What are the key red flags to look for in a patient with URTI that may indicate a more serious underlying condition?

Key red flags in a patient with an upper respiratory tract infection indicating a more serious underlying condition include:

• High fever, especially if persistent or accompanied by headache, neck stiffness, or altered consciousness, which may suggest bacterial meningitis ².
• Non-blanching petechial or purpuric rash, which is a sign of meningococcal disease ².
• Severe breathlessness or oxygen saturation below 90% on room air, indicating possible pneumonia or severe lower respiratory tract infection ⁴.
• Respiratory rate ≥24 breaths per minute, heart rate >100 beats per minute, systolic blood pressure ≤90 mmHg, or abnormal mental status, all of which suggest severe illness such as pneumonia ⁴.
• Persistent or recurrent chest infections, especially in patients aged 40 and over, which may indicate underlying lung cancer and warrant urgent chest X-ray ³.
• Unexplained weight loss, fatigue, or appetite loss in conjunction with respiratory symptoms, raising suspicion of malignancy ³.
• Persistent unexplained hoarseness in patients aged 45 and over, which may indicate laryngeal cancer ³.
• Signs of poor feeding, lethargy, irritability, or unusual behaviour in children, which may indicate serious infection ².

These red flags should prompt urgent clinical assessment and consideration of hospital referral or further investigations to exclude serious conditions such as bacterial meningitis, pneumonia, or cancer ²,³,⁴.