The patient was a 3-year-old male who presented with a 4-day history of fever. He became
acutely ill and vomiting during lunch. Over the next 4 days he developed fever as high as 40°C
that were controlled by Tylenol. He also developed cough, rhinorrhea, and conjunctivitis. He
appeared to be fatigued and his parents reported that he was “very sleepy". Over the past two
days, his eyes begun to itch and were painful. His parents noted that his eyes were puffy and he
was sensitive to light. He had no rashes. The patient‘s lips were dried and cracked, and he had a
greatly reduced urinary output.
Other history pertinent to his illness is that he attended preschool twice per week, where he had
multiple sick contacts. His 1-year old sibling had otitis, some wheezing, vomiting, and a
productive cough.
On physical examination he had a temperature of 38.6°C pulse rate of 126/min, and respiratory
rate of 28/min. The significant findings included bilateral conjunctivitis with exudate in the left
eye, bleeding, cracked lips and rhinorrhea. He had shotty lymphadenopathy, but no rash. His
feet were slightly edematous. His respiratory examination was normal. Laboratory findings were
all normal. A nasopharyngeal swab was sent for rapid antigen testing for RSV and influenza A
virus.
Questions:
What is the most likely diagnosis of this patient? What symptoms does he have which
are consistent with his illness?
• How do you think this child became infected?
• What is the agent causing his infection? What are the key virulence factors of this agent?
• What is the usual outcome of this infection in this patient population?
• The finding of conjunctivitis in this child made the pediatrician examining him attempt to
elicit a history of rash. What was the clinical syndrome that this physician was concerned
about in this child given his clinical presentation?
• The infection this child has a vaccine preventable. Briefly describe the vaccine that is
used to prevent this disease. How this vaccine currently employed in the developing
countries?
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