DIFFERENTIAL DIAGNOSIS

Mercy Makena Ndege Level (IV) MBChB Supervisor: Prof. Nduati

1) Bacterial pneumonia with underlying malnutrition. 2) Pulmonary tuberculosis 3) Nosocomial pneumonia 4) Asthma 5) Malaria 6) H.I.V associated pneumonia(R/O HIV infection)

Bacterial pneumonia with underlying malnutrition Evidence of bacterial pneumonia: Cough 1 month Difficulty breathing 1 month Fever intermittent Crackles on auscultation Increased respiratory rate (>50 breathes/min) Absence of central cyanosis, grunting or lower chest wall indrawing. The patient was alert and was able to breastfeed although poorly.

Evidence of malnutrition: Reduced growth rate/ stunted? Poor feeding Low weight for age (z-score?) ,despite absence of visible physical wasting. Diarrhoea Increased susceptibilty to infections due to decreased immunity.

Evidence: Cough (>2weeks) Contact with an adult suffering from tuberculosis. Fever intermittent but for 1 month. Night sweats Poor weight gain Tachypnoea Wheezing?/ crackles Reduced breath sounds Difficulty breathing Lives in a crowded house

Pulmonary tuberculosis

Nosocomial pneumonia
The patient had sought prior treatment for malaria infection and might have developed hospital acquired pneumonia due to immunosuppression.Pathogens include: Gram negative enterobacteriaceae ( Klebsiella, Serratia, E- coli) Pseudomonas Staph. aureus

Asthma
Evidence: Tight chest 1 month Cough 1 month, worse at night and early morning. Difficulty breathing that was worse at night and early morning. Poor feeding and loss of weight. Tachypnoea Wheeze Father that smokes cigarettes indoors. Poor ventilation due to overcrowding in the house. N.B : There is no family history of asthma or allergies.

Evidence: Intermittent fever that is associated with night sweats. Drowsiness Poor feeding Low weight for age. Prior malaria infection Poor compliance to medication could have resulted in recurrence of the disease.

Malaria