MICROBIOLOGY The patient is a 6-year-old male with multiple medical problems and was referred to the clinic to evaluate
Posted: Tue May 17, 2022 10:45 pm
MICROBIOLOGY
The patient is a 6-year-old male with multiple medical problems and was referred to the clinic to evaluate apparent weakness and recurrent pulmonary infections.
The patient had had severe pneumonia eight times during the previous six years, including three episodes necessitating hospital admission. Each infection was characterized by the sudden onset of fever with a temperature as high as 103°F., shaking chills, nausea, anorexia, and subcostal chest pain. A persistent chronic cough had been present for two years, yielding approximately a half cup of yellow-green sputum daily with occasional blood streaking. Studies for acid-fast organisms in the sputum had been negative.He had received antibiotic treatment on numerous occasions because of recurrent sinusitis.The patient gradually lost 5 pounds in weight during the two years before admission, with associated increasing weakness. Nine weeks before entry, explosive diarrhea developed, with the passage of six watery stools every morning and one or two every evening; there was no nausea, vomiting, and no mucus was observed in the stools.
On several occasions, the diarrhea was preceded by crampy lower abdominal pain. There was no specific food intolerance.
Physical examination revealed a thin, pale child weighing 32 pounds who appeared chronically ill. Several nontender posterior cervical nodes and numerous 1-cm Inguinal nodes were palpable bilaterally. The anteroposterior diameter of the chest was increased, and the thorax was hyper resonant. The breath sounds were slightly decreased at the bases, and numerous rhonchi were audible, especially during expiration. The heart was not enlarged. The abdomen was flat and taut; the bowel sounds were normal. The liver was normal. There was mild pitting edema of the ankles. The neurologic examinationwas negative.
The table below shows the results of the patient's laboratory work. The values between parenthesis are the reference normal values.
Blood Group
O Positive
Antibody screening
Negative for anti-nucleus antibodies (autoimmunity
Serum IgA
0.8 mg/dL (90-325 mg/dL)
Serum IgG1
2.4 mg/dL (500-1200 mg/dL)
Serum IgG2
1.6 mg/dL (200-600 mg/dL)
Serum IgG3
0.6 mg/dL (50-100 mg/dL)
Serum IgG4
0.8 mg/dL (50-100 mg/dL)
T lymphocyte count
1200 cells/mm3 (500-1600cells/mm3)
B lymphocyte count
140cells/mm3 (100-320cells/mm3)
Based on patient history, clinical signs, and laboratory data, answer the following questions:
The patient is a 6-year-old male with multiple medical problems and was referred to the clinic to evaluate apparent weakness and recurrent pulmonary infections.
The patient had had severe pneumonia eight times during the previous six years, including three episodes necessitating hospital admission. Each infection was characterized by the sudden onset of fever with a temperature as high as 103°F., shaking chills, nausea, anorexia, and subcostal chest pain. A persistent chronic cough had been present for two years, yielding approximately a half cup of yellow-green sputum daily with occasional blood streaking. Studies for acid-fast organisms in the sputum had been negative.He had received antibiotic treatment on numerous occasions because of recurrent sinusitis.The patient gradually lost 5 pounds in weight during the two years before admission, with associated increasing weakness. Nine weeks before entry, explosive diarrhea developed, with the passage of six watery stools every morning and one or two every evening; there was no nausea, vomiting, and no mucus was observed in the stools.
On several occasions, the diarrhea was preceded by crampy lower abdominal pain. There was no specific food intolerance.
Physical examination revealed a thin, pale child weighing 32 pounds who appeared chronically ill. Several nontender posterior cervical nodes and numerous 1-cm Inguinal nodes were palpable bilaterally. The anteroposterior diameter of the chest was increased, and the thorax was hyper resonant. The breath sounds were slightly decreased at the bases, and numerous rhonchi were audible, especially during expiration. The heart was not enlarged. The abdomen was flat and taut; the bowel sounds were normal. The liver was normal. There was mild pitting edema of the ankles. The neurologic examinationwas negative.
The table below shows the results of the patient's laboratory work. The values between parenthesis are the reference normal values.
Blood Group
O Positive
Antibody screening
Negative for anti-nucleus antibodies (autoimmunity
Serum IgA
0.8 mg/dL (90-325 mg/dL)
Serum IgG1
2.4 mg/dL (500-1200 mg/dL)
Serum IgG2
1.6 mg/dL (200-600 mg/dL)
Serum IgG3
0.6 mg/dL (50-100 mg/dL)
Serum IgG4
0.8 mg/dL (50-100 mg/dL)
T lymphocyte count
1200 cells/mm3 (500-1600cells/mm3)
B lymphocyte count
140cells/mm3 (100-320cells/mm3)
Based on patient history, clinical signs, and laboratory data, answer the following questions: