Patient case: Pneumonia in Sub-Saharan Africa.
J.N, a 4-year-old girl, is brought to the rural health clinic by her mother with complaints of fever, cough, and difficulty breathing for the past five days.
J.N 's illness began with a high fever and cough that her mother initially treated with traditional remedies. Despite this, J.N 's condition worsened, and she developed rapid breathing, wheezing, and poor appetite. Her mother also noticed that Josephine appeared more fatigued than usual and was not interested in playing with other children.
J.N lives in a small, thatched house with her parents and two siblings. The family relies on wood for cooking, which produces significant indoor smoke. Access to clean water and sanitation is limited. The village has a high prevalence of respiratory infections, especially among young children.
- General: Ill-appearing, lethargic, moderate respiratory distress
- Vitals: BP 90/60 mmHg, HR 130 bpm, RR 48 breaths/min, SpO2 88% on room air, temperature 39.5°C
- Respiratory: Tachypnoea, nasal flaring, intercostal retractions, decreased breath sounds with crackles and bronchial breath sounds in the right lower lobe
- Cardiovascular: Tachycardia, no murmurs
- Abdomen: Soft, non-tender, no organomegaly
- Chest X-ray: Consolidation in the right lower lobe, suggestive of bacterial pneumonia
- Complete Blood Count (CBC): Elevated white blood cell counts with a left shift
- Blood Culture: Pending
- Pulse Oximetry: SpO2 88% on room air
Community-Acquired Pneumonia (CAP)
Management Plan
- Antibiotic Therapy: Initiation of broad-spectrum antibiotics (e.g., amoxicillin) to cover common bacterial pathogens.
- Oxygen Therapy: Supplemental oxygen to maintain SpO2 above 92%.
- Fluid Management: Intravenous fluids to maintain hydration and electrolyte balance.
- Fever Management: Antipyretics (e.g., paracetamol) to reduce fever and improve comfort.
- Monitoring and Supportive Care: Close monitoring of respiratory status, hydration, and nutritional support.
J.N is admitted to the local hospital for further observation and management. His condition will be monitored closely, with adjustments to treatment based on clinical response and laboratory results. His family is educated on the importance of completing the full course of antibiotics and measures to reduce indoor smoke exposure.
This case highlights the challenges and typical presentation of pneumonia in a young child living in a resource-limited setting in sub-Saharan Africa.
A). Skin rash and joint pain
B). High fever, cough, and difficulty breathing
C). Vomiting and diarrhoea
D). Headache and dizziness
A). Living near a factory
B). Exposure to indoor smoke from wood cooking
C). High altitude
D). Drinking contaminated water
A). Swollen lymph nodes
B). Decreased breath sounds with crackles and bronchial breath sounds in the right lower lobe
C). Enlarged liver
D). Abdominal tenderness
A). Metronidazole
B). Amoxicillin
C). Ciprofloxacin
D). Acyclovir
