Why does my child have a high WBC count despite antibiotics?
Patient's Query
Hi doctor,
My 4-year-old son has been ill for the past two weeks. Initially, it was diagnosed as a viral infection due to the season change. He was given fever and cold medicine (Asthalin). The fever was mostly between 100 and 101 degrees Fahrenheit. He had an occasional cough, maybe five times a day. He had the medicine for five days, but there was no improvement.
Then his doctor asked for a blood test. His WBC count was 23900 at that time. I have attached the entire report for your review. Due to a high WBC count, the doctor suspected a bacterial infection and prescribed him two antibiotics, Amoxicillin and Cephalosporin.
In the next four days, his fever improved. But he had an occasional low-grade fever under 100 degrees, and he just wanted to lie down always. His activity has subsided now. He is not interested in eating food. Only two small cups of orange juice a day and a few bites of food.
I took him to the doctor again. He said antibiotics have not worked and asked for a blood test and blood culture again. He also requested an X-ray, suspecting pneumonia, and a sonography of the abdomen and pelvis.
The X-ray showed prominent bronchovascular markings in both lower zones. Sonography was normal. The liver, gallbladder, pancreas, spleen, kidneys, and bowel loops were all normal. No mass, lesion, fluid or dilatation was found. The blood test again showed an increased WBC of 31300.
The doctor said that he seems to have mucus in his bronchi, and that seems to be the infection. The doctor admitted him to the hospital and started giving him Linezolid and Cephalosporin along with Ipravent and Asthalin solutions and Pandotec (PPI).
Today, his blood culture report came back as negative. No bacterial infection was shown. The doctor asked for another blood report now, and the results are appended. The WBC is still high, with a value of 29900. His doctor is again saying that he has both a bacterial and viral infection. We are very concerned. He is hardly eating anything and has already lost 4 lbs of weight. For two weeks, he was absolutely fine and fit. He was physically very active.
What seems to be wrong with him now?
Please help.
Thank you.
Hi,
Welcome to icliniq.com.
Your child has definitely got a bacterial infection. It is from contact with a person who has a latent infection through coughing.
From your attached reports (attachment removed to protect patient identity), the reasons are as follows.
1. His initial CRP (C-reactive protein) was 17.3, which has come down to 10.3. CRP is an acute phase reactant that indicates acute infection; as the infection decreases, the CRP tends to become lower and then becomes normal. It is a very efficient test for detecting acute infection.
2. The WBC (white blood cell) count was initially 23,900 with a predominance of neutrophils; later it was 31,300 with neutrophil dominance, and the last count was 23,788 with neutrophil dominance. This indicates infection. The WBC count decreases after some time as the child recovers; the WBC count improves at a slower pace than CRP levels, which is why the second report has increased WBC levels.
3. The X-ray is showing prominent bronchovascular markings in both lower zones, which also suggests infection of the lower zones of the lungs along with the symptoms of fever and cough.
4. Blood culture can be negative sometimes under the influence of antibiotics that have already been started. So, a negative blood culture does not always rule out infection. But if the child is not responding to antibiotics, then the blood culture must show the infectious organisms.
5. In this age group, the respiratory tract infection is mostly caused by Streptococcus pneumoniae and Haemophilus influenzae, while Mycoplasma and chlamydia may also infect children.
6. The initial treatment that was given was correct, and rightly, as the child did not respond; they changed it to second-line antibiotics. This is definitely not a viral infection, as viral infections do not last for two weeks.
7. Since your child has been ill for two weeks, there might be a multivitamin deficiency, so now you need to give a multivitamin syrup for at least 15 days so that the child regains all his nutrients.
8. The weight loss is also due to the illness; your child will regain weight in two weeks. You just try to give proper food to the child. During illness, there is also a change in taste, so the child might not like the food, but you should keep on trying to give him proper food.
I would like to know how your child is now.
- And for how many days is he on Linezolid and Cephalosporin?
- Have they done any repeat X-rays of the chest after the antibiotic course?
- What is the latest blood culture report?
Please repeat a chest X-ray. blood culture, and CRP (C-reactive protein).
Cover your child's mouth during sneezing.
I hope it helps.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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