Edit concept Question Editor Create issue ticket

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]
  • 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]
  • Methods A prospective cohort study was conducted in China and 223 HCWs were recruited from fever clinics and respiratory, paediatric, emergency/Intensive medication wards.[bmcinfectdis.biomedcentral.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]
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]
  • 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]
  • […] of the throat that often worsens during swallowing Causes The virus or bacteria can cause a sore throat You can catch a sore throat after a viral infection like a cold A sore throat caused due to bacterial infection is called strep throat that is less[beingtheparent.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]
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]
  • Patients with adenoviral pharyngitis often have pharyngeal exudate, so the disease can mimic streptococcal pharyngitis.[microbiologybook.org]
  • 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]
  • Pharyngitis Viral pharyngitis typically resolves in 1-2 weeks, but immunocompromised persons may have a more severe course.[emedicine.medscape.com]
  • In this study the sample comprised of those patients diagnosed with URTI’s that met inclusion criteria for patients with only a single diagnosis from the following list: common cold, pharyngitis, tonsillitis, pharyngitis, pharyngitis and Tonsillitis ([omicsonline.org]
Nasal Congestion
  • Because newborns and young infants prefer to breathe through their nose, even moderate nasal congestion can create difficulty breathing.[merckmanuals.com]
  • 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]
  • 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]
  • 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]
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]
  • 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]
Mouth Breathing
  • 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]
Toothache
  • […] 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 often have fever for 1 wk, facial pain–especially unilateral, maxillary toothache[medical-dictionary.thefreedictionary.com]
Hepatomegaly
  • 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]
Eye Pain
  • Symptoms include eye pain, bulging of the eye, redness of the eye, changes in vision and fever. Mastoiditis.[rileychildrens.org]
Eczema
  • The presence of underlying chronic illness such as asthma or eczema did not predict re-consultation.[academic.oup.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]
  • Some Infectious Agents that Cause the Common Cold Agents* Human Serotypes Other unique symptoms in addition to coryza Myxoviruses Influenza A, B, C Myalgia and fatigue Parainfluenza 1, 2, 3, 4 Myalgia and fatigue Respiratory syncytial virus 1 (possibly[atsu.edu]
  • 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]
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]
Insomnia
  • Note that these products can be associated with insomnia, nervousness, and irritability in some patients. Often decongestants are combined with other drugs (especially antihistamines) in OTC medications.[med.uth.edu]

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.

Pseudomonas
  • During URI and AOM, there were increases in abundance of otopathogen genera and decreases in Pseudomonas, Myroides, Yersinia, and Sphingomonas.[ncbi.nlm.nih.gov]
  • Pseudomonas aeruginosa is the usual causative organism.[microbiologybook.org]

Treatment

  • 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]
  • 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]
  • This study does not address the issue whether a subgroup of children with SAVURTI might benefit from antibiotic treatment.[academic.oup.com]

Prognosis

  • Rhinosinusitis The prognosis is generally favorable for acute rhinosinusitis, and many cases appear to resolve even without antibiotic therapy.[emedicine.medscape.com]
  • 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]
  • Bacterial infections, people with weak immune systems, and those with complications of upper respiratory infections (listed above) may have less favorable prognosis.[medicinenet.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]
  • Epidemiological comparison of three mycoplasma pneumoniae pneumonia epidemics in a single hospital over 10 years. Korean J Pediatr. 2015;58(5):172–7.[bmcinfectdis.biomedcentral.com]
  • Epidemiology The common cold is worldwide in distribution. A child younger than 5 years of age can acquire five to seven colds per year, and an adult can acquire one or two colds per year. The common cold is usually seen in the winter months.[atsu.edu]
  • 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]
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, rhinovirus 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]
  • Recruitment Information about the study was provided to staff members by district level staff members from the Beijing Centre for Disease Prevention and Control (CDPC).[bmcinfectdis.biomedcentral.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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 19:58