Differential Diagnosis for a 4-year-old child with 5 days of high fever, runny nose, mild cough, lethargy, and normal breathing
- Single most likely diagnosis:
- Viral upper respiratory tract infection (URTI): This is the most likely diagnosis given the symptoms of high fever, runny nose, mild cough, and lethargy, which are common in viral infections. The fact that the fever comes and goes and the child can hold fluids and is peeing properly suggests a self-limiting condition.
- Other Likely diagnoses:
- Influenza: Although the child's symptoms have been present for 5 days, influenza can cause prolonged fever and respiratory symptoms. The presence of lethargy also raises the possibility of influenza.
- Pharyngitis: The child's symptoms of fever, runny nose, and mild cough could also be consistent with pharyngitis, especially if caused by a virus.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bacterial meningitis: Although the child is breathing normally and can hold fluids, bacterial meningitis can present with non-specific symptoms such as fever and lethargy. It is crucial to consider this diagnosis due to its high mortality rate if left untreated.
- Pneumonia: The child's mild cough and normal breathing do not rule out pneumonia, especially if it is in the early stages. Pneumonia can be life-threatening if not treated promptly.
- Sepsis: Any child with a high fever and lethargy should be evaluated for sepsis, a life-threatening condition that requires immediate medical attention.
- Rare diagnoses:
- Kawasaki disease: This rare condition can cause fever, lethargy, and respiratory symptoms, although it typically presents with additional symptoms such as rash, conjunctivitis, and lymphadenopathy.
- Leukemia: Although extremely rare, leukemia can cause prolonged fever, lethargy, and respiratory symptoms. A thorough evaluation would be necessary to rule out this diagnosis.