The Patient was a 5 -week-old male who was transferred to a university hospital from a small community hospital with a 10-day history of choking spells. The child's spells began with repetitive coughing and progressed to his gasping for breath. In the prior 2 days, he also had three episodes of vomiting in association with his choking spells. His physical examination was significant for a pulse of 160 beats per min and respiratory rate of 72/min. The child's chest radiograph was clear. There was no evidence of tracheal abnormalities. His white cell count was 15,500/ìl. Culture from a nasopharyngeal swab revealed a small Gram-negative bacillus.