(a) The absence
of fever and wheezing helps to distinguish C. trachomatis pneumonia
from respiratory syncytial virus pneumonia(1). In our study we had
taken only those infants who presented with acute respiratory distress
and chest wheezing.
(b) In GER
disease, 85% of infants have excessive vomiting during the first week
of life. Aspiration pneumonias occur in about one-third of patients in
infancy and only those in whom symptoms persist until later childhood,
chronic cough, wheezing and recurrent pneumonia are common(2). We had
included infants with acute respiratory distress and chest wheezing
and none had history of recurrent vomiting or regurgitation. So we had
not felt the necessity for evaluation of GER.
(c) All cases of
bronchiolitis may not have wheezing but we had included in our study
only those infants who presented with wheezing. As shown in Fig. 1
of the article, 8 infants who had fever more than 100ºF were finally
diagnosed as bronchiolitis as their blood counts were normal. In
bronchiolitis, the white blood cell and differential cell counts are
usually within normal limits. Lymphopenia commonly associated with
many viral illnesses is usually not found(3).
(d) Bronchial
asthma if associated with bacterial infection will present as wheezing
infant having fever more than 100ºF so will be treated with
antibiotics just like bronchopneumonia as per our study. However, it
may be impossible to distinguish bronchiolitis/viral pneumonia from
asthma in the first attack in the absence of family history of
asthma/allergic disorders. It seems prudent to follow all infants who
have had bronchiolitis and reserve the diagnosis of asthma for those
who have recurrent bouts of wheezing(4).
(e)
Bronchopneumonia in our study meant bacterial pneumonia. Viral
pneumonia was clubbed with bronchiolitis due to study purpose. For
diagnosis of bronchopneumonia due to bacterial origin, fever of 100ºF
in an infant with acute respiratory distress and chest wheezing had
88% sensitivity, 76.4% specificity and 84.6% positive predictive
value.
(f) Dr. Ghosh
seems to have missed the basic inclusion criteria i.e. acute
respiratory distress and wheezing. We do not find any difficulty in
documenting wheezing even in crying infants. Patients of acute severe
asthma with silent chest were not included in the study as inclusion
criteria was respiratory distress and wheezing.
