Epiglottitis and tonsilitis Flashcards
What is the typical presentation of epiglottitis?
Until recently, the typical presentation has been a 2–4-year-old child with a short history of fever, irritability, dyspnoea, dysphonia and dysphagia, pooling of oral secretions, and drooling of saliva. The child may be sitting forward, breathing carefully.
Why has the typical patient with epiglottitis changed?
As the use of Haemophilus influenzae type b conjugated vaccine increases, the typical person presenting with epiglottitis is an adult rather than a child. Sore throat is the most prominent symptom in older children and adults.
Why is it important to consider epiglottiitis before examination?
It is important to consider epiglottitis before examination because There is a rapidly progressive cellulitis of the epiglottis and adjacent structures that has the potential to cause abrupt and complete airway obstruction.
When should patient with suspected epiglottitis have their throat examined?
People with suspected epiglottitis should not have their throat examined unless there are facilities for immediate intubation/tracheotomy because of the possibility of precipitating complete airway obstruction or cardiopulmonary arrest.
What is tonsillitis?
Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils.
This definition does not include tonsillitis as part of infectious mononucleosis, although tonsillitis may occur in isolation or as part of a generalised pharyngitis
Most common cause of tonsillitis
Most cases of tonsillitis are caused by viruses, and it is useful to outline this and the fact that antibiotics to do not help cure viruses any quicker than a person’s own immune system, and can be associated themselves with other unwanted effects, such as stomach upset.
Typical patient with tonsillitis
Acute tonsillitis is most common between the ages of 5 and 15 years but can occur at any age. Predominantly but not exclusively a disease of school children. Tonsillitis, whether viral or bacterial, is an infectious condition and can be spread by exposure to an infected person.
Symptoms of tonsillitis
Pain on swallowing
Many patients with acute tonsillitis have a high temperature.
Patients with acute tonsillitis, particularly when it is caused by group A beta-haemolytic streptococci, often have purulent exudate on the tonsillar surface.
What suggests Group A streptococcal tonsillitis?
Acute Group A streptococcal (GAS) pharyngitis/tonsillitis is common in children and adolescents aged 5 to 15 years and is more common in the winter (or early spring) in temperate climates. Streptococcal infection is suggested by fever > 38.5°C, exudate on the pharynx/tonsils, anterior neck lymphadenopathy, and absence of cough.
Investigation of tonsillitis
Throat culture
Management of tonsillitis
Painkillers
Antibiotics for group A beta-haemolytic streptococcal infection
Tonsillectomy for recurrent infections.
What is the Centor criteria?
1) The Centor criteria was developed to predict bacterial infection in people with acute sore throat (validated for children over 3 years).
The four Centor criteria are:
1) Presence of tonsillar exudate.
2) Presence of tender anterior cervical lymphadenopathy or lymphadenitis.
3) History of fever (over 38 degrees C).
4) Absence of cough.
How do analyse Centor criteria score?
Each of the Centor criteria score 1 point (maximum score of 4). A score of 0, 1 or 2 is thought to be associated with a 3 to 17% likelihood of isolating streptococcus. A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.
The absence of three or four of these signs suggests that the person is unlikely to have an infection (80% chance), and antibiotics treatment is unlikely to be necessary.
What is the FeverPain criteria?
The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
o Fever over 38°C.
o Purulence (pharyngeal/tonsillar exudate).
o Attend rapidly (3 days or less)
o Severely Inflamed tonsils
o No cough or coryza
A score of 0 or 1 is associated with a 13% to 18% likelihood of isolating streptococcus. A score of 2 or 3 is associated with a 34% to 40% likelihood of isolating streptococcus. A score of 4 or 5 is associated with a 62% to 65% likelihood of isolating streptococcus.
