Patient Presentation The patient is an 18month old girl who

Patient Presentation

The patient is an 18-month old girl who presented unconscious at the ER with high fever (41.2° C) and convulsive seizures. She was immediately intubated and sedated (diazepam 0.8 mg/kg) and started on intravenous antibiotics (ceftriaxone 2 g/day, gentamicin 2.5 mg/kg, vancomycin 15mg/kg/ 8 hours). Her condition is currently stable.

Past Medical History

Patient history includes a diagnosis of cyanotic heart disease early in life during crying spells. This led to diagnosis of an endocardial cushion defect, which was repaired surgically (Blalock-Taussing shunt), and the patient healed appropriately. The patient had a previous septic infection of Klebsiella pneumonia that was treated with antibiotics (cephalosporin) and resolved. Patient has received no childhood vaccines, except first series of diphtheria/tetanus/pertussis.

Family History

The patient is the daughter of parents originating from southern Utah, and the parents are distant relations. The patient had an older brother who died of overwhelming sepsis from Streptococcus pneumonia infection at age 3, and currently has a newborn sister (8 weeks) who is healthy. The mother recently stopped breast-feeding the patient due to the new baby, and the patient was also recently enrolled in a day care program with other children. The parents have chosen to not to complete vaccination of their children due to concerns that it might cause autism. Patient did receive first series of diphtheria/tetanus/pertussis vaccinations.

Do you expect this patient to be suffering from systemic infection? Is an immune response occurring? What based on their presentation and past medical history led you to your answer?

Please help.

Solution

NO, the patient is not suffering from systemic infection because as the name suggests that the systemic infection spreads through the systems. The details stated infers that the child is having febrile seizures that occur during high fever in children in young age.

Yes, there are chances of immune response as the child is having a high fever and has undergone surgery for cyanotic heart and had a cardiovascular defect. The child has not vaccinated also as per the vaccines available except the first dose of diphtheria/tetanus/pertussis. So the chances of an immune response are higher as the child is having a high fever and does not receive the booster doses of the given vaccines along with the other immunizations.