Infection with normal WBC

Nurses General Nursing

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Patient had sudden onset infection (15minutes). Diagnosed cellulitis in rt leg. WBC is 8.3. and has remained stable over 72 hrs. Received Vancomycin for 48hrs, fever persisted. Varies from 102-104.4

Added Zosyn. Fever is starting to break.

Patient has a history of 8 episodes of cellulitis over 20yrs. Current, active Aspergillosis infection in lungs. Fungal ball present. When infection hit O2 fell to 62.

How can he have a normal WBC? What could be the issue? Neuropathy in both legs from knees down. Charcot foot in left ft. NOT diabetic.

Dr.'s are stumped. Any ideas?

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Specializes in Complex pedi to LTC/SA & now a manager.

Is this your patient? Has ID been consulted?

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ID is on board. Followed by ID for lungs. ID from hospital is on. They have no answers. He is confusing them.

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Specializes in Complex pedi to LTC/SA & now a manager.
ID is on board. Followed by ID for lungs. ID from hospital is on. They have no answers. He is confusing them.

Who "he" is confusing "them" (who is them)?Two ID physicians?

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Immune compromised?

HIV?

Viral as opposed to bacterial?

A fungal infection may not be bacterial, and may not increase WBC?

Hard to tell without whole picture, however, very interesting.

Let us know what they find.

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Specializes in ED, Cardiac-step down, tele, med surg.

I've had pt's with infections and a normal WBC count. Look at the differential. Ask the infectious disease doctor and tell us what you find out.

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Specializes in Hospital Education Coordinator.

blood work may be a late sign. If antibiotics started soon then could account for it. However, there has to be more to this story.

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Specializes in LTC, med/surg, hospice.

Is the differential WNL? Sed rate? What is his baseline? The 8.3 may be an elevation for him.

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