Write a pediatrics case presentation with fever cough and cold A case of acute febrile illness

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Pediatric Case Presentation: Acute Febrile Illness with Fever, Cough, and Cold

PATIENT IDENTIFICATION


Name	Master Arjun K.
Age	3 years 6 months
Sex	Male
Weight	14 kg
Informant	Mother (reliable)
Date of Admission	July 21, 2026
IP No.	2026/PEDS/0721

CHIEF COMPLAINTS

Fever - 4 days
Cough - 3 days
Runny nose and nasal congestion - 3 days
Decreased appetite - 2 days

HISTORY OF PRESENT ILLNESS

Master Arjun K., a 3½-year-old male child, previously well and fully immunized, presented to the pediatric OPD with a 4-day history of acute onset high-grade fever, cough, and coryza.

Fever: Onset was sudden, high-grade (recorded maximum 39.4°C at home). The fever was continuous in pattern with partial relief on paracetamol. No rigors or chills. No associated rash, photophobia, neck stiffness, or altered sensorium. No seizures.

Cough: Dry, non-productive cough beginning 1 day after the onset of fever. No barking quality, no whooping, no blood in sputum. The cough was worse at night. No history of stridor or audible wheeze.

Coryza / Cold: Watery nasal discharge progressing to thick, grayish-yellow discharge. Bilateral nasal obstruction. Sneezing present. No epistaxis. The nasal mucosa appeared swollen on examination.

Throat: Mother reports the child was complaining of throat discomfort on day 1-2, which has since partially resolved.

Feeding / Activity: Appetite significantly reduced. Oral intake approximately 50% of normal. Tolerating liquids. No vomiting. No diarrhea. Urine output adequate (last voided 3 hours prior to admission). Activity mildly reduced - child is playful but tires easily.

Breathing: Mother denies any fast breathing, noisy breathing, or chest retractions. No cyanosis observed. Sleep relatively undisturbed except for cough.

HISTORY OF SIMILAR COMPLAINTS

Three similar episodes in the past 2 years, all self-limiting, occurring mostly in winter months. No prior hospitalization. No known diagnosis of asthma or recurrent wheezing. No history of allergic rhinitis.

BIRTH HISTORY

Full-term normal vaginal delivery, hospital born
Birth weight: 3.1 kg
No perinatal complications, no NICU admission
Cried immediately after birth

DEVELOPMENTAL HISTORY

Age-appropriate milestones achieved. Speaks in full sentences, runs and climbs well. No regression noted.

IMMUNIZATION HISTORY

Immunized as per National Immunization Schedule (NIS) up to date:

BCG, OPV, IPV, Hepatitis B - completed
DPT series - 3 primary + 1 booster completed
MMR - 1st dose at 9 months, 2nd dose at 15 months
Typhoid conjugate vaccine - given at 9 months
Influenza vaccine - not given (relevant to current illness)

DIETARY HISTORY

Mixed diet appropriate for age
Currently on 1,200 kcal/day estimated intake at baseline
Breast-fed until 18 months; weaned appropriately
No significant food allergies

FAMILY HISTORY

Father: 30 years, healthy, non-smoker
Mother: 27 years, healthy
No siblings
No family history of asthma, tuberculosis, cystic fibrosis, or atopic disease
No sick contacts in immediate family; child attends preschool where 3 other children reportedly had similar illness in the past week (epidemiological clue)

PAST MEDICAL HISTORY

No chronic illness
No prior hospitalizations
No known drug allergies
No prior surgical procedures

SOCIAL HISTORY

Lives in urban area, 2-bedroom house, adequate ventilation
No indoor smoking exposure
Attends playschool (possible source of infection)
No recent travel history

GENERAL PHYSICAL EXAMINATION

Parameter	Finding
General appearance	Alert, moderately sick-looking child, irritable but consolable
Temperature	38.8°C (axillary)
Heart Rate	110 bpm, regular, good volume
Respiratory Rate	28 breaths/min (normal for age: <40/min)
SpO2	98% on room air
Blood Pressure	90/60 mmHg (appropriate for age)
Weight	14 kg (on 50th percentile for age)
Capillary refill time	<2 seconds
Skin	Warm, moist; no rash, no petechiae, no jaundice
Eyes	No conjunctival injection, no pallor, no icterus
Hydration	Mildly reduced oral intake; mucous membranes moist; anterior fontanelle not applicable (closed)
Lymph nodes	Bilateral submandibular and anterior cervical lymph nodes palpable, 0.5-1 cm, soft, mobile, mildly tender - consistent with reactive adenopathy

SYSTEMIC EXAMINATION

Respiratory System

Inspection: Chest wall symmetrical; no nasal flaring; no subcostal, intercostal, or supraclavicular retractions; no tracheal tug
Palpation: Equal chest expansion bilaterally; tactile fremitus normal
Percussion: Resonant throughout; no dullness
Auscultation: Air entry equal bilaterally; bilateral scattered coarse crepitations in upper lung fields, predominantly on the right; no wheeze; no bronchial breathing; no pleural rub

Ear, Nose, Throat (ENT)

Ears: Tympanic membranes intact, no erythema, no bulging (otitis media excluded)
Nose: Bilateral mucosal erythema; swollen, erythematous turbinates; thick grayish nasal discharge
Throat: Posterior pharyngeal wall mildly erythematous and congested; tonsils grade I, no exudates, no crypts; uvula midline
Oral cavity: No Koplik spots; dentition normal

Cardiovascular System

S1 and S2 heard normally; no murmurs; no gallop rhythm; no hepatosplenomegaly

Abdomen

Soft, non-tender; no organomegaly; bowel sounds present; no guarding

Neurological

Conscious, oriented to mother; no neck stiffness; no Kernig's or Brudzinski's sign; pupils equal and reactive to light; no focal neurological deficit

PROVISIONAL DIAGNOSIS

Primary Diagnosis:

Acute Viral Upper Respiratory Tract Infection (URTI) - most likely rhinovirus or parainfluenza virus etiology - presenting as acute febrile illness with fever, cough, and coryza in a preschool-age child

Differential Diagnoses (to rule out):

Influenza - high-grade fever, dry cough, rapid onset; possible given no influenza vaccine received
Streptococcal pharyngitis - throat erythema present; need rapid strep test
Early bacterial pneumonia - coarse crepitations on auscultation; needs CXR
Croup (Laryngotracheobronchitis) - barky cough + stridor pattern; less likely (no barking cough, no stridor)
RSV bronchiolitis - more typical in infants < 2 years; less likely at this age
Measles - fever + cough + coryza (3 Cs); must check for Koplik spots and rash; excluded here (immunized, no Koplik spots, no rash)

INVESTIGATIONS

Ordered

Investigation	Rationale
Complete Blood Count (CBC) with differential	Distinguish viral vs bacterial etiology; leukopenia or lymphocytosis suggests viral; leukocytosis with left shift suggests bacterial
C-Reactive Protein (CRP)	Inflammatory marker; elevated significantly in bacterial vs viral
Chest X-ray (PA view)	Rule out pneumonia (consolidation, lobar infiltrate) and assess lung fields
Rapid Strep Antigen Test (throat swab)	Rule out Group A beta-hemolytic Streptococcus pharyngitis
Nasopharyngeal swab (Rapid Influenza Test)	Influenza A/B antigen detection - especially relevant (no influenza vaccine)
Blood culture (if CBC shows bacterial pattern)	Rule out bacteremia if indicated
Serum electrolytes + blood glucose	Baseline, given reduced oral intake
Urine R/E	Exclude urinary source of fever

Anticipated Results (Viral URTI Pattern)

CBC: WBC 8,000-11,000/µL; lymphocytic predominance; normal or mildly elevated CRP (<20 mg/L)
CXR: No consolidation; possible mild perihilar haziness (viral pattern); no lobar collapse
Rapid Strep: Negative
Rapid Influenza: Positive/Negative (diagnostic)

TREATMENT PLAN

General Measures

Ensure adequate oral fluid intake (ORS if needed); encourage breast fluids and soups
Nasal saline drops (0.9% NaCl) for nasal congestion, 2-3 drops per nostril, 3-4 times daily
Steam inhalation under supervision for symptomatic relief
Rest; avoid exposure to cold

Symptomatic Treatment

Drug	Dose	Frequency	Route
Paracetamol (acetaminophen)	15 mg/kg = 210 mg per dose	Every 4-6 hours when temp > 38.5°C	Oral syrup
Saline nasal drops	2-3 drops/nostril	TDS-QID	Intranasal
Honey (for cough, age > 1 year)	2.5 mL	At bedtime	Oral

Note: Antihistamines, decongestants, and OTC cough-cold preparations are NOT recommended in children under 6 years. Aspirin is contraindicated (risk of Reye's syndrome).

Antibiotics

Not indicated at this time (viral etiology most likely)
Will reconsider if: rapid strep positive, CXR shows consolidation, CBC shows marked leukocytosis, clinical deterioration, or persistent fever >5-7 days

Indications for Hospital Admission (review at 24-48 hrs)

Respiratory rate >40/min or SpO2 <95%
Chest indrawing / subcostal retractions
Unable to maintain oral hydration
Altered mental status or inconsolable cry
Fever persisting beyond 5 days without improvement
Signs of sepsis

COUNSELING AND PARENT EDUCATION (Discharge Instructions)

When to return immediately:
- Child develops fast breathing, noisy breathing (stridor/wheeze), or chest retractions
- Child becomes extremely sleepy, unresponsive, or has a seizure
- Development of skin rash, petechiae, or redness of eyes
- Earache develops (watch for otitis media)
- No urine output for >8 hours (dehydration)
- Fever persisting beyond 5 days or spike >40°C
Medication instructions: Paracetamol only for fever above 38.5°C; do not give aspirin or combination cough-cold syrups
Diet: Encourage small frequent feeds; push fluids; warm broths
School: Keep child away from school for at least 5 days or until fever-free for 24 hours (to limit spread in preschool cluster)
Hand hygiene: Meticulous handwashing for all family contacts; cover mouth and nose when coughing
Immunization advice: Influenza vaccine recommended for next season; review vaccine schedule

PROGNOSIS

Good. Viral URTI in an otherwise healthy, well-nourished, immunocompetent child is a self-limiting illness typically resolving within 7-10 days. Nasal congestion may persist for up to 2 weeks. Close monitoring for complications (secondary bacterial otitis media, sinusitis, or pneumonia) is warranted.

PROBLEM LIST (SOAP Summary)


S	3½-year-old male; 4-day fever, 3-day dry cough, bilateral nasal congestion, reduced appetite; preschool contact with similar illness
O	Temp 38.8°C, HR 110, RR 28, SpO2 98% RA; bilateral scattered coarse crepitations; erythematous posterior pharynx; swollen turbinates; reactive cervical lymphadenopathy
A	Acute viral URTI (most likely); rule out influenza, streptococcal pharyngitis, early pneumonia
P	Symptomatic (paracetamol, saline drops); investigations (CBC, CRP, CXR, rapid strep, rapid flu); no antibiotics at present; parent education; follow up in 48 hours

References:

Swanson's Family Medicine Review, 9e - "A 4-Year-Old Child with a Runny Nose, Sore Throat, and Nonproductive Cough" (URTI case)
Park's Textbook of Preventive and Social Medicine - IMNCI classification of cough/cold and pneumonia management in children 2 months to 5 years
Rosen's Emergency Medicine - Differential diagnosis of respiratory illness in pediatric patients; antipyretic counseling for parents
Medical Microbiology, 9e - Viral etiologies of pediatric respiratory illness (rhinovirus, parainfluenza, RSV, adenovirus, influenza)

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