Jenny is 3 years old. She has had a cold for a few days. Since yesterday she has had a fever of 39.5° and has been coughing through the night. You examine her and find that her throat is inflamed, her tympanic membranes are pink and she has some wheezing and coarse crepitations throughout her chest.
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(a) What additional signs would you look for to check whether she might have a lower respiratory tract infection?
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You need to look for signs of respiratory distress. In childhood the signs are alar flaring, tachypnoea, tracheal tug and subcostal and intercostal retractions. If present they indicate significant respiratory distress.
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(b) How reliable is auscultation and percussion in a child of this age?
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In childhood it is very easy to hear transmitted noises from the upper respiratory tract. It can be difficult to differentiate these sounds from lower respiratory tract signs, which is why the external signs of respiratory distress are so important. The location of signs can also be unreliable.
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(c) What investigations would you consider?
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If Jenny is poorly and showing signs of respiratory distress, a full blood count and blood culture are indicated along with a chest radiograph. If she seems well, once she is apyrexial, and there is no evidence of respiratory distress, she is unlikely to have serious lower respiratory tract disease and investigations are not required.
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(d) What is the likely causative organism?
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Given that the consolidation is focal rather than diffuse, a bacterial rather than viral cause is likely. Common organisms include Streptococcus pneumoniae and Haemophilus influenzae type B are most common. Less common are mycoplasma, group A streptococcus, and Staphylococcus aureus.
