Child Dies From Inadequate Treatment of Infection

Case Overview

The case takes place in Maryland and involves a young girl who presented to the ER with complaints of fever and sinus congestion. She was diagnosed with the Flu some time before her ER visit by the family physician. She was given a course of Tamiflu, which she completed. Some time later, the girl presented to the ER again complaining of new symptoms. Testing performed at the hospital revealed several suspicious findings, including an elevated white blood count, however the patient was discharged from the hospital with a prescription for a basic antibiotic. The next day, the patient was again rushed to the emergency room exhibiting signs of respiratory distress. The patient died shortly after being admitted to the hospital, at which time a significant bacterial infection of her lungs was discovered.

Questions to the Infectious Disease and Communicable Disease expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

I have taken care of many children with similar presentations. It appears that this infant presented with Influenza and was appropriately prescribed Tamiflu. As is not uncommon with influenza, it then appears that this child had a bacterial superinfection with Pneumococcus and was appropriately prescribed antibiotics (an antibiotic that would have activity against Pneumococcus) when he arrived at the ED.

Do you believe this patient may have had a better outcome if the care rendered had been different? IE: antibiotic therapy?

Unfortunately, this child succumbed to a bacterial superinfection. Possibilities for this poor outcome could be an unusually resistant Pneumococcus (as Augmentin should normally have activity against this organism) or a delay in presenting to the ED on February 16th.

Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.

I have served in a previous case of a teenager who passed away from Influenza. The family was concerned that he never was prescribed Tamiflu upon initial presentation. That case was different from this case as he had no underlying risk factors for severe influenza.

Please tell us why you're qualified to serve as an expert reviewer of this case.

As I routinely see children hospitalized with viral and bacterial infections, I believe I am qualified to serve as a reviewer of this case.

About the expert

This double board certified doctor is fellowship trained in pediatric infectious diseases and practices at one of the top medical universities in the country. Widely published, she is a reviewer for the Journal of Pediatric Infectious Diseases, The Pediatric Infectious Diseases Journal, and Clinical Infectious Diseases, among others. Currently an Assistant Professor of Pediatric Infectious Diseases, this expert is also the Director of the Pediatric Antimicrobial Stewardship Program, wherein she oversees the use of all antibiotics in the Children's Center and assists physicians with the selection, dose, duration, and frequency of antibiotics.

E-005391

Specialties:

Infectious Disease and Communicable Disease