Acute Respiratory Infections (ARI), and of them pneumonia, are today a health problem for the world, with great impact for children under five years of age who are mostly being the most affected, that is why since the year 1976 Jellife refers to pneumonia, malnutrition and diarrhea as the three major problems among childhood exterminating diseases. Pneumonia is known as a disease since Hippocrates, but it was not until approximately 100 years ago that the etiological role of the infection was established. Currently, pneumonia is defined as the inflammation of the lung parenchyma caused by an infectious agent and is usually characterized by the presence of fever, cough and pulmonary infiltrates on the chest x-ray. Its intensity and type depend on the etiological agents that produce it. These factors together with the age of the patient and their immunological condition determine to a large extent the physiopathology, the clinical and radiological manifestations of the respiratory infection.
With regard to the subject, we are motivated to present the case of a 4-month-old infant who enters the Hospital of due to fever or respiratory distress, with a history of delivery, transvaginal, term, normal weight at birth, 3.01 kg , in exclusive breastfeeding, the daughter of an HIV negative mother, who reported that the baby had been sick for a week with wet, persistent cough, fever of up to 38.5 ^ C, phlegm semiliquid diarrhea up to two a day, as well as loss of appetite and marked intake of the general state; Physical examination revealed the presence of a seriously ill child, with signs of respiratory failure due to nasal flaring, occasional moan, moderate subcostal and intercostal retractions, decreased vesicular murmur in the left hemitorax with the presence of crackles at that level. as bilaterally isolated sibilants and oxygen saturation of less than 92% in spite of supplemental oxygen, with this table their urgent admission was decided, in the acute care cubicle, as there was no intensive care unit in our hospital.
Chest X-ray showed the presence of radiopaque lesions with an inflammatory aspect occupying the entire left lung, radiological signs of extensive pneumonia of the entire left lung, and the presence of pleural effusion or empyema at that level was not ruled out. performed aspiration of the pleural fluid obtaining a thick purulent fluid confirming the presence in addition to empyema, the sample was taken for the bacteriological study, culture and sensitivity; The surgeon was asked to complete the drainage of the empyema, obtaining approximately 700 ml of pus.
The treatment was stratified as follows: General Measures: Strict monitoring of clinical evolution, with follow-up of vital signs every 4 hours; Adequate food according to the needs. Maintain breastfeeding, because despite its severity was tolerated breastfeeding. Increase fluid intake, with maintenance parenteral hydration with 5% Dextrose polyelectrolyte solution, sodium and potassium according to needs, while their clinical condition required it, as well as proceeding to offer oral rehydration salts to supply the losses through diarrhea.
Control of temperature and pain: with the use of Paracetamol at 15mg / kg / dose every 8 hours Oxygen therapy via nasal catheter, guaranteeing a saturation of O2≥94%. Maintain the semi-sitting position to improve breathing dynamics), Monitoring the water balance to maintain an adequate diuretic rhythm. Natremia was monitored by inadequate secretion of antidiuretic hormone. An adequate supply of zinc was guaranteed, with the use of zinc sulphate at a rate of 10 mg daily. Antimicrobial treatment
The choice of antibiotic was based on the possible etiology according to the age of the patient, the severity of the symptoms, the characteristics of the radiological image, the result of clinical laboratory studies, which is why we started treatment with Cextriaxone (100 mg / kg / day ), evolutionarily and taking into account the clinical characteristics of the picture, it was decided to add Cotrimoxazole treatment at a rate of 75 mg / kg / day divided into three sub-doses, taking into account also the high incidence of Pneumocystis jiroveci in the region.
Thanks to the team work and the effective follow-up of the pediatrician, Dr. Yamile Padilla Torres, from Santiago de Cuba, who provides services at the Mankayane Hospital as part of the Cuban Medical Brigade, after 16 days of admission, managed to discharge the patient, with evident improvement in his infectious disease, with a very favorable evolution despite the severity of his condition and the complications detected. We also continued monitoring the evolution of the recovery phase in outpatient consultation, which continues to be satisfactory, which allowed us to complete the antianemic treatment with oral ferrous salts, folic acid and vitamin C, which is being well tolerated.