Differential Diagnosis for a 2-year-old with URI and Fever
- Single most likely diagnosis:
- Acute Otitis Media (AOM) - The child's symptoms of tugging at the right ear, fever, irritability, and decreased appetite are classic for AOM, especially following a URI which often precedes AOM.
- Other Likely diagnoses:
- Viral pharyngitis or tonsillitis - Given the initial URI symptoms and the development of fever and irritability, a viral infection of the throat is possible.
- Sinusitis - Although less common in this age group, sinusitis could be considered, especially if the child has persistent nasal congestion and fever.
- Viral gastroenteritis (without vomiting) - Though the child is not vomiting, some viral gastrointestinal infections can present with fever and irritability without prominent gastrointestinal symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bacterial meningitis - Although rare, the symptoms of fever, irritability, and decreased appetite could be early signs, and it's crucial to consider this diagnosis, especially if there's any sign of neck stiffness or bulging fontanelle.
- Pneumonia - Could present with fever and irritability, and while the primary symptom of tugging at the ear suggests AOM, pneumonia should be considered, especially if there are respiratory symptoms or signs.
- Sepsis - Any child with fever and significant irritability should be evaluated for signs of sepsis, particularly if there's a history of underlying health conditions.
- Rare diagnoses:
- Retropharyngeal abscess - Though rare, this condition can present with fever, irritability, and neck stiffness, and is a medical emergency.
- Mastoiditis - A complication of AOM, presenting with fever, irritability, and signs of infection behind the ear, such as swelling or redness.
- Lemierre's syndrome - A rare condition following a throat infection, characterized by fever, neck pain, and swelling, due to a jugular vein thrombosis.