MICROBIOLOGY case diagnosis.

The patient was a 3-year-old male who presented with a 4-day history of fever. He became acutely ill and vomiting during lunch. Over the next 4 days he developed fever as high as 40°C that were controlled by Tylenol. He also developed cough, rhinorrhea, and conjunctivitis. He appeared to be fatigued and his parents reported that he was “very sleepy”. Over the past two days, his eyes begun to itch and were painful. His parents noted that his eyes were puffy and he was sensitive to light. He had no rashes. The patient‘s lips were dried and cracked, and he had a greatly reduced urinary output.

Other history pertinent to his illness is that he attended preschool twice per week, where he had multiple sick contacts. His 1-year old sibling had otitis, some wheezing, vomiting, and a productive cough.

On physical examination he had a temperature of 38.6°C pulse rate of 126/min, and respiratory rate of 28/min. The significant findings included bilateral conjunctivitis with exudate in the left eye, bleeding, cracked lips and rhinorrhea. He had shotty lymphadenopathy, but no rash. His feet were slightly edematous. His respiratory examination was normal. Laboratory findings were all normal. A nasopharyngeal swab was sent for rapid antigen testing for RSV and influenza A virus.

Questions:

• What is the most likely diagnosis of this patient? What symptoms does he have which are consistent with his illness?