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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
