Differential Diagnosis for Infant with Scald Injury and Fever

The infant's presentation with a high fever, low white blood count, and a clean burn wound eight hours after treatment for a scald injury requires careful consideration of potential diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • (c) Toxic Shock Syndrome: This condition is characterized by fever, hypotension, and involvement of three or more organ systems, which can be triggered by a burn injury. The high fever and low white blood cell count in the context of a recent burn make toxic shock syndrome a leading consideration.

• Other Likely Diagnoses

  • (b) Clostridial Wound Infection: Although less common, clostridial infections (e.g., gas gangrene) can occur in burn wounds. The presence of a clean wound does not entirely rule out this possibility, especially if the wound was contaminated before treatment.
  • (d) Pseudomonas Wound Infection: Pseudomonas aeruginosa can infect burn wounds, leading to severe infections. However, the early onset and the fact that the wound is described as clean make this less likely compared to toxic shock syndrome.

• Do Not Miss Diagnoses

  • (e) Pneumocystis Pneumonia: Although less likely given the context of a burn injury, pneumocystis pneumonia (PCP) can present with fever and respiratory symptoms. In immunocompromised patients, PCP is a critical diagnosis not to miss due to its high mortality if untreated.
  • (a) Cytomegalovirus Infection: CMV infection can cause significant morbidity, especially in immunocompromised hosts. While it might not be the first consideration in this scenario, it's crucial not to overlook it, especially if the infant has risk factors for immunocompromise.

• Rare Diagnoses

  • Other rare infections or conditions could potentially present with similar symptoms but are less likely given the provided information. These might include other bacterial infections, fungal infections, or systemic inflammatory responses not directly related to the burn wound.

Each of these diagnoses requires careful consideration of the clinical context, including the timing of symptoms, the nature of the burn injury, and any underlying health conditions of the infant. Prompt and accurate diagnosis is critical for guiding appropriate treatment and improving outcomes.