6yr old recurring pneumonia and fever

[Honeynutz]

Our 6yr old has been sick since Dec. 16, '07.  He started out with bronchitis and was put on Azithromycin for 3 days.  Once he was off he had high fever and still coughing.  We took him back to his doctor and had x-rays taken.  He then had pneumonia in his right lower lobe and was put on Cleocin for 10 days.  Once he was off the Cleocin he started having fever again and still had his cough.  Took him back to his doctor and had more x-rays.  He had pneumonia again, but in his left lower lobe.  He was put back on Cleocin.  Ended up taking him to Children's hospital where they treated him for pneumonia for 2 days then sent home to take Cefdinir for 12 days.  Once the 12 days were over he once again started with the high fever and his cough never left.  His doctor did x-rays once again and put him back on Cefdinir for 10 days.  He ended up going back to Children's E.R. where they said he had decreased air movement in his lower left lobe and put him on Amox-Clav ES for 14 days.  He is still running fever with a wet cough.  Through all of this, he has continued to have a wet cough.  Whenever he comes off a med he runs fever.  We feel we are getting no where.  The only thing we have been hearing is, "He's been a healthy child before Dec. so they are hesitant about running other test."  They say his pneumonia looks good but then put him on Amox-Clav ES.  They say it could be viral, but the test are negative.  He is still running fever on the Amox and it's been two days since he has started.  He does complain of his head and chest hurting.  Any ideas?

Thank you.

[National Jewish Health]

Two months of recurrent cough and fever is worrisome and a reason to be concerned, especially in a child with no prior evidence of lung disease, such as cystic fibrosis.  What you describe suggests either recurrent or never completely resolved bacterial infection.  It also suggests that the antibiotic therapy has not been based upon bacterial cultures of sputum or blood.  The recurrent transient responses to the antibiotics suggests 3 possibilities:  1) that the pneumonia is caused by an uncommon bacterium or a non-bacterial infectious agent, one only partially susceptible to the antibiotics your son has received; 2) that the infection resides elsewhere in the body, such as an abscess in the heart or even in the lungs, and is recurrently ‘seeding’ bacteria to the lungs; and 3) that the pneumonia is a non-infectious process, which is much less likely.

At this point, it would be wise to consult with a pediatric infectious disease specialist.  This might be a time to hold the antibiotics and repeat comprehensive blood and urine cultures.  This consultant might also want to do body imaging studies, such as an echocardiogram, positron emission tomography (PET) scanning or other radio-nucleotide imaging, to search for infection elsewhere in the body.

Finally, if not already done, testing should be done to rule-out an acquired immunodeficiency state.

As a rule, viral pneumonias do not behave this way and it should not be assumed that this is a viral infection.  However, what begins as a viral pneumonia can frequently lead to a superimposed bacterial infection.

Good luck.

Please give us a follow-up to let us know how your son is doing.

[Honeynutz]

Thank you, for your response.  It has helped greatly in reassurring us with his current treatment.

I'm not sure what the DR. in ER was doing, because our son was admitted back to Children's Hospital a few days later.  They decided to do a chest CT.  The CT ruled out anything foreign in his lungs and showed he actually had pneumonia in both his lungs this go around.  They also, did blood work/cultures, which all came back good.  They had infectious disase do a  TB test, which also turned out okay.  They have decided, as you mentioned, it is bacterial and not viral.  They are treating him with the Cleocin for three weeks (2tsp/ 3x day) hoping longer treatment will be the key.  They said, they chose Cleocin, because he responded to it.   Hopefully, this does the job and he will be healthy again.  He still has two weeks left on his medicine before he goes in for follow up x-rays.  

I am in no way downing Children's Hospital.  It is a wonderful place with skilled Doctors and staff that are amazing at what they do.  As parents, we have been frustrated and scared, since he has been sick for so long, and felt we were getting no where.

Thanks again, for your reply and I will update after his follow up in a few weeks.