A 6-year-old boy is brought to the emergency department with a 3-day history of progressive cough and dyspnea. His mother reports he has been wheezing and has had low-grade fevers. Vital signs show: temperature 39.1°C, heart rate 120/min, respiratory rate 34/min, oxygen saturation 87% on room air, and blood pressure 102/65 mmHg. On examination, you appreciate subcostal and intercostal retractions with diffuse wheezing and fine crackles on auscultation. A chest X-ray demonstrates hyperinflation with bilateral interstitial infiltrates. Nasopharyngeal swab with immunofluorescence microscopy shows multinucleated giant cells. Complete blood count reveals lymphocytic predominance with normal white blood cell count. The patient attends daycare and has no recent travel history. Which of the following is the most likely diagnosis?
- A)Adenovirus pneumonia with bronchial obstruction
- B)Influenza A with secondary bacterial superinfection
- C)Respiratory syncytial virus (RSV) bronchiolitisGABARITO
- D)Parainfluenza virus with laryngotracheobronchitis
- E)Human metapneumovirus with atypical pneumonia
Explicação
RSV bronchiolitis is the most likely diagnosis. The clinical presentation is classic: a young child (peak age 2-12 months, but can extend to age 6) with 2-4 day prodrome of upper respiratory symptoms followed by lower respiratory involvement. Key diagnostic fe... Ver explicação completa e trilha adaptativa →