Sandbox:Prince

Variable		Croup	Epiglottitis	Pharyngitis	Bacterial tracheitis	Tonsilitis	Retropharyngeal abscess	Subglottic stenosis
Presentation	Cough	✔	—	Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting	Barking cough, stridor, fever, chest pain, ear pain, difficulty breathing, headache, dizziness.	Sore throat, pain on swallowing, fever, headache, cough	Neck pain, stiff neck, torticollis fever, malaise, stridor, and barking cough	Depends on severity. May have respiratory distress at birth, exercise-induced dyspnea, intermittent wheezing. Inspiratory stridor.
	Stridor	✔	✔
	Drooling	—	✔
	Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever		Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice
Causes	Parainfluenza virus		H. influenza type b, beta-hemolytic streptococci, Staphylococcus aureus, fungi and viruses.	Group A beta-hemolytic streptococcus.	Staphylococcus aureus	Most common cause is viral including adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,	Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)	Congenital, trauma
Physical exams findings	Suprasternal and intercostal indrawing, Inspiratory stridor, expiratory wheezing, Sternal wall retractions		Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis	Inflammed pharynx with or without exudate	Subglottic narrowing with purulent secretions in the trachea	Fever, especially 100°F or higher.Erythema, edema and Exudate of the tonsils. cervical lymphadenopathy, Dysphonia.	Child may be unable to open the mouth widely. May have enlarged cervical lymph nodes and neck mass.	Signs of respiratory distress, intermittent wheezing. Inspiratory stridor.
Age commonly affected	Mainly 6 months and 3 years old rarely, adolescents and adults		Used to be mostly found in pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals with a mean age of 44.94 years.	Mostly in children and young adults, with 50% of cases identified between the ages of 5 to 24 years.	Mostly during the first six years of life	Primarily affects children between 5 and 15 years old.	Mostly between 2-4 years, but can occur in other age groups.	May be congenital congenital or acquired. Mean age in acquired is 54.1 years
Imaging finding	Steeple sign on neck X-ray		Thumbprint sign on neck x-ray	—	Lateral neck xray shows intraluminal membranes and tracheal wall irregularity.	Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.	On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen	Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.
Treatment	Dexamethasone and nebulised epinephrine		Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.	Antimicrobial therapy mainly penicillin-based and analgesics.	Airway maintenance and antibiotics	Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases.	Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.	Endoscopic balloon dilation for patients with low-grade subglottic stenosis, glucocorticoid injections, and resection.

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  Peritonsillar abscess Image courtesy of RadsWiki and copylefted
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  Peritonsillar abscess Image courtesy of RadsWiki and copylefted
• 
  Peritonsillar abscess Image courtesy of RadsWiki and copylefted
• 
  Peritonsillar abscess Image courtesy of RadsWiki and copylefted

Treatment

Treatment is, as for all abscesses, through surgical incision and drainage of the pus, thereby relieving the pain of the stretched tissues. The drainage can often be achieved in the Outpatient Department using a guarded No. 11 blade in an awake and co-operative patient. Sometimes, a needle aspiration can suffice. Antibiotics are also given to treat the infection.

Peritonsillar abscesses are widely considered one of the most painful complications, primarily the surgical draining of the abscess itself. The patient is operated on awake, surgically slicing open the tonsil and draining the abscess.

Complications

• Parapharyngeal abscess
• Extension of abscess in other deep neck spaces leading to airway compromise
• Septicaemia

Alternaria spp

Rhodotorula spp

Acremonium spp.

Dreschlera spp

Malassezia spp

Scedosporium spp

Arthrographis spp

Blastoschizomyces (11, 12),

Paecilomyces (13, 14), 

Aureobasidium (15),

Clavispora (16), Ustilago (17),

Exophiala (Wangiella) (18),

and Exserohilum (19, 20).

On the other hand, most cases of fungal CNS infections are caused by only a few important species, 

The common causes of fungal meningistis may be classified into two subgroups. This inlcudes:

Primary fungal pathogens of humans

All of these may cause CNS infections. This group includes: C. neoformans (22, 23),

Coccidioides immitis (24, 25, 26),

Blastomyces dermatitidis (27, 28),

Paracoccidioides brasiliensis (29, 30),

Sporothrix schenckii (31, 32),

H. capsulatum (33, 34), 

Pseudallescheria boydii (Scedosporium apiospermum) (35, 36),

dematiaceous fungi (37, 38, 39).

The second group is considered opportunists, which take advantage of significant immune defects in the host. This group includes

Candida species (40, 41, 42),

Aspergillus species (43, 44, 45),

mucormycosis (46, 47), and

Trichosporon species (48, 49).

Title:Fungal Meningitis Author / Creator:Horan ; Perfect, Jennifer, John L. R. Language: English Is Part Of: Infections of the Central Nervous System Identifier: ISBN: 978-1-4698-8366-3 Source: Gale Virtual Reference Library (GVRL)

According to severity of the disease
Mild	Early diagnosis and treatment Responds to medical treatment Typical clinical presentation Good prognosis
Moderate	May present late with typical or atypical symptoms May present with complications Variable response to treatment
Severe	Presents with complications or prolonged illness Immunocompromised Common in extremes of age Delayed diagnosis and treatment Surgical treatment may be required in addition to medical treatment Increased morbidity and mortality
According to the duration of disease
Acute	Lasts few weeks Patient acutely ill Mostly in HIV-associated patients Impaired consciousness Seeks medical treatment early due to sudden deterioration
Subacute	Lasts less than 4 weeks Patient acutely ill Mostly in HIV-associated patients Impaired consciousness Seeks medical treatment early due to sudden deterioration
Chronic	Lasts more than 4 weeks Gradual deterioration of patient Prolonged history of atypical symptoms Common in older patients
Recurrent	Multiple episodes which lasts less than 4 weeks History of incompliance to medication immunosuppression may be the underlying cause

Variable	Empyema Thoracis	Lung abscess	Pleural effusion	Pneumonia	Lung cancer
Presentation	Variable presentation but may follow long standing pneumonia	Usually has history of aspiration pneumonia, alcoholics, drug abusers, seizure disorder, have undergone recent general anesthesia, or have a nasogastric or endotracheal tube.	Usually follows pneumonia as a complication	presents with fever, pleuritc chest pain, cough	mostly asymptomatic but may have cough productive with hemoptysis and chronic history of smoking
Causes	In general any bacteria can cause an empyema, however different bacteria are associated with different rates of empyema formation.[1]  Common causes include bacteroides, fusobacterium,  haemophilus influenzae, pneumococcal infections, staphylococcus aureus, streptococcus, TB	Lung abscess is commonly caused by bacterial infections and these include bacteroides, peptostreptococcus and prevotella mostly after aspiration	Common causes of transudative pleural effusion include;[1][2][3][4][5] left ventricular failure, Nephrotic syndrome, and cirrhosis, while common causes of exudative pleural effusions[6] are bacterial pneumonia and malignancy	Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, parasites, and chemical injury to the lungs	Direct cause of lung cancers is DNA mutations that often result in either activation of proto-oncogenes (e.g. K-RAS) or the inactivation of tumors suppressor genes (e.g. TP53) or both. The risk of these genetic mutations may be increased following exposure to environmental components example smoking
Laboratory findings	The pleural fluid typically has a low pH (<7.20), low glucose (<60 mg/dL), and contains infectious organisms. Therefore, the diagnosis relies on the presence of pus or organisms on gram stain. A positive bacteria culture from pleural fluid is not needed to make diagnosis of empyema.	Raised inflammatory markers ( eg high ESR, CRP) are usual but not specific	The most widely used criteria is to differentiate between exudate and transudate using the light's criteria. Fluid is exudate when: Pleural fluid protein/serum protein ratio >0.5 Fluid/serum lactic dehydrogenase (LDH) ratio >0.6 Fluid LDH greater than 2/3 the upper limits of normal of the serum LDH	Laboratory findings are non specific example leukocytosis, sputum samples for gram staining and culture. Other tests include urine antigen test, PCR, C-reactive protein and procalcitonin	The laboratory findings are  non specific including: neutropenia, hyponatremia, hypokalemia, hypercalcemia, respiratory acidosis, hypercarbia, hypoxia, and tumor cells in sputum and pleural effusion cytology.
Physical examination	On examination, the following findings may be seen: Lateral chest wall swelling and tenderness, clubbing of the fingernails, dull percussion note, r educed breath sounds on the affected side of the chest, egophony, coarse crackles, increased tactile fremitus, mediastinal shift to opposite side with large empyema	Chest examination shows features of consolidation such as localised dullness on percussion, bronchial breath sound etc. Dental decay is common especially in alcoholics and children. Clubbing is present in one third of patients.	Bulging of the intercostal spaces, decreased chest expansion bronchovesicular breath sounds of decreased intensity, egophony, dullness to percussion, decreased or absent fremitus.	Physical examination increased respiratory rate, low oxygen saturation, difficulty breathing, bronchial breathe sounds, increased tactile fremitus crackling sounds, or increased whispered pectoriloquy.	Physical examination findings are non specific and may include decreased/absent breath sounds, pallor, low-grade fever, tachypnea and cachezia.
CXR	Chest X ray of empyema shows air-fluid level continuos homogenous pattern from the mediastinum to the chest wall forming obtuse angle with the lung parenchyma.	Chest xray shows often unilateral cavity containing an air-fluid level and consolidation of lung parenchyema.	A homogenous opacification is noted at the affected side. The costophrenic angle is obliterated with a meniscus.	CXR shows areas of diffused opacities.	CXR may show lung mass, widening of the mediastinum, atelectasis, or pleural effusion.
Chest ultrasound	Ultrasound in empyema is positive for suspended microbubble sign, air fluid level, curtains sign and loss of gliding sign.	Ultrasound in lung abscess is negative for suspended microbubble sign, curtains sign and loss of gliding sign but air fluid level may be seen,.	Ultrasonography is helpful in making diagnosis of pleural effusion particularly in differentiating effusion from masses. The extended thoracic spine sign on sonography has high sensitivity and specificity for diagnosing pleural effusion. Chest or upper abdominal ultrasound may show subpulmonic effusion as shown below.	Not reqiured unless complicated with empyema	USG is helpful in guiding biopsy, staging and estimating prognosis. It may show hypo- and hyperechogenic masses.
CT scan	Seen as a lung mass whose cavity is regular with smooth and regular lumen, well-defined boundary and shape changes with change in patient's position. Mass may resolve on antibiotics The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess)	Lung mass whose cavity is rregular with undulated lumen, irregular-poorly defined boundary and shape does not change with change in patient's position. Mass may resolve on antibiotics	In most cases CT imaging may not provide additional information that would influence the clinical decision-making process. CT scan shows heterogeneous opacification of the affected side and cardiomediastinal shift to the opposite site in unilateral effusion.	CT findings in pneumonia include:[1] Airspace consolidation Ground-glass oppacities Pleural effusion Hiliar and/or mediastinal lymphadenopathy Bronchiectasis Tree-in-bud appereance	Seen as a spiculated irregular solid mass that does not resolve on antibiotics