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The mother complains that her child, aged6 months, has daily cleansing of a clear and / or thick secretion from the nose, from birth. The temperature was only two times up to.5oC. He had a full-term, normal delivery, and no neonatal problems. His immunisations are up to date. There is no family or social history of note. There have been2 bronchoobstruction, treated with salbutamol in inhalation. Above the lungs, auscultation, a normal breathing sound is heard. Systolic noise is heard over the left precordium. Occasionaly she is disgruntled.
DD
• Allergic
• Primary Cilial Dysfunction
• Infective
• Immune deficiency • Cystic Fibrosis • Idiopathic
• Cystic Fibrosis • Idiopathic
• Idiopathic
Most probably it is a case of Primary Ciliary Dyskinesia • 50% with situs inversus – high index of suspicion • Often presents in infancy with rhinitis but not diagnosed until 4 years (avge) • ? ↑ suspicion if a cough also presents check the heart.
Transient hypogammaglobulinemia of infancy, • IgG subclass deficiency, • impaired polysaccharide responsiveness (partial antibody deficiency) • IgA deficiency. All four illnesses are characterized by recurrent bacterial respiratory infections such as purulent rhinitis, sinusitis, otitis, and bronchitis.
Idiopathic neonatal rhinitis, Related to reflux.
In this age of child explanated conditions can most relate to primary cilliary dyskinesia. It is necessary to check microbiological examination of sputum and make a nasal brush biopsy and check nasal smear. Certainly, don't hurry with treatment because the child is in good condition. In the same time, would think about cystic fibrosis, unilateral choanal atresia, possible foreign body in the nose, check nursemaid's health, cracks on the meninges, selective IgA immunodeficiency, secretory brain tumors, craniosynostosis syndromes, CHARGE syndrome, etc.