FAR EASTERN UNIVERSITY

DR. NICANOR REYES MEDICAL FOUNDATION MEDICAL CENTER

Regalado Ave., Corner Dahlia Street, West Fairview Quezon City 1118
Telephone Number: 427-02-13

DEPARTMENT OF CHILD HEALTH

CASE DISCUSSION

This is a case of T,S, 7 month old, male, with an admitting diagnosis Acute
Nasopharyngitis, viral; To consider Dengue Fever Syndrome, who came in with a chief complaint
of fever for 4 days.

TS, presented with cough and colds, which is a usually prodrome of an upper respiratory
tract infection. Few days after, the cough gradually became productive and distressing with
watery nasal discharge, this was associated with fever for 4 days, decreased in appetite and
decreased in activity. The above signs and symptoms were seen in Nasipharyngitis. He was on
supportive therapy such as Paracetamol 100mg/ml, 1ml drops every 4 hours for temperature of
>/= 37.8 C (TD:11.9mg/kg/dose) and Sodium Chloride nasal drops, to instill 1-2 drops per nostrils
as decongestant.

Nasopharyngitis is an acute, benign disease, very common in children. This is an

inflammation of the mucous membranes of the upper pharynx, the nasopharynx, or the
nasopharyngeal duct, which extends between the oral and nasal palate. Nasopharyngitis is
commonly caused by a virus, such as rhinovirus, coronavirus or respiratory syncytial virus.

Colds occur year-round, but the incidence reflects seasonal prevalence of the viral
pathogens associated with cold symptoms. Viruses that cause the common cold are spread by
small-particle aerosols, large particle aerosols and direct contact.

The most common pathogens associated with nasopharyngitis are the more than 200
types of human rhinoviruses, but the syndrome can be caused by many different virus families.
Rhinoviruses are associated with more than 50% of colds in adults and children. In young
children, other viral etiologies of the common cold include respiratory syncytial virus, human
metapneumovirus, parainfluenza viruses, and adenoviruses. Common cold symptoms may also
be caused by influenza viruses, non-polio enteroviruses, and human coronaviruses. Many
viruses that causes rhinitis are also associated with other symptoms and signs such as cough,
wheezing, and fever.

Viruses that cause the common cold are spread by 3 mechanisms: direct hand contact
(self-inoculation of ones own nasal mucosa or conjunctivae after touching a contaminated
person or object), inhalation of small-particle aerosols that are airborne from coughing, or
deposition of large-particle aerosols that are expelled during a sneeze and land on nasal or
conjunctival mucosa. Viral infection of the nasal epithelium can be associated with destruction
of the epithelial lining, as with influenza viruses and adenoviruses, or there can be no apparent
histologic damage, as with rhinoviruses and RSV. Regardless of the histopathologic findings,
infection of the nasal epithelium is associated with an acute inflammatory response
characterized by release of a variety of inflammatory cytokines and infiltration of the mucosa
by inflammatory cells. is acute inflammatory response appears to be partially or largely
responsible for many of the symptoms associated with the common cold.

Symptoms of the common cold vary by age and virus. In infants, fever and nasal
discharge may predominate. Fever is uncommon in older children and adults. e onset of
common cold symptoms typically occurs 1-3 days after viral infection. The first symptom noted
is often sore or scratchy throat, followed closely by nasal obstruction and rhinorrhea. The sore
throat usually resolves quickly and, by the 2nd and 3rd day of illness, nasal symptoms
predominate. Cough is associated with two-thirds of colds in children and usually begins after
the onset of nasal symptoms. Cough may persist for an additional 1-2 week after resolution of
other symptoms.

The physical findings of the common cold are limited to the upper respiratory tract.
Increased nasal secretion is usually obvious; a change in the color or consistency of the
secretions is common during the course of the illness and does not indicate sinusitis or bacterial
super- infection but may indicate accumulation of polymorphonuclear cells. Examination of the
nasal cavity might reveal swollen, erythematous nasal turbinates, although this finding is
nonspecific and of limited diagnostic value. Abnormal middle ear pressure is common during
the course of a cold. Anterior cervical lymphadenopathy or conjunctival injection may also be
noted on exam.

The viral pathogens associated with the common cold can be detected by polymerase
chain reaction, culture, antigen detection, or serologic methods. ese studies are generally not
indicated in patients with colds because a specific etiologic diagnosis is useful only when
treatment with an antiviral agent is contemplated, such as for influenza viruses.

Source: Nelsons 20th edition

Dr. Bautista/ Genuino-Magtoto/Campos/Ng Sinco/ Peralta/JiIC Rondina/ Co-JIIC de Luna/ Co-

JIIC Evangilista