At 9:00 AM on Tuesday, Jan. 8th, 2001 Mr. and Mrs. Otopainski show up at your clinic with their 18 month old boy. They mention that their son, Tommy, had a cold for about 3 days and except for a mild cough and runny nose he was fine until 1:00 AM last night. He woke up crying and he felt very hot to the touch. His temperature was 103oF and he was very fussy. After 2 hours of holding and carrying their son they gave him some Tylenol® and in about 30 min he settled down and got back to sleep again at 4:00 AM. At 8:00 AM he awoke again crying. The high fever (104oF) had returned and they noticed Tommy was tugging on his left ear. Tommy's parents are hoping this isn't something too serious because he has missed 3 days of daycare and the parents have used up all their sick days due to their son's previous illnesses (1 episode of pneumonia [1/30/00], 4 episodes of otitis media [5/10/00, 7/15/00, 12/20/00, 10/4/00]) over the past year.
Other than the Tylenol® he took last night he is not taking any medications. All his immunizations are up-to-date. Tommy is allergic to penicillin.
Physical Examination:
Vital signs: Temperature: 104o F, Heart rate:
140 beats/min, Height: 25 inches, Blood pressure: 120/80
mmHg, Respiratory rate: 30 breaths/min, Weight: 25 lbs
| General Appearance | Head | Eyes | Ears |
| Nose | Throat | Chest | Heart |
Obtain the answers to the following questions and email your answers to nchamberlain@kcom.edu by the deadline (October 5, 2001; 4:00 PM).
1. What is the most likely diagnosis of this patient's current problem?
2. What are the most common causes of this patient's problem?
4. What antibiotic would you prescribe for this child's current problem?
Take Care and Think Microbiologically!
Neal R. Chamberlain, Ph.D.
Infectious Diseases, Course Director.