Nice day with Prof Z

He is The Man.

6 year old H is the younges of 10 children. whose parents are farmers. all the family members are well and alive. H has been doing well going to school.

He is admitted with meningoencephalitis caused by streptococcal pnemonia proved by latex from cerebrospinal fluid. he has never recieved meningococcal vaccination. The meningitis is complicated with seizures and impaired consciouseness level. H is been treated with antibiotics and is responding to it.

H is looked for immunodeificiency or diseases such as chronic juvenile arthritis/malignancy(hair loss) that may require immuno suppresents. EAR - look the roof, colesteatoma, perforated, losss of cone of light. EYE - no bulbar telengiectasiaeye no cataract. NOSE - no polyp, no mid line defect, H is not dysmorphic, growth is normal, developmentally appropriate for age and has been vaccinated with routing vacccines up to his age. the scar of tuberculosis vaccine is present, , no pallor,no edema, no clubbing, no oral ulcers, no oral /perinial CANDIDIASIS, no rash, no eczema, his lymph nodes are shotty, tonsils not enlarged, liver just palpable without any palpable spleen. lung shape is not deformed

he will be reviwed for complications;
craneal nerves sp 3.4.6. lowere motor (bulbar) , heqaring impairment, visual impairment, seizures, learning problems, etc Nutrition is another factor here, but hopefully he will be able to tolerate orally or fed through nasogastric tube sooon.

history also suggrest children below 5 are incontact with house hold members of H and will be screened and offered immunization for the child/

socially H is from a big family though financially average may not be affordable for expensive investigations. already CT scan is been done, and few investigations are been carried, he is still in primary, may not cover for all investigations. her mother is been accomoanying him the last 4 days and willl be here for another few days sacrificing the daily earnings plus spending on transport for the relatives as well.


second case was embarassing,
5 year old youngest of 5 from no related parents who are in mid 40s,
she is syndromic child, with absent corpus callosum, global developmental delay, failure to thrive, spastic quadrilplegia, the child has hip dislocated, and i did not recorgnize tht....!!!ah