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Upper Respiratory Infection

URI

Upper respiratory infections include the components of the upper airway and are most commonly caused by viruses.


Presentation

The onset of symptoms occurs 2 to 3 days after exposure to the infectious agent. The illness usually lasts for 7 to 10 days. Nasal congestion, sneezing and sore throat are the hallmarks of the common cold. The patients usually present with a runny nose, sneezing, post-nasal drip and throat pain. At first there is a clear mucus discharge from the nose. This often becomes thick and yellow or green within 2 to 3 days. The other symptoms include mild to high grade fever, conjunctivitis, fatigue and myalgias.

In some of the cases of upper respiratory infections, cough is the main symptom. This is because of the inflammation in the airways caused by infection. Cough is usually dry and associated with fever, headache and body aches.

In infants and children, the upper airways may become inflamed causing viral croup and acute laryngotracheobronchitis. Initially, the child gets a cold with cough, coryza and low grade fever. Gradually in 12 to 24 hours, the cough becomes croupy (also called “barking cough”). It causes varying degrees of respiratory distress with retractions and even cyanosis [7].

Cough
  • This paper discusses the mechanism of cough in man and describes some clinical investigations on the effects of codeine on cough associated with URTI.[ncbi.nlm.nih.gov]
  • Subjects with productive cough or no cough showed no consistent changes during infection. Twenty-six control subjects who reattended without URI showed no change in capsaicin sensitivity.[ncbi.nlm.nih.gov]
  • The objective of this study was to determine the effects of a placebo treatment on cough in patients with cough associated with acute upper respiratory tract infection (URTI).[ncbi.nlm.nih.gov]
  • Wet cough iStock/lisafx A persistent cough is common with a URI. (Related: Find out these natural cough remedies .) Eventually, that cough becomes productive and allows for the body to push out mucus.[rd.com]
Common Cold
  • (common cold) , Acute nasopharyngitis [common cold] , acute rhinitis , acute rhinitis (diagnosis) , rhinitis acute , common cold , common cold (diagnosis) , Common cold syndrome , Rhinitis (infective) , Infective nasopharyngitis, NOS , Acute nasopharyngitis[fpnotebook.com]
  • Garlic for the common cold. Cochrane Database of Systematic Reviews 2014, Issue 11. Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6. Singh M, Singh M. Heated, humidified air for the common cold.[care.american-rhinologic.org]
  • cold in children The common cold is one of the most common illnesses.[hopkinsmedicine.org]
Sore Throat
  • Soothe a sore throat. Gargle with warm salt water. This helps your sore throat feel better. Make salt water by dissolving ¼ teaspoon salt in 1 cup warm water. You may also suck on hard candy or throat lozenges. You may use a sore throat spray.[drugs.com]
  • The benefits of tonsillectomy in preventing recurrent sore throat are modest.... Access to the complete content on Oxford Medicine Online requires a subscription or purchase.[oxfordmedicine.com]
  • Risk Factors • Contact with other people who are sick • Poor hygiene • Sleep deprivation • Over-training • Smoking Symptoms • Cough • Nasal congestion • Runny nose • Sneezing • Sore throat • Muscle aches • Possibly fever Sports Medicine Evaluation and[sportsmedtoday.com]
  • The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold.[ncbi.nlm.nih.gov]
Sneezing
  • They are spread by droplets expelled by a person with a cold who sneezes, coughs or speaks. The handling of money is one way of passing on or ‘catching’ a cold.[time-to-run.com]
  • Sneezing Sneezing is commonly present with a cold. Sneezing is not common with the flu. Sneezing is common. Sudden Symptoms Cold symptoms tend to develop over a few days. The flu has a rapid onset within 3-6 hours.[fauquierent.net]
  • The following are the most common symptoms of an upper respiratory infection: Stuffy, runny nose Scratchy, tickly throat Watery eyes Sneezing Mild hacking cough Congestion Sore throat Achy muscles and bones Headaches Low-grade fever Chills Watery discharge[coppellfamilymedicine.com]
  • […] virus enters your body, it causes a reaction – the body's immune system begins to react to the foreign virus causing: An increase in mucus production (a runny nose) Swelling of the lining of the nose, making it hard to breathe and causing congestion Sneezing[baylorrichardsondoctors.com]
  • Symptoms typically associated with upper respiratory tract infections include sneezing, coughing, discharge from the nose and/or eyes, difficulty breathing, and sometimes fever.[petmd.com]
Nasal Congestion
  • Chronic nasal congestion lasting greater that 2-3 weeks may be a sign of a sinus infection or a foreign body placed in the nose (causes one-sided foul smelling thick runny nose).[farrellpediatrics.com]
  • The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold.[ncbi.nlm.nih.gov]
  • They are not effective in treating nasal congestion, sinus pressure, sore throat, headache, or malaise from infections.[studenthealth.ucsf.edu]
  • To find relief from nasal congestion, try some extra humidity. Use a humidifier in your room. You can also use a neti pot or saline water for some relief. [ Read: Nasal Congestion Relief During Pregnancy ] 5.[momjunction.com]
  • Eighty well children and 74 children with URI and nasal congestion were recruited from the University of Utah Pediatric Clinic. Subjects were 2 to 23 months of age.[ncbi.nlm.nih.gov]
Fever
  • Seek medical attention when you have a fever that is greater than 100.4 F or 38 C, fever unresponsive to fever reducer, fever present for more than two to three days, or a rash.[campushealth.unc.edu]
  • Get medical care if you have: Difficulty swallowing liquids White or yellow spots in throat Increased pain after 3 days For fever: Self-care is okay for fever less than 101 F (38.3 C).[uhs.umich.edu]
  • XSQJ bag tea was used to treat 239 cases of high fever caused by viral upper respiratory infection, widely spreading in summer and autumn.[ncbi.nlm.nih.gov]
  • Your child may have a fever with the cold. A fever usually happens at the beginning of the cold, and lasts for 3 to 5 days. The influenza virus causes a respiratory infection with high fevers that can last up to 7 days.[aboutkidshealth.ca]
  • Fever may be present, but it is not typical in persons with croup. Fever may be seen with influenza laryngitis.[emedicine.medscape.com]
Fatigue
  • For fatigue: Self-care is okay if you have general aches. Get medical care if you have excessive fatigue. For earache: Self-care is okay if you have stuffy or clogged ears. Get medical care if you have pain in or discharge from ears.[uhs.umich.edu]
  • Fatigue, may persist Sore throat Sometimes a sore throat Normal energy level Exhaustion Children suffer more colds each year than adults, due to their immature immune systems and to the close physical contact with other children at school or day care[chop.edu]
  • Body aches / fatigue Get plenty of rest—at least 8-10 hours of sleep with rest periods during the day. Take an oral pain reliever. Seek medical attention when you have persistent fatigue for more than 8-10 days or a rash.[campushealth.unc.edu]
  • Symptoms of Upper Respiratory Infections Sore throat Runny nose Coughing Sneezing Aches and pains Painful swallowing Fever Headache Fatigue Insomnia Malaise Post nasal drip Swelling of the throat Soreness in other parts of the body You need to pay attention[enkivillage.com]
  • […] infection: Stuffy, runny nose Scratchy, tickly throat Watery eyes Sneezing Mild hacking cough Congestion Sore throat Achy muscles and bones Headaches Low-grade fever Chills Watery discharge from the nose that thickens and turns yellow or green Mild fatigue[coppellfamilymedicine.com]
Malaise
  • The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold.[ncbi.nlm.nih.gov]
  • Influenza, however, tends to cause symptoms and complaints that involve the entire body, including fever, chills, muscle aches and pains, and general malaise or feeling poorly.[idcare.com]
  • Influenza : initially presents with systemic symptoms, including fever, rigors, headaches, myalgia, malaise and anorexia.[patient.info]
  • In some instances a secondary bacterial infection occurs producing a thickened yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise (discomfort and uneasiness caused by an illness) , myalgia, and dry cough.[time-to-run.com]
  • They are not effective in treating nasal congestion, sinus pressure, sore throat, headache, or malaise from infections.[studenthealth.ucsf.edu]
Chills
  • Chills iStock/George Clerk Patients with pneumonia often report teeth-chattering chills that cannot be remedied. Chills are a sign of fever and that the body is working overtime to regulate temperature.[rd.com]
  • Chills Chills are uncommon with a cold. 60% of people who have the flu experience chills. No chills. Tiredness Tiredness is fairly mild with a cold. Tiredness is moderate to severe with the flu. Tiredness is moderate.[fauquierent.net]
  • Influenza, however, tends to cause symptoms and complaints that involve the entire body, including fever, chills, muscle aches and pains, and general malaise or feeling poorly.[idcare.com]
  • The following are the most common symptoms of an upper respiratory infection: Stuffy, runny nose Scratchy, tickly throat Watery eyes Sneezing Mild hacking cough Congestion Sore throat Achy muscles and bones Headaches Low-grade fever Chills Watery discharge[coppellfamilymedicine.com]
Lymphadenopathy
  • Lymphadenopathy may be present in the anterior cervical nodes. Fever may be present, but it is not typical in persons with croup. Fever may be seen with influenza laryngitis.[emedicine.medscape.com]
  • Her throat appeared to have erythematous, swollen tonsils, greater on the left with left-sided cervical lymphadenopathy and diffuse, painful swelling. Her breath sounds were positive for scattered wheezing with rales on the left.[healio.com]
  • Modified Centor Criteria for Pharyngitis and Tonsillitis Clinical finding Points Absence of cough 1 Age 3 to 14 years 1 15 to 45 years 0 Older than 45 years –1 Anterior cervical lymphadenopathy 1 Fever 1 Tonsillar erythema or exudates 1 Table 2.[aafp.org]
  • Infectious mononucleosis (glandular fever) : presents with persistent severe sore throat, fever, cervical lymphadenopathy and malaise; it is particularly common in teenagers and young adults.[patient.info]
Nausea
  • Less common symptoms include reduced ability to smell, headache, shortness of breath, sinus pain, itchy and watery eyes, nausea, vomiting, diarrhea, bad breath, and body aches. Symptoms usually last between 3 and 14 days.[walgreens.com]
  • Continuous use may cause nausea. Prescriptions for flu: Antiviral drugs, available by prescription, may decrease the severity and duration of illness if taken within 48 hours of onset of symptoms.[uhs.umich.edu]
  • Nausea. Vomiting. These signs and symptoms for upper respiratory tract infection last for more than a week. But if the symptoms continue for more than a couple of weeks the illness can be as serious as pneumonia or bronchitis.[epainassist.com]
  • Zinc supplements have been shown to modestly reduce the duration of cold symptoms if taken less than 24 hours after symptom onset, but it can cause nausea and a bad taste.[jewishjournal.com]
  • Unnecessary antibiotics may lead to antibiotic resistant bacteria (often needing treatment in the hospital), allergic reactions, and/or side effects (e.g. nausea, vomiting, diarrhea).[campushealth.unc.edu]
Odynophagia
  • Common symptoms of upper respiratory infection generally include: nasal congestion, runny nose (rhinorrhea), nasal discharge (may change from clear to white to green) nasal breathing, sneezing, sore or scratchy throat, painful swallowing (odynophagia)[medicinenet.com]
Dysphagia
  • […] of smell Watchful waiting in mild cases; amoxicillin for severe or complicated bacterial rhinosinusitis 10 Common cold Runny nose, cough, sore throat, sneezing, nasal congestion Symptomatic treatment; antibiotics are not recommended 11 Epiglottitis Dysphagia[aafp.org]
  • Clinical Manifestations The syndrome of epiglottitis begins with the acute onset of fever, sore throat, hoarseness, drooling, dysphagia and progresses within a few hours to severe respiratory distress and prostration.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Outcomes for harms include antibiotic-related adverse events (eg, abdominal pain, diarrhea, rash), Clostridium difficile colitis, development of resistance, and cost.[pediatrics.aappublications.org]
  • Headache, confusion, abdominal pain, nausea, vomiting and diarrhea may be present, depending on the age of the patient and the organisms involved.[ncbi.nlm.nih.gov]
Halitosis
  • Halitosis may be noted, because resident flora processes the products of the inflammatory process. Anterior cervical lymphadenopathy is seen with viral and bacterial infections.[emedicine.medscape.com]
  • Other signs may include bad breath ( halitosis ), cough, voice hoarseness , and fever. Laboratory testing is generally not recommended in the evaluation of upper respiratory infections.[medicinenet.com]
Myalgia
  • In some instances a secondary bacterial infection occurs producing a thickened yellow nasal discharge, watering eyes, mild fever, sore throat, headache, malaise (discomfort and uneasiness caused by an illness) , myalgia, and dry cough.[time-to-run.com]
  • Influenza : initially presents with systemic symptoms, including fever, rigors, headaches, myalgia, malaise and anorexia.[patient.info]
  • […] antistaphylococcal agent active against methicillin-resistant Staphylococcus aureus 12 or intravenous monotherapy with ceftriaxone (Rocephin), cefotaxime (Claforan), or ampicillin/sulbactam (Unasyn) 13 – 15 Influenza Abrupt onset of fever, headache, myalgia[aafp.org]
  • People with influenza commonly have acute onset of fever, myalgia, headache, and cough.[wwwnc.cdc.gov]
Headache
  • Headache A headache is fairly uncommon with a cold. A headache is very common with the flu, present in 80% of flu cases. A headache is not unusual. Sore Throat Sore throat is commonly present with a cold.[fauquierent.net]
  • […] changes (e.g. agitation or confusion) Severe headache with fever greater than 101 F (38.3 C) and rash anywhere on the body For body ache: Self-care is okay if you have general aches.[uhs.umich.edu]
  • Pharyngitis/tonsillitis—this is caused by both bacterial and viral organisms, with sore throat often accompanied by fever, headache, and other symptoms, with or without enlarged and tender cervical lymph nodes, tonsillar erythema, and exudate.[oxfordmedicine.com]
  • They are not effective in treating nasal congestion, sinus pressure, sore throat, headache, or malaise from infections.[studenthealth.ucsf.edu]
  • Be aware of these differences: Cold symptoms Flu symptoms Low or no fever High fever Sometimes a headache Commonly a headache Stuffy, runny nose Sometimes a stuffy nose Sneezing Sometimes sneezing Mild, hacking cough Cough, may progress Slight aches and[chop.edu]
Lethargy
  • Upper respiratory infections are one of the most frequent causes for a doctor visit with varying symptoms ranging from runny nose, sore throat , cough , to breathing difficulty, and lethargy.[medicinenet.com]
  • Patients with glomerulonephritis may have loss of appetite, lethargy, dull back pain, and dark urine. Blood pressure may be elevated, and edema may occur.[emedicine.medscape.com]

Workup

Upper respiratory tract infections are usually obvious from the common cold symptoms and do not require a medical diagnosis. However, the following investigations are necessary to establish the diagnosis with certainty.

  • White blood cell count: Leukocytosis is very common with counts more than 10,000 per cubic millimeter and a predominance of polymorphs and immature neutrophils.
  • Direct visualization: A laryngoscope helps visualize an enlarged, swollen and erythematous epiglottis in case of epiglottitis.
  • Radiographic studies: X-ray of soft tissues of neck reveals subglottic narrowing. The presence of “thumb sign” is a common radiographic marker for epiglottitis [8].
  • Throat culture: It is the primary method for the diagnosis of streptococcal pharyngitis and tonsillitis and the most reliable means of differentiating streptococcal from viral pharyngitis. Viral culture from nasopharyngeal secretions and viral antibody titer may help establishing the diagnosis of bronchiolitis.

Treatment

In cases of upper respiratory infections, management is mostly symptomatic. Infants with respiratory distress should be hospitalized. Heated and humidified air may improve symptoms. The following agents may also be helpful.

  • Nasal decongestants: Topical nasal decongestant sprays such as pseudoephedrine may be helpful [9]. They should only be used for 2 to 3 days.
  • Intranasal cromolyn sodium and ipratropium bromide: These are helpful in reducing the severity of common cold symptoms.
  • Analgesics: These include acetaminophen, aspirin and ibuprofen. They may help to improve the symptom of sore throat. Aspirin should not be used in children with acute viral illnesses because of the risk of Reye syndrome.
  • Antibiotics: Antibiotics are used if the upper respiratory tract infection has a bacterial etiology [10].
  • Antihistamines: These drugs help improve the symptoms like sneezing and rhinorrhea. These should be used with caution in elderly patients as they can cause sedation and anticholinergic effects.
  • Ribavirin: It is an antiviral agent that can be used for the treatment of severe bronchiolitis due to respiratory syncytial virus.
  • Intravenous fluids: They help to prevent dehydration. Respiratory acidosis and electrolyte imbalance must be corrected as well.
  • Avoid smoking: Smoke irritates the nose and the throat. Therefore, staying away from smoky environments is recommended.
  • Prop up position: Raising the head of your bed slightly by placing a pillow under the mattress may help reduce cough at night.

Prognosis

Most of the people with upper respiratory infections recover within a week with proper medication and good hygiene. So overall, the prognosis is excellent.

Untreated cases may lead to severe complications like otitis media, bronchitis, pneumonia and meningitis [6]. Serious complications may result in significant morbidity and rare deaths.

Etiology

A number of viruses are responsible for causing upper respiratory infections. The most common virus responsible for common cold is rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, cytomegalovirus, coxsakievirus and respiratory syncytial virus. Over 200 viruses have been known to cause symptoms of the common cold.

Some cases of acute pharyngitis may also be caused by bacteria, most commonly Streptococcus pyogenes [2]. Other bacterial causes include Streptococcus pneumoniae, Hemophilus influenzae, Corynebacterium diphtheriae, Bordetella pertussis and Bacillus anthracis [3].

Epidemiology

Acute upper respiratory tract infection is the leading cause of illness and death of children under 5 years of age. It constitutes around 30 to 60% of patients in a hospital outpatient. 80% of the children have upper respiratory infections.

Children usually have 3 to 8 episodes of viral respiratory infections per year. Adults have approximately 2 to 4 colds per year whereas people older than 60 years have less than one cold annually.

Streptococcal bacteria causes 5 to 15% of all cases of pharyngitis. Moreover, the upper respiratory infections are most common in cold weather, with a peak incidence from late winter to early spring. These illnesses are the leading reasons for people missing work and school.

Sex distribution
Age distribution

Pathophysiology

Acute upper respiratory infections occur by transmission of microorganisms by aerosol, droplet or hand-to-hand contact with infected secretions. The viral infection arises from direct microbial invasion with subsequent bacteremia. This results in marked edema and inflammation with polymorphs and fibrin deposition.

The microorganisms encounter several barriers such as the hair lining the nose, mucus coats and ciliated cells lining the respiratory tract.

Initially, the infection occurs in the nasopharynx. It then extends to the larynx and trachea, causing redness and swelling and ultimately narrowing of the lumen by the fibrinous exudate.

Sometimes, genetic variations may also be involved in determining which patients have more severe disease courses than others [4][5].

Prevention

The upper respiratory infections are usually contagious so the spread can be prevented by covering mouth and nose while coughing, washing hands carefully and avoiding touching one’s eyes and nose. Sharing of cups and kitchen utensils is also not to be avoided.

Regular exercise may also have a beneficial role as it helps improve the immune system. There are currently vaccines available that can provide protection against certain respiratory tract infections.

Summary

Upper respiratory infections include infections of the nose, sinuses, pharynx and larynx. The common cold is the most well-known form. Other types of upper respiratory infections include rhinitis, sinusitis, pharyngitis, epiglottitis, laryngitis, laryngotracheitis and tracheitis. These infections are the most common acute illnesses and are usually characterized by mild fever, cough, fatigue, sneezing and nasal congestion [1] and range from simple common cold to severe life threatening illnesses such as epiglottitis.

Patient Information

The upper respiratory infections are the most common illnesses of respiratory tract. The patients usually have mild fever with sore throat, a runny nose, cough and fatigue. Children tend to get more upper respiratory tract infections than adults.

References

Article

  1. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 summary. National health statistics reports. Aug 6 2008(3):1-39.
  2. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Nov 15 2012;55(10):1279-1282.
  3. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Apr 2012;54(8):e72-e112.
  4. Juno J, Fowke KR, Keynan Y. Immunogenetic factors associated with severe respiratory illness caused by zoonotic H1N1 and H5N1 influenza viruses. Clinical & developmental immunology. 2012;2012:797180.
  5. Horby P, Nguyen NY, Dunstan SJ, Baillie JK. The role of host genetics in susceptibility to influenza: a systematic review. PloS one. 2012;7(3):e33180.
  6. Arola M, Ruuskanen O, Ziegler T, et al. Clinical role of respiratory virus infection in acute otitis media. Pediatrics. Dec 1990;86(6):848-855.
  7. Shvalko AD. [Features of whooping cough during the first 6 months of life]. Sovetskaia meditsina. Mar 1962;25:78-82.
  8. Grover C. Images in clinical medicine. "Thumb sign" of epiglottitis. The New England journal of medicine. Aug 4 2011;365(5):447.
  9. Eccles R, Jawad M, Jawad S, et al. Efficacy of a paracetamol-pseudoephedrine combination for treatment of nasal congestion and pain-related symptoms in upper respiratory tract infection. Current medical research and opinion. Dec 2006;22(12):2411-2418.
  10. Arroll B, Kenealy T, Falloon K. Are antibiotics indicated as an initial treatment for patients with acute upper respiratory tract infections? A review. The New Zealand medical journal. Oct 17 2008;121(1284):64-70.

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