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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 8
| Issue : 2 | Page : 114-115 |
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All tachypnea is not coronavirus disease 2019: A child with neglected airway foreign body
Suchit Jogu1, Manjinder Singh Randhawa1, Ravi Prakash Kanojia2, Suresh Kumar Angurana1
1 Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatric Surgery, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Submission | 02-Dec-2020 |
| Date of Decision | 30-Dec-2020 |
| Date of Acceptance | 09-Jan-2021 |
| Date of Web Publication | 10-Mar-2021 |
Correspondence Address:
Dr. Suresh Kumar Angurana
Department of Pediatrics, Division of Pediatric Critical Care, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jpcc.jpcc_186_20
How to cite this article:
Jogu S, Randhawa MS, Kanojia RP, Angurana SK. All tachypnea is not coronavirus disease 2019: A child with neglected airway foreign body. J Pediatr Crit Care 2021;8:114-5 |
How to cite this URL:
Jogu S, Randhawa MS, Kanojia RP, Angurana SK. All tachypnea is not coronavirus disease 2019: A child with neglected airway foreign body. J Pediatr Crit Care [serial online] 2021 [cited 2021 Apr 20];8:114-5. Available from: http://www.jpcc.org.in/text.asp?2021/8/2/114/311060 |
The focus of health-care professionals in the ongoing pandemic of coronavirus disease 2019 (COVID-19) has resulted in the occasional neglect of care for children with other treatable illnesses. Foreign-body aspiration (FBA) is a common medical emergency presenting to the pediatric emergency room (PER) with an incidence of 2–30/1,000,000.[1] Nearly 90% of Western patients aspirate organic materials, peanuts accounting for half of these; while bones were the most common in Southeast Asia and China.[2] The complications of a delayed diagnosis include dislodgement into deeper bronchi, chronic lung disease, pneumothorax, pneumonia, and lung abscess.[3] As children are unable to give a proper history, a high index of suspicion is necessary to diagnose FBA based on the characteristic history includes a choking or gagging episode followed by cough, wheezing, and stridor which has sensitivity of 86%–97%.[2],[3]
An 18-month-male presented with the sudden onset of cough and rapid breathing 2 weeks ago. He was taken to a nearby hospital where he was classified as severe acute respiratory illness and declined care due to a suspicion of COVID-19. Over the next 2 days, he visited 2 more nearby hospitals from where he was referred to a tertiary care hospital where he was admitted, screened for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and once negative transferred to the pediatric intensive care unit. Chest radiograph revealed right-sided pneumothorax [Figure 1]. He underwent right-sided intercostal drainage tube (ICDT) insertion, oxygen followed by mechanical ventilation for 5 days, and multiple antibiotics. Later, he developed left-sided pneumothorax for which another ICDT was inserted and referred to our center for further care. At the presentation to PER, a detailed history was elicited from the parents, which revealed that the symptoms started during feeding. FBA was suspected and he underwent rigid bronchoscopy on the emergency basis. An organic foreign body (white chickpea) was removed from the right main bronchus. Postprocedure, there was the resolution of respiratory distress. The ICDTs were removed, and he was extubated on day 2 and discharged after 4 days.
Lockdown of services and human activities are claimed to be successful preventive measures for reducing the spread of SARS-CoV-2 infection.[4] As there are two sides to every coin, the lockdown has also led to unparalleled disruption of health-care services, limited transport of patients to higher centers for further care, pressure on health-care systems to prepare for the management, virtual closure of non-COVID-19 care, and missed diagnosis and management of other treatable conditions.[4],[5] Due to the fear of COVID-19, people are forced to stay at home, avoiding consultation for minor ailments, reduction in hospital visits for non-COVID-19-related conditions, resulting in worsening of common treatable disease and even death. Many factors probably led to the delayed diagnosis of FBA, causing life-threatening events. Due to the COVID-19 hysteria, a proper history may not have been elicited. All children with respiratory symptoms were assumed to be suffering from COVID-19. We wish to emphasize that all tachypnea is not COVID-19 and a careful clinical history and physical examination can identify these non-COVID-19 diseases.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Lowe DA, Vasquez R, Maniaci V. Foreign body aspiration in children. Clin Pediatr Emerg Med 2015;16:140-8.  |
| 2. | Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med 2016;7:5-12. |
| 3. | Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatr Rev 2000;21:86-90. |
| 4. | Signorelli C, Scognamiglio T, Odone A. COVID-19 in Italy: Impact of containment measures and prevalence estimates of infection in the general population. Acta Bio-Medica Atenei Parm 2020;91:175-9. |
| 5. | Mathew JL. Child health and delivery of care during the COVID-19 pandemic and beyond. Indian J Pediatr 2020;87:579-82. |
[Figure 1]
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