Acute Bacillary dysentery

A 3 years old male child presented to emergency department with a 2 days history of
frequent loose stools mixed with blood and mucus, accompanied by fever, abdominal pain,
and irritability. On examination the child was ill-appearing, irritable, his vitals were HR 130
bpm, RR 30/min, temp 101F, BP 92/64 mmHg, he showed signs of moderate dehydration
(sunken eyes, dry mucosa, delayed skin turgor, eager to drink), abdominal exam showed
soft, non-distended abdomen with mild tenderness in lower abdomen with increased bowel
sounds, no hepatosplenomegaly or masses. Patient was admitted in paediatrics ward on i/v
fluids, i/v ceftriaxone (50mg/kg OD), oral paracetamol, zinc supplements and probiotics.
Relevant investigations showed Hb 12.1, TLC 15.7 with raised neutrophils 89%, CRP 55
mg/dl, K 4.6, Na 133, stool R/E showed presence of RBCs, pus cells and mucus, stool culture
was positive for Shigella spp. Blood C/S showed no growth. USG abdomen was
unremarkable. Child responded well to fluids and i/v abx, fever resolved by day 2 of
hospitalization, stool frequency reduced significantly by day 3, oral intake improved and
child was discharged on day 4 with instruction on hygiene, nutrition and follow up after 1
week.

Meningitis

A 6-year-old previously healthy boy was brought to the emergency department with a 2-day history of
high-grade fever, persistent vomiting, and progressive lethargy. On the day of presentation, he
developed severe headache, photophobia, and neck stiffness. His parents also reported an episode of
generalized tonic-clonic seizure lasting approximately 2 minutes. On examination, the child was febrile
(101.5°F), irritable, and had a positive Kernig’s and Brudzinski’s sign, along with signs of increased
intracranial pressure including papilledema. He was hemodynamically stable but drowsy, with a Glasgow
Coma Scale score of 12/15. Laboratory investigations revealed leukocytosis with a predominance of
neutrophils. A lumbar puncture was performed, showing cloudy cerebrospinal fluid (CSF) with elevated
opening pressure, high protein, low glucose, and abundant neutrophils on cytology. The child was
started empirically on intravenous ceftriaxone and vancomycin, along with dexamethasone to reduce
inflammation. Supportive care including fluid management, antipyretics, and seizure control was also
provided. The child gradually improved over the course of a 10-day hospital stay, with resolution of
fever and neurological symptoms. He was discharged on oral antibiotics to complete the course, with a
follow-up plan for hearing assessment and neurodevelopmental evaluation.

ARI

A 2-year-old female child was brought to the pediatric outpatient department with a 3-day history of
cough, nasal congestion, and fever. The parents reported rapid breathing and poor feeding for the past
24 hours. On examination, the child appeared irritable, febrile (38.7°C), and had signs of respiratory
distress including nasal flaring, intercostal retractions, and a respiratory rate of 54 breaths per minute.
Auscultation revealed bilateral wheezing and scattered crepitations. Oxygen saturation was 92% on
room air. A diagnosis of acute lower respiratory infection, likely viral bronchiolitis, was made based on
clinical findings. A chest X-ray showed peribronchial thickening but no consolidation. The child was
admitted for supportive care, which included humidified oxygen, antipyretics, and maintenance of
hydration. Antibiotics were withheld initially due to the clinical picture suggestive of a viral etiology. The
patient showed gradual improvement over 3 days, with normalization of respiratory rate and oxygen
saturation. She was discharged on day 4 with advice on home care, warning signs, and follow-up in one
week.

ADHD

An 8-year-old boy was brought to the pediatric common clinic by his parents with concerns of
inattention, hyperactivity, and impulsive behavior that had been persistent for over a year. According to
the parents and school reports, the child had difficulty sustaining attention in tasks, frequently made
careless mistakes in schoolwork, was easily distracted, and often failed to follow through on
instructions. Additionally, he was described as being constantly on the move, talking excessively,
interrupting others, and having difficulty waiting his turn. These behaviors were present both at home
and school, significantly impairing his academic performance and social relationships. There was no
history of seizures, head trauma, or developmental delay. His birth and early developmental milestones
were normal. Physical and neurological examinations were unremarkable. The child was referred to
child psychiatry for psychological evaluation, and behavioral therapy and parent management training.

Acute tonsillitis

5-year-old girl was brought to the OPD with a 3-day history of high-grade fever, sore throat, difficulty
swallowing, and decreased appetite. Her parents also noted irritability and bad breath. There was no
history of cough or runny nose. On examination, she was febrile (102°F), moderately dehydrated, with
enlarged, erythematous tonsils covered with whitish exudates. Tender anterior cervical
lymphadenopathy was present bilaterally. No signs of respiratory distress were noted. Based on the
clinical findings and absence of viral symptoms, a diagnosis of acute bacterial tonsillitis, was made. The
child was started on i/v co-amoxiclav, i/v fluids along with antipyretics for fever. She showed marked
clinical improvement within 48 hours and was discharged home on oral syp co-amoxiclav for 5 days.