Primary Diagnosis
Riley’s examination shows numerous symptoms associated with respiratory viruses, such as fluid behind TMs, discharge, turbinate edema, pharyngeal erythema, barking cough, a rash, and high temperature within 72 hours after the appearance of symptoms. Based on the findings, the most likely potential diagnosis would be croup (ICD 10 J05.0). Croup is a disease that affects children within Riley’s age group (6 months to three years of age) and is caused by the parainfluenza virus. Symptoms include, but are not limited to:
- Barking cough
- Hoarseness
- Fever
- Stridor and respiratory distress
It is possible that Riley’s barking cough is the result of an upper respiratory infection, which then progressed to become a croup, as during a URI a follow-up infection with a rhinovirus is a common occurrence. However, the boy’s analyses show that the airflow is not disrupted and there is no blockage of the larynx, meaning that this version of croup is relatively mild (Johnson, 2016).
Other Potential Diagnoses
Based on the symptoms, there are other potential diagnoses that need to be ruled out before the primary diagnosis is accepted. These diagnoses are as follow:
- Roseola (ICD 10 B08.2)
- Bronchiolitis (ICD 10 J21.8)
- Influenza (J10.1)
- Pneumonia (J18.9)
- Erythema infectiosum (ICD 10 B08.3)
Roseola is a viral infection caused by HHV-6 and HHV-7 viruses. It is dangerous to children aged between 6 months and 3 years as it has no vaccine and can be spread from nasopharyngeal secretions (Stone, Micali, & Schwartz, 2014). Its major symptoms are high fever and high irritability, both of which are present in Riley. After a period of 3-5 days, it is followed by a barely noticeable rash that may develop around the child’s neck. However, the pattern of the patient’s rash and the lack of wheezing suggest that this diagnosis is unlikely.
Bronchiolitis is an acute respiratory infection often caused by the respiratory syncytial virus. It targets young children due to their high susceptibility to the disease because of their weak immune systems. The majority of the patients are two years of age or younger. The disease causes the inflammation of the airways, necrosis, and edema (AAP, 2014). The majority of the symptoms are related to the state of the respiratory tract. Wheezing and increased respiratory effort are common. However, the absence of the majority of these symptoms in Riley’s case makes this diagnosis unlikely.
Influenza is another viral respiratory infection that could be potentially diagnosed in Riley. It is caused by influenza A and B viruses, and its symptoms include a dry cough, fever, headache, sore throat, fatigue, dry cough, etc., which are all present in the patient (Hay, Levin, Deterding, & Azbug, 2014). While a rash is not among the most common signs of influenza, it is possible that he could have had a co-infection with the primary diagnosis, or that he may have had croup after becoming sick with influenza (Ferroni & Jefferson, 2011).
In all cases that involve respiratory diseases, it is very important to rule out the possibility of pneumonia. Pneumonia is most often caused by a bacteria called Streptococcus Pneumoniae. While the threat of the disease is reduced by vaccination and immunization efforts, it remains the primary cause of pneumonia (Lau, Woo,& Yen, 2014). Symptoms of pneumonia include fever, obstructed breathing patterns, rhonchi, and increased heartbeat rate (Stuckey-Schrock, Hayes, & George, 2012). The child exhibits some of the symptoms associated with pneumonia, which are fever, cough, and fatigue. In order to rule out the possibility of that disease spreading, it is recommended to perform a CBC and a chest x-ray.
Conclusion
Erythema infectiosum is the last disease on the list of possible diagnoses for Riley. It is a viral infection caused by parvovirus B19. Its symptoms include a low fever, sore throat, and nausea (Allmon, Deane, & Martin, 2015). Aside from these symptoms, some of which were present in the patient, Erythema is also characterized by a red rash that can spread all over the body. However, the visual appearance of the rash pattern and the presence of a barking cough suggests that Riley is unlikely to be afflicted by this infection.
References
Allmon, A., Deane, K., & Martin, K. L. (2015). Common skin rashes in children. American Family Physician, 92(3), 211-216.
American Academy of Pediatrics (AAP). (2014). Clinical practice guideline: The diagnosis, management and prevention of bronchiolitis. American Academy of Pediatrics, 134(5), 1474-1502.
Ferroni, E., & Jefferson, T. (2011). Influenza. BMJ Clinical Evidence, 2011, 911.
Hay, W., Levin, M., Deterding, R., & Abzug, M. (2014). Current diagnosis and treatment: Pediatrics (22nd ed.). New York, NY: McGraw Hill.
Johnson, D. W. (2016). Croup. American Family Physician, 94(6), 476-478.
Lau, S. K., Woo, P. C., & Yuen, K. Y. (2014). Toxic scarlet fever complicating cellulitis: Early clinical diagnosis is crucial to prevent a fatal outcome. New Microbiology, 27(2), 203-6.
Stone, R. C., Micali, G. A., & Schwartz, R. A. (2014). Roseola Infantum and its casual human herpesviruses. International Journal of Dermatology, 53(4), 397-403.
Stuckey-Schrock, K., Hayes, B., & George, C. (2017). Community acquired pneumonia in children. American Family Physician, 86(7). 661-667.