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Acute epiglottitis

This refers to acute inflammation of the epiglottis, which is often caused by the bacteria Haemophilus influenzae type B.

It needs to be recognised and treated quickly as it can lead to airway obstruction.

It usually presents in children. However, due to the Haemophilus influenzae type B vaccination, its prevalence has decreased.

 

Symptoms

Rapid onset high fever and malaise

Drooling of saliva

Muffled voice – due to very sore throat

Inspiratory stridor (is a high-pitched sound due to turbulent air flow in the upper airway)

 

Key tests

Usually clinical diagnosis, but fibre-optic laryngoscopy may be performed in cases with diagnostic uncertainty

 

Management

This is a medical emergency as there is a high risk of upper airway obstruction

ABCDE approach – intubation may be needed if risk of airway compromise

IV antibiotics (such as ceftriaxone)

 

Whooping cough

This is a condition which is caused by Bordetella Pertussis- a Gram-negative bacterium

It is a notifiable disease, and so it is required by law to report it to government authorities

Infants are immunised during the children, but this does not give lifelong protection

 

Symptoms

These last 10-14 weeks and are more severe in infants

2-3 days of coryzal symptoms first

Sudden coughing attacks with a distinctive inspiratory whoop, which is caused by forced inspiration against a closed glottis

Coughing episodes which are followed by vomiting, increases the chance of diagnosis

More frequent at night and following meals

Complications include: rib fractures,  pneumothorax,  central cyanosis, subconjunctival haemorrhages and apnoea

 

Diagnosis

Patient must have an acute cough >2 weeks with one or more of following features:

i) Paroxysmal cough (during inspiration)

ii) Inspiratory whoop

iii) Post-tussive vomiting

iv) Apnoeic attacks in infants

 

Key tests

PCR and serology testing for antibodies

 

Management

If < 6 months admit to hospital

1st line is oral macrolide (clarithromycin) if onset of cough is within previous 21 days

Give prophylactic antibiotics to household contacts

School exclusion for 48hours after starting antibiotics

 

Influenza (Flu)

This is caused by the influenza virus, which is most common in the winter.

There are many types of influenza virus, but types A and B account for the majority of clinical disease.

Symptoms usually begin two days after exposure to the virus and last about a week.

However, the cough may last for more than 2 weeks

 

Symptoms

Coryzal symptoms (runny nose)

High fever

Sore throat and malaise

Muscle and Joint pain

Coughing

 

Management

Most cases are self-limiting

If there are red-flag signs such as cyanosis or significant respiratory distress, this requires admission to hospital 

Vaccination
 

Tonsillitis

This is an infection of the tonsils, which can be viral or bacterial

One of the most common bacterial causes is Streptococcus Pyogenes

Symptoms

Sore throat, high fever, malaise

Tonsils become oedematous, with yellow/white pustules

 

Management

Prescribe antibiotics if Centor score 3 or 4. Points are scored for

i) Tonsillar exudate

ii) Absence of cough

iii) High fever

iv) Cervical Lymphadenopathy

Tonsillectomy is considered if person has 5 or more episodes/year, symptoms occurring for a least a year and the episodes are functionally disabling.

Complications
 

Acute Rhinosinusitis

This refers to acute inflammation of the walls of the paranasal sinuses, which is usually secondary to viral or bacterial pathogens.

Risk factors include smoking, swimming and nasal obstruction

It can be due to viruses (e.g., rhinovirus) as well as bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae).

 

Symptoms

Facial pain – pain over affected sinus, which characteristically increases in severity on leaning forward

Thick and purulent nasal discharge with nasal congestion/obstruction

Feeling of fullness in the face

 

Management

Symptomatic relief with paracetamol and intranasal decongestants

If symptoms last > 10 days, intranasal corticosteroid for 14 days

Give back-up antibiotic, e.g., phenoxymethylpenicillin if suspicion of bacterial cause

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