Case history
Case history
A 10-week-old boy presents to his family doctor in January because his mother feels his breathing is laboured. His pregnancy, labour and delivery were uncomplicated. His mother smoked during pregnancy and continues to do so. The family history is negative for asthma or allergy. He developed rhinitis and a tactile fever 3 days prior to presentation. Over the next few days he developed increasing cough, increased work of breathing, and decreased oral intake. On examination, his temperature is 38.0°C (100.4°F), his respiratory rate is 42 breaths per minute, and his oxyhaemoglobin saturation, measured by pulse oximetry, is 93% while breathing room air. He has a wet cough. His chest examination reveals mild intercostal and subcostal retractions, scattered crackles bilaterally, and expiratory wheezes bilaterally.
Other presentations
Infants with bronchiolitis may present with apnoea. This can sometimes be the sole presenting sign and is cited to occur in 1.6% to 5% of hospitalised infants. Risk factors for apnoea include age <1 month in full-term infants or <8 weeks’ post-conceptional age for preterm infants, lower birth weight, and the presence of any previous apnoeic event at presentation to the hospital.[1][2] Respiratory syncytial virus (RSV) infection can also be associated with croup. Seizures and cardiac dysrhythmias have been reported with severe RSV infection.
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