CASE STUDY #1

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The patient was a 52-week-old male who was transferred to our institution with a 10-day history of choking spells. The child's spells began with repetitive coughing and progressed to his turning red and gasping for breath. In the prior 2 days, he also had three episodes of vomiting in association with his choking spells. His physical examination was significant for a pulse of 160 beats per min and respiratory rate of 72/min (both highly elevated). The child's chest radiograph was clear. There was no evidence of trachial abnormalities. His white cell count was 15,500/Fl with 70% lymphocytes. The culture from the nasopharyngeal swab is seen in Figure 1.

1. What was the organism infecting this child?

2. Why are specimens form the nasopharynx the specimens of choice in the diagnosis of this infection?

3. Why did this patient have a predominance of lymphocytes?

4. Were this child's clinical course and chest radiograph consistent with his infection? Explain your answer.

5. What is the epidemiology of this infection, and how might it be prevented?

6. The drug of choice to treat this infection is erythromycin. Clinically, the cough may persist for some time following therapy with erythromycin. Give possible reasons why a cough may persist in the face of erythromycin therapy.

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