Q. My child's WBC count remains high even under antibiotics. What is wrong with him?

Answered by
Dr. Deepak Patel
and medically reviewed by iCliniq medical review team.
Published on Apr 01, 2017 and last reviewed on: Nov 15, 2019

Hi doctor,

My 4 year son is ill for past two weeks. Initially it was diagnosed as viral infection due to season change. He was given fever and cold medicine (Asthaline). Fever was mostly between 100-101 degree F.  He had occasional cough may be five times a day. He had the medicine for 5 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 look. Due to high WBC count, doctor suspected it as bacterial infection and prescribed him two antibiotics, Amoxycillin and Cephalosporin. In the next four days his fever got improved. But he had occasional low grade fever under 100 degree and he just wanted to lay down always. His activity has got subsided now. He is not interested in eating food. Only two small cups of orange juice a day and few bites of food.

I took him to doctor again. He said antibiotics have not worked and asked for blood test and blood culture again. He also requested an x-ray suspecting pneumonia and a sonography of abdomen and pelvis. X-ray showed prominent bronchovascular marking in both lower zones. Sonography was normal. Liver, gall bladder, pancreas, spleen, kidneys and bowel loops were all normal. No mass or lesion or fluid or dilatation found. Blood test again showed increased WBC of 31300. Doctor said that he seems to have mucus in his bronchi and that seems to be the infection. Doctor admitted him in the hospital, started giving him Linezolid and Cephalosporin along with Ipravent and Asthaline solutions, Pandotec (PPI).Today his blood culture report came as negative. No bacterial infection was shown. Doctor asked for another blood report now and the results are appended. The WBC is still high with the value of 29900. His doctor is again telling that he has both bacterial and viral infection. We are very concerned. He is hardly eating anything and has already lost 2 kg of weight. Before two weeks, he was absolutely fine and fit. He was physically very active. What seems to be wrong with him now? Please help.

Dr. Deepak Patel

Child Health Paediatrics
#

Hi,

Welcome to icliniq.com.

Your child has definitely got bacterial infection. From your attached reports (attachment removed to protect patient identity) the reasons are as follows.

  • His initial CRP (C-reactive protein) was 17.3 which has came down to 10.3. CRP is an acute phase reactant which indicates acute infection; as the infection decreases the CRP tends to become lower and then becomes normal. It is a very efficient test of detecting acute infection.
  • WBC (white blood cell) count was initially 23,900 with predominance of neutrophil, later it was 31300 with neutrophil dominance and the last count is 23788 with neutrophil dominance, this indicates infection. WBC count decreases after some time as the child recovers; WBC count improves at slow pace than CRP levels, that is why the second report has increased WBC levels.
  • X-ray is showing prominent bronchovascular marking in both lower zones which also suggests infection of lower zone of lungs along with the symptoms of fever and cough.
  • Blood culture can be negative sometimes under the influence of antibiotics which 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 infective organisms.
  • In this age group, the respiratory tract infection is mostly caused by Streptococcus pneumonia and Haemophilus influenza, while mycoplasma and chlamydia may also infect child.
  • Th initial treatment which 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 infection does not last for 2 weeks.
  • Since, your child is ill for 2 weeks, there might be multivitamin deficiency so now you need to give a multivitamin syrup for at least 15 days so that the child regains all his nutrients.
  • The weight loss is also due to the illness, your child will regain weight in 2 weeks. You just try to give proper food to the child. During illness, there is also 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 is your child now? And for how many days he is on Linezolid and Cephalosporin? Have they done any repeat x-ray of chest after antibiotic course? What is the latest blood culture report?

The Probable causes:

Contact with a person who has latent infection by coughing.

Investigations to be done:

Repeat x-ray chest, blood culture and CRP.

Differential diagnosis:

1. Atypical pneumonia.
2. Slowly resolving pneumonia.

Treatment plan:

Continue full course of antibiotics.

Preventive measures:

Cover mouth during sneezing.

Regarding follow up:

Revert back with the answers for the above questions to a paediatrician online.---> https://www.icliniq.com/ask-a-doctor-online/paediatrician

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