Family Medicine 21 12-Year-Old Female with Fever
Patient History of Present Illness
Marissa Payne is a female patient who is 12 years old and has complaints of cough, fever, sore throat, muscle aches, and headaches over the past three days. She has not had contact with a sick person. There are no crackles in the cervical lymphadenopathy, but there is a hyperemic oropharynx, occasional wheezes, and generalized rhonchi on physical examination. She has not been immunized against COVID-19 and the influenza virus.
In this case, influenza is the primary diagnosis. Influenza is associated with symptoms in the infection of the respiratory tracts, as well as systemic symptoms like myalgia, headache, fever, and fatigue (Mayo Clinic, 2021). Children with influenza often have headaches, sore throats, and a general feeling of malaise before their upper respiratory symptoms, like coughing, show up (Mayo Clinic, 2021). It is common for patients to be able to pinpoint the exact hour of influenza’s onset. Winter is a common time for outbreaks to occur. In some adults and children, headache is the initial symptom. Young children commonly have a fever above 102.2 °F (Mayo Clinic, 2021).
On the other hand, older children may appear with a jumble of symptoms, making it difficult to tell if they have influenza (Mayo Clinic, 2021). Fever-induced seizures can occur in infants as young as six months old. Flu symptoms might induce rhonchi on a lung exam. Rhonchi are a side effect of influenza and not one of the most important things that a practitioner looks for when someone has the flu (Mayo Clinic, 2021). Influenza mostly affects a greater percentage of preschool and school-aged youngsters each year (Mayo Clinic, 2021). Children under the age of two are more likely to experience complications and need hospitalization (Mayo Clinic, 2021). It is possible that Marissa’s aches and pains are a sign of influenza. Marissa has a sore throat, which does not necessarily mean she has influenza, but it is part of a larger set of symptoms that are not prevalent in other diseases.
Group A streptococcal pharyngitis is another possible diagnosis. This infection causes fever, sore throat, lack of cough, and sensitive lymphadenopathy of the cervical region are the most common symptoms (Arnold & Nizet, 2018). Group A streptococcal pharyngitis could be a possibility, but considering Marissa’s other symptoms and the discovery of painful cervical lymphadenopathy, this appears less plausible than it might seem.
Acute bronchitis is the other possible diagnosis. Acute bronchitis is coughing due to inflammation of the major airways in the lungs Sputum with purulent content is found in 50% of patients with inflammation of the tracheobronchial system (Singh et al., 2022). Viruses are the most common cause. It is difficult to tell the difference between a URI and acute bronchitis in the first few days. When it comes to acute bronchitis, a cough that lasts longer than five days is common (Singh et al., 2022). Patients with bronchitis can have rhonchi, scattered wheezes, or a normal lung exam, depending on the severity of their illness (Singh et al., 2022). When the big airways are inflamed or mucus-filled, they produce rhonchi, a series of pulsating sounds (Singh et al., 2022). In this case, Marissa is experiencing signs of acute bronchitis, including coughing, fever, and rhonchi; however, her other symptoms, including headache, myalgia, and sore throat, cannot be explained by this condition.
To confirm the primary differential diagnosis, tests are recommended. Therefore, in this case, we need a rapid influenza test to confirm the presence of influenza (CDC, 2019). The rapid influenza lab result is positive. Also, a rapid test for group A Streptococcus is recommended to rule out Streptococcal Pharyngitis whereby the results are negative hence ruling out group A Streptococcal Pharyngitis (Luo et al., 2019). On the other hand, a lipid profile test is recommended. A lipid profile test consists of the following: Total cholesterol, High-density lipoprotein, as well as Low-density lipoprotein (Lee & Siddiqui, 2021). These tests help in assessing cholesterol and lipoprotein abnormalities caused by obesity.
Marissa’s situation does not warrant the use of influenza medications like Oseltamivir or Zanamivir because they are only suggested for use within 48 hours of the onset of the symptoms (CDC, 2022). In this case, ibuprofen and acetaminophen are recommended for pain and fever treatment, respectively (Clinic Cleveland, n.d.). In addition, honey and lemon might be taken by the patient (Jovinally, 2021). According to several studies, coughs and sore throats may be lessened and soothed with honey and lemon.
Educating the patient on how to prevent virus transmission by cleaning the hands, covering the nose when sneezing, and remaining home from school until the symptoms have subsided (CDC, 2022). Education on the dangers of secondhand smoke exposure (CDC, 2022). Influenza and bronchitis could be exacerbated by smoke (CDC, 2022). Exercises and balanced diet: Marissa is obese because her body mass index (BMI) is greater than the 95th percentile. An exercise plan is recommended for kids with high cholesterol or low LDL (Enkhmaa et al., 2018). In Marissa’s case, her cholesterol was 185mg/dl, which is beyond the normal range of 170 mg/dl (Enkhmaa et al., 2018). Her LDL level (120mg/dl) was within the normal range, so she did not require any medical treatment.
Referral to a dietitian. Some of the dishes in the school’s dietary pattern are unhealthy and could lead to obesity in other children (Kim et al., 2019). As a result, she requires assistance managing her weight and diet, as well as identifying any issues that may arise. Obesity will be addressed in this way.
Arnold, J. C., & Nizet, V. (2018). Pharyngitis. In Principles and Practice of Pediatric Infectious Diseases (pp. 202-208.e2). Elsevier. https://doi.org/10.1016/b978-0-323-40181-4.00027-x
CDC. (2019, November 12). Rapid influenza diagnostic tests. Cdc.Gov. https://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm
CDC. (2022). Influenza antiviral medications: Summary for clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
Clinic Cleveland. (n.d.). The common cold and the flu. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13756–colds-and-flu-symptoms-treatment-prevention-when-to-call
Enkhmaa, B., Surampudi, P., Anuurad, E., & Berglund, L. (2018). Lifestyle changes: Effect of diet, exercise, functional food, and obesity treatment on lipids and lipoproteins. MDText.com. https://www.ncbi.nlm.nih.gov/books/NBK326737/