological blood tests to rule out immunodeficiency syndromes and cystic fibrosis
    – Sweat test to exclude cystic fibrosis
    – Refer to paediatrician for further specialist investigations because the child has had 6 or more infections
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