Miscellaneous cases in infancy and childhood

Chapter 7 Miscellaneous cases in infancy and childhood



Case 7.1



1. What is the most likely diagnosis?

Acute bronchitis.


2. What type of aetiological agents can cause this disorder?

Viruses or bacteria can cause acute bronchitis, but a viral aetiology is the most common finding in children.


3. If Ruby was to develop fever, dyspnoea and chest pain, how would your diagnosis alter?

You would need to consider pneumonia as a diagnosis, as acute bronchitis:


• does not cause chest pain

• generally only causes dyspnoea in individuals with an underlying respiratory problem

• is frequently not accompanied by a fever.

4. In this situation, what type of investigations would be necessary?
• chest X-ray

• sputum microscopy, culture and sensitivity.


Case 7.2



1. What is the most likely diagnosis?

Croup (laryngotracheobronchitis).


2. Describe the epidemiological features of this disorder.

In general, the disorder usually occurs in the under 5-year-old age group, and is unusual in older children (although possible). It is most common in the second and third years of life. There is a slight male predominance.


The infectious form is most commonly due to parainfluenza viruses.


3. Is Evan likely to have another episode?

Yes, this disorder may recur, especially if it is the non-infectious type (called ‘spasmodic croup’). This type of croup is thought to be allergic in nature.



Case 7.3



1. What do you think the condition is (give medical name and common name)?

Seborrheic dermatitis or ‘cradle cap’.


2. Is the white–yellow material a true ‘crust’? If not, what is it?

The white–yellow material are scales, not a crust. A crust is dried exudate, and occurs as a result of an inflammatory process. Scales consist of masses of dead cells.


3. Describe the pathogenesis of the disorder.

As this disorder usually occurs during the first 6 weeks of life, it has been suggested that maternal hormones still present in the infant may cause overactivity of sebaceous glands in the scalp. Their secretions tend to result in the older skin cells remaining attached to the scalp, rather than falling off as normal. There is further suggestion that skin yeasts ‘malassezia’ may be involved.[1]


4. Are there any complications of this condition?

Complications are rare, although it may take many months for the condition to resolve.



Case 7.4



1. What is the likely diagnosis?

Pediculosis (aka ‘lice’ infestation).


2. Describe the epidemiological features of this disorder.

The aetiology is pediculus humanus capitis, which are blood sucking ectoparasites.


It most commonly affects children, although any individual who becomes in contact with the parasite may be infested. Females are affected more commonly than males, especially in the adolescent age group. Communication is due to either close contact with an individual with lice, or contact with fomites such as combs, brushes, towels, clothes and bed linen.


3. On hearing the diagnosis, his mother wishes to ask you some questions, as she has heard so many different stories about the condition.
a What exactly are the ‘lumps’ attached to the hairs?

The eggs of the parasites (aka ‘nits’). These are very hard to remove, as they adhere to the hair by a substance called ‘chitin’, which acts like a cement.

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Miscellaneous cases in infancy and childhood

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