Differential Diagnosis for Infant with Scald Injury and Fever
The infant's presentation of fever and low white blood count 8 hours after a scald injury requires careful consideration of potential infections and other complications. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Toxic Shock Syndrome (C): This condition is characterized by fever, rash, desquamation, hypotension, and involvement of three or more organ systems. The low white blood count and high fever shortly after a burn injury could suggest toxic shock syndrome, especially if the burn wound is clean and other signs such as hypotension or organ involvement are present.
Other Likely Diagnoses
- Pseudomonas Wound Infection (D): Although less likely given the early timeframe and the description of the wound as clean, Pseudomonas infections can occur in burn patients. However, they typically present later in the course of treatment.
- Clostridial Wound Infection (B): This is a consideration in traumatic wounds, including burns, especially if the wound is contaminated. However, the wound is described as clean, making this less likely.
Do Not Miss Diagnoses
- Toxic Shock Syndrome (C): Already mentioned, but it's crucial to reiterate due to its high mortality rate if not promptly recognized and treated.
- Clostridial Wound Infection (B): Despite being less likely due to the wound's cleanliness, the potential for gas gangrene makes it a diagnosis that cannot be missed due to its rapid progression and high mortality.
- Sepsis from Other Causes: While not listed, sepsis from any bacterial source is a do-not-miss diagnosis in a febrile infant post-injury.
Rare Diagnoses
- Cytomegalovirus Infection (A): This would be unusual in this context, as CMV infections are more commonly associated with congenital infections or immunocompromised states.
- Pneumocystis Pneumonia (E): Typically seen in immunocompromised patients, this diagnosis is unlikely given the context of a recent burn injury without mention of immunodeficiency.