Nocturnal

A 12 year old boy presents with a persistent non-productive cough for 5 weeks, associated with nocturnal paroxysms, inspiratory whoops, and intermittent post-tussive vomiting. He also experienced on and off wheezing.

He was anorectic, and lost around 2 kg of weight during the same period. His symptoms did not respond to a course of Amoxicillin.

He was completely healthy earlier, with unremarkable medical and surgical histories. All immunizations are up to date.

Select Relevant Investigations
FBC + CRP

Performed

Hb: 13.4 g/dL (11.5-15.5)
WBC: 17,200/mm3 (4,000-11,000)
Neutrophils: 40%
Lymphocytes: 55%
Platelets: 289,000/mm³ (150,000-350,000)
C-reactive Protein: 2 mg/dL (< 6)
Chest X-Ray

Performed

The X-ray of the chest appears normal.
Flexible Bronchoscopy

Performed

Flexible bronchoscopy will be performed tomorrow.
Sputum Induction and Cultures

Performed

Nebulization is used to induce samples of sputum. Cultures show no growth, but PCR is positive for Bordetella pertussis.

Select Relevant Management
Oxygen
Prophylaxis of Close Contacts
Clarithromycin
Immunization