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Viral Upper Respiratory Tract Infection

Viral Upper Respiratory Tract Infections

Upper respiratory tract infections are frequent illnesses in the general population. They are caused by either viruses or bacteria. A viral infection may become complicated subsequently by bacteria. The location of the disease dictates its gravity, as viral upper respiratory tract infections range from simple ones, like viral nasopharyngitis to more severe ones, like rhinosinusitis, epiglottitis, laryngotracheitis and otitis media.


Presentation

In viral nasopharyngitis patients have profuse nasal discharge [1], fever, halitosis, mouth breathing leading to dry mouth, hyposmia, sneezing and odynophagia, symptoms that occur 2-3 days after inoculation and last for 7-14 days, depending on the age of the patient [2]. Nasal secretions are initially clear and after 2-3 days turn green or yellow, which may signify a superimposed bacterial infection [3]. Examination of the uvula and posterior pharynx reveals inflammation. Cough may result from postnasal drip. Conjunctivitis and photophobia may accompany ocular pain.

More severe viral upper respiratory infections also cause vomiting, nausea, diarrhea and abdominal pain, as well as myalgia, fatigue or malaise- more frequent in influenza virus infection.

Viral rhinosinusitis [4] is also characterized by nasal discharge with mucopurulent secretion that does not improve with decongestants or antihistamines administration. Facial or dental pain related to the affected sinus raise rhinosinusitis suspicion. Other symptoms include sore throat, dry mouth, cough, posttussive emesis, hyposmia, and fatigability.

Laryngeal involvement is recognized by hoarseness or voice loss and dry cough [5].

Epiglottitis may represent a potential lethal emergency [6]. It is characterized by an acute onset of symptoms like fever, dyspnea, fatigability, odynophagia- as severe as to prevent saliva swallowing, leading to drooling, dysphonia or total voice loss [7]. Severe episodes are accompanied by respiratory distress, manifested as tachypnea, tachycardia, perioral cyanosis and use of accessory respiratory muscles.

Acute viral otitis media also has a rapid onset [8], consisting of fever, otalgia, difficulty sleeping, irritability, headache, loss of appetite, fluid drainage from the ear and diminished hearing [9].

All viral upper respiratory tract infections can cause cervical lymphadenopathy. Specific etiologies lead to specific signs: mononucleosis is accompanied by splenomegaly and hepatomegaly, herpes virus infection causes palatal vesicles, vesicles located on the uvula, palate and anterior tonsillar pillars suggest herpangina. Tonsil hypertrophy is a common finding. Cough may be severe enough to produce conjunctival hemorrhages.

Fever
  • It is characterized by an acute onset of symptoms like fever, dyspnea, fatigability, odynophagia- as severe as to prevent saliva swallowing, leading to drooling, dysphonia or total voice loss.[symptoma.com]
  • RESULTS: Two variables from the clinician's records ('age' and 'cough') and two variables from the CARIFS completed by carers on the day of consulting ('fever' and 'low energy, tired') explained approximately 15% of the variation present in CARIFS scores[ncbi.nlm.nih.gov]
  • Abstract We report the cases of eight military patients with fever ( 38 C) induced by viral upper respiratory tract infection (URTI) who requested treatment with acupuncture in the military medical service room.[ncbi.nlm.nih.gov]
  • These were ‘fever’ ( P 0.01) and ‘low energy, tired’ ( P 0.04).[academic.oup.com]
Sudden Infant Death Syndrome
  • These results are relevant to sudden infant death syndrome (SIDS). The combination of prone sleeping and URTI reproduces the nasopharyngeal flora seen in SIDS.[ncbi.nlm.nih.gov]
Cough
  • Two previous studies incorporating capsaicin cough challenge methodology have demonstrated that cough reflex sensitivity is transiently enhanced during URI. These studies used single measurements of cough reflex sensitivity during the URI period.[ncbi.nlm.nih.gov]
  • Cough may result from postnasal drip. Conjunctivitis and photophobia may accompany ocular pain.[symptoma.com]
  • Measurement of cough reflex sensitivity Measurement of cough reflex sensitivity has allowed insight into the effects of viral URI on human cough reflex sensitivity.[jtd.amegroups.com]
  • European Respiratory Journal 2011 38: p3510; DOI: Abstract One previous study has demonstrated that cough reflex sensitivity to inhaled capsaicin is transiently enhanced during acute viral respiratory tract infection (URI) by comparing single cough reflex[erj.ersjournals.com]
  • RESULTS: Two variables from the clinician's records ('age' and 'cough') and two variables from the CARIFS completed by carers on the day of consulting ('fever' and 'low energy, tired') explained approximately 15% of the variation present in CARIFS scores[ncbi.nlm.nih.gov]
Sore Throat
  • Other symptoms include sore throat, dry mouth, cough, posttussive emesis, hyposmia, and fatigability. Laryngeal involvement is recognized by hoarseness or voice loss and dry cough. Epiglottitis may represent a potential lethal emergency.[symptoma.com]
  • Clinical and psychosocial predictors of illness duration from randomised controlled trial of prescribing strategies for sore throat. Br Med J 1999 ; 319 (7212): 736 –737. 6 Hay AD, Wilson A, Fahey T, Peters TJ.[academic.oup.com]
  • Strep Throat" - sore throat as 1st symptom , may not have runny nose /cough/ sneezing.[quizlet.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]
  • throat, conjunctivitis–with adenovirus infections; sore throat with pain on swallowing, fever, absence of cough, and exposure to a person with streptococcal pharyngitis in the prior 2 wks support Dx of GABHS-related pharyngitis; Pts with acute sinusitis[medical-dictionary.thefreedictionary.com]
Nasal Congestion
  • The majority of patients in health care settings that present with complaints of runny nose, nasal congestion, cough and headache have a viral upper respiratory infection (the common cold).[healthcentral.com]
  • Often, the first 2 to 3 days are marked by nasal congestion and stuffiness, followed by several days of sniffling and a runny nose.[care.american-rhinologic.org]
  • Typical symptoms include nasal congestion, a runny nose, scratchy throat, cough, and irritability. The diagnosis is based on symptoms. Good hygiene is the best way to prevent these infections, and routine vaccination can help prevent influenza.[merckmanuals.com]
  • Case 1 A 43-year-old female presents to your office with a 5 day history of low grade fever of 100.1 F, nasal discharge initially clear, but now turning yellow in color, nasal congestion and a minimally productive cough.[medicine.uiowa.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]
Pharyngitis
  • […] lesions,” tender anterior cervical lymphadenopathy, and occasionally a scarlatiniform rash; pharyngeal or palatal vesicles and ulcers (herpangina) suggest enteroviral or herpetic pharyngitis; pharyngeal exudates are most common in GABHS-related pharyngitis[medical-dictionary.thefreedictionary.com]
  • Acute pharyngitis. N Engl J Med. 2001;344(3):205–11. PubMed CrossRef Google Scholar 121. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):383–90. PubMed Google Scholar 122. Shulman ST, et al.[link.springer.com]
  • On Day one, at the initial consultation, clinicians recorded age, duration of illness and clinical characteristics (coryza, cough, raised temperature, pharyngitis, enlarged lymph nodes, malaise).[academic.oup.com]
  • Acute pharyngitis with fever - Adenoviruses are a common cause of an acute sore throat. Pharyngoconjunctivical fever - Adenoviruses may cause an acute conjunctivitis together with a shore throat and fever.[quizlet.com]
  • Links: common cold croup epiglottitis (acute) otitis media acute mastoiditis acute pharyngitis sinusitis acute tonsillitis laryngitis NICE guidance - antibiotic prescribing for self-limiting respiratory tract infections[gpnotebook.co.uk]
Nasal Discharge
  • The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI.[ncbi.nlm.nih.gov]
  • In viral nasopharyngitis patients have profuse nasal discharge, fever, halitosis, mouth breathing leading to dry mouth, hyposmia, sneezing and odynophagia, symptoms that occur 2-3 days after inoculation and last for 7-14 days, depending on the age of[symptoma.com]
  • Complaints of sinus pressure or discolored nasal discharge and the finding of sinus tenderness were strongly associated with the diagnosis of sinusitis.[ncbi.nlm.nih.gov]
  • Symptoms & Signs In infants :fever , nasal discharge, difficulty feeding, decreased appetite, and difficulty sleeping. In school-aged children:nasal congestion, sneeze, fever, nasal discharge, headache, sore throat , hoarseness and cough 10.[slideshare.net]
  • discharge; hoarseness suggests laryngitis; difficulty in swallowing oral secretions and stridor should raise suspicion for epiglottitis or pharyngeal abscess; influenza presents as a sudden illness characterized by high fever, severe headache, myalgia[medical-dictionary.thefreedictionary.com]
Loss of Appetite
  • Acute viral otitis media also has a rapid onset, consisting of fever, otalgia, difficulty sleeping, irritability, headache, loss of appetite, fluid drainage from the ear and diminished hearing.[symptoma.com]
Colic
  • Br J Pharmacol 2011;163:116-24. [ PubMed ] Dicpinigaitis PV, Colice GL, Goolsby MJ, et al. Acute cough: a diagnostic and therapeutic challenge. Cough 2009;5:11. [ PubMed ] Dicpinigaitis PV, Alva RV. Safety of capsaicin cough challenge testing.[jtd.amegroups.com]
Drooling
  • It is characterized by an acute onset of symptoms like fever, dyspnea, fatigability, odynophagia- as severe as to prevent saliva swallowing, leading to drooling, dysphonia or total voice loss.[symptoma.com]
Myalgia
  • Accompanying symptoms such as headache, myalgia and nasal obstruction also showed a tendency to decrease. Within 3 days of treatment, six of the eight patients had recovered from the URTI. No adverse effects of acupuncture treatment were reported.[ncbi.nlm.nih.gov]
  • More severe viral upper respiratory infections also cause vomiting, nausea, diarrhea and abdominal pain, as well as myalgia, fatigue or malaise- more frequent in influenza virus infection.[symptoma.com]
  • […] nasal discharge; hoarseness suggests laryngitis; difficulty in swallowing oral secretions and stridor should raise suspicion for epiglottitis or pharyngeal abscess; influenza presents as a sudden illness characterized by high fever, severe headache, myalgia[medical-dictionary.thefreedictionary.com]
  • She denies myalgias, shortness of breath, and ear pain, but does admit to mild headache. On physical exam, the nasal mucosa is swollen and erythematous. There is a small amount of whitish discharge inside the left naris.[medicine.uiowa.edu]
  • […] not associated with other manifestations of the common cold (eg, cough, sore throat, fever) Influenza – Although influenza virus may cause the common cold, it usually causes more severe illness; abrupt onset of fever (often 39 C [102.2 F]), headache, myalgia[slideshare.net]
Sleep Disturbance
  • In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected sinusitis; their absence favors a diagnosis of URI.[ncbi.nlm.nih.gov]

Workup

The diagnosis of viral upper respiratory tract infection is mostly clinical, but several tests may also be helpful. For instance, the physician may order influenza rapid test, Epstein-Barr heterophile antibody test, cell culture for herpes simplex virus identification [10] or polymerase chain reaction in order to detect the same type of infection. Epiglottitis can be diagnosed by direct visualization during laryngoscopy, provided that the patient's clinical status allows it. The microbiological specimen is obtained from throat or nasal swabs or washes; they are cultured on special media in order to identify respiratory syncytial virus, influenza and parainfluenza virus and adenovirus. Antibody titers should be observed in a dynamic manner.

The complete blood cell count shows lymphocytosis in acute viral infections, but lymphopenia may also be noticed in some cases. A high white blood cell number is not unusual. In case dyspnea is noticed, foreign body inhalation should be excluded using imaging methods. In croup, the steeple sign representing subglottic stenosis may be noticed [11]. In acute viral otitis media, tympanometry may be useful.

Treatment

  • Within 3 days of treatment, six of the eight patients had recovered from the URTI. No adverse effects of acupuncture treatment were reported. Published by the BMJ Publishing Group Limited.[ncbi.nlm.nih.gov]
  • If clinicians had feasible tools for predicting which children are likely to suffer a prolonged course, then additional explanations and possibly treatments could be provided at the initial consultation that might enable carers to manage the condition[ncbi.nlm.nih.gov]
  • INTERPRETATION: Intranasal sodium cromoglicate is not a useful additional treatment for this infection. Our results further clarify the role of prescribed drugs for children with these frequent illnesses.[ncbi.nlm.nih.gov]
  • Gregory DeMuri and Ellen Wald at the University of Wisconsin, antibiotic therapy is recommended, and amoxicillin–clavulanate is generally the first-line treatment.[blogs.nejm.org]
  • Charts were reviewed to ascertain patient demographics, past history, current symptoms, physical findings, and treatment prescribed.[ncbi.nlm.nih.gov]

Prognosis

  • Hillary Clinton's Pneumonia: How Serious, the Prognosis Posted 12 Sep 2016 by Drugs.com MONDAY, Sept. 12, 2016 – Democratic presidential candidate Hillary Clinton's pneumonia may have heightened questions about her overall health, but doctors say pneumonia[drugs.com]
  • Upper Respiratory Infection Prognosis (Outlook) Upper respiratory infections are a common occurrence and most people will get two to four colds per year.[emedicinehealth.com]

Etiology

  • A viral etiology was identified in 62 of 108 (57.4%) samples. Symptom measures that best differentiated children with a viral etiology from those without were significant runny nose and significant cough on days 1-4 of the illness.[ncbi.nlm.nih.gov]
  • Specific etiologies lead to specific signs: mononucleosis is accompanied by splenomegaly and hepatomegaly, herpes virus infection causes palatal vesicles, vesicles located on the uvula, palate and anterior tonsillar pillars suggest herpangina.[symptoma.com]
  • Viruses and bacteria in the etiology of the common cold. J Clin Microbiol. 1998;36(2):539–42. PubMed PubMedCentral Google Scholar 80. Hindiyeh M, Hillyard DR, Carroll KC.[link.springer.com]
  • In viral panel negative patients, high CRP levels might show infections rather than virus in etiology.[bloodjournal.org]

Epidemiology

  • Molecular epidemiology of human rhinovirus in children with acute respiratory diseases in Chongqing, China. Sci Rep. 2014;4:6686. PubMed PubMedCentral CrossRef Google Scholar 75. Linder JE, et al.[link.springer.com]
  • […] recommended; a rapid antigen detection test is also available for adenovirus, RSV, and parainfluenza virus; serologic tests for viruses that can cause a mononucleosis-type illness should be done in the correct clinical setting; influenza serologies have only epidemiologic[medical-dictionary.thefreedictionary.com]
  • EPIDEMIOLOGY incidence Between 60 and 80 % of children have at least one episode of AOM by one year of age Children who have had little or no experience with AOM by the age of three years are unlikely to have subsequent severe or recurrent disease.[slideshare.net]
  • […] beneficial in their case. [23] There is low-quality evidence indicating that the use of nasal irrigation with saline solution may alleviate symptoms in some people. [24] There are also saline nasal sprays which can be of benefit. [ citation needed ] Epidemiology[en.wikipedia.org]
  • Paediatric and Perinatal Epidemiology 2013;27:532-541. Laaksi I, Ruohola JP, Tuohimaa P, et al. An association of serum vitamin D concentrations 40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr 2007;86:714-7.[vitamindcouncil.org]
Sex distribution
Age distribution

Pathophysiology

  • PATHOPHYSIOLOGY innate immune response to infection viral replication occurs in only a small number of nasal epithelial cells The infected cells release cytokines, including interleukin (IL)-8 6.[slideshare.net]
  • Cause [ edit ] In terms of pathophysiology, rhino virus infection resembles the immune response. The viruses do not cause damage to the cells of the upper respiratory tract but rather cause changes in the tight junctions of epithelial cells.[en.wikipedia.org]

Prevention

  • While Sphingobium may play a role in preventing AOM complicating URI, the commonly used probiotic Bifidobacterium did not play a significant role during URI or AOM.[ncbi.nlm.nih.gov]
  • It is characterized by an acute onset of symptoms like fever, dyspnea, fatigability, odynophagia- as severe as to prevent saliva swallowing, leading to drooling, dysphonia or total voice loss.[symptoma.com]
  • Their enormous prevalence also indicates that rigorous research should be undertaken in order to tackle them, in both the prevention and treatment field.[link.springer.com]
  • August 22, 2017 A multi-site Canadian study found that vitamin D supplements do not prevent upper respiratory infections in young healthy children.[pulmonologyadvisor.com]

References

Article

  1. Winther B. Rhinovirus infections in the upper airway. Proc Am Thorac Soc. 2011;8(1):79–89.
  2. Heikkinen T, Järvinen A. The common cold. Lancet. 2003;361(9351):51–59.
  3. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.
  4. Thomas M, Yawn BP, Price D, et al. European Position Paper on Rhinosinusitis and Nasal Polyps Group. EPOS primary care guidelines: European position paper on the primary care diagnosis and management of rhinosinusitis and nasal polyps 2007—a summary. Prim Care Respir J. 2008;17(2):79–89.
  5. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults Cochrane Database Syst Rev. 2007;(2): CD004783.
  6. Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am. 2006;53(2):215–242.
  7. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. 2008;122(8):818–823.
  8. Heikkinen T, Thint M, Chonmaitree T. Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med. 1999;340(4):260–264.
  9. Chonmaitree T. Viral and bacterial interaction in acute otitis media. Pediatr Infect Dis J. 2000;19(5 suppl):S24–S30.
  10. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006; 4(55):1-94.
  11. Ragosta KG, Orr R, Detweiler MJ. Revisiting epiglottitis: a protocol--the value of lateral neck radiographs. J Am Osteopath Assoc. 1997;97(4):227-229.

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Last updated: 2018-06-21 17:13