case discussion: query

hi all
I have a case to share, and would be glad to have expert opinion.

 

8 month baby presented on 26 feb with history of measles 10 days prior, and respiratory distress since then, xray after admission showed bilateral parahilar opacities closely resembling bronchopneumonia, counts were near normal, child was given supportive care, was discharged on oral amox-clav as a so called prophylaxis for preventing secondary bacterial infection ( I disagree). Complete XRC resolution was documented within 3 days of admission, child was discahrged on oral antibiotics. There was no fever documented since admission.

 

After 3-4 days, child had fever again.. she couldnt come to hospital over weekend, when she followed up on 6 th March with fever of almost 3 days high grade; there was no refusal to feeds, she refused admission for some reasons, she was sent home after changing antibiotics to oral cefixime as monitoring wasnt possible.

 

There was no relief with same medicines, she was readmitted on around feb 10, on admission... the same patch on Xrchest was obvious, child was having significant distress and there were bilateral crepts, with high fever, again responded to conservative therapy, fever responded to cefotaxim IV after 3 days of therapy, distress settled.
The interesting thing in this course was that... the counts

 

on admission 26 feb TC 12000 poly 62  Lympho33
on readmission on 10 march TC 55000 P73  L 25, rest atypical L cytes
after 8 days of antibiotic therapy.. TC 99000 P 60 L 37, rest attypical L cytes.

 

Can we discuss what exactly we were dealing with?

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Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai