Upper Respiratory Tract Infection
Upper respiratory tract infection is a nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi. The prototype is the illness known as the common cold, which is discussed here, in addition to pharyngitis, sinusitis, and tracheobronchitis. Influenza is a systemic illness that involves the upper respiratory tract and should be differentiated from other URIs.
Viruses cause most URTIs, with rhinovirus, parainfluenza virus, coronavirus, adenovirus, respiratory syncytial virus, coxsackievirus, and influenza virus accounting for most cases. Human metapneumovirus is a newly discovered agent causing URIs. Group A beta-hemolytic streptococci (GABHS) cause 5% to 10% of cases of pharyngitis in adults. Other less common causes of bacterial pharyngitis include group C beta-hemolytic streptococci, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Chlamydia pneumoniae, Mycoplasma pneumoniae, and herpes simplex virus (HSV). Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms that cause the bacterial superinfection of viral acute sinusitis. Less than 10% of cases of acute tracheobronchitis are caused by Bordetella pertussis, B. parapertussis, M. pneumoniae, or C. pneumoniae.
Most upper respiratory tract infection occurs more frequently during the cold winter months, because of overcrowding. Adults develop an average of two to four colds annually. Antigenic variation of hundreds of respiratory viruses results in repeated circulation in the community. A coryza syndrome is by far the most common cause of physician visits in the United States. Acute pharyngitis accounts for 1% to 2% of all visits to outpatient and emergency departments, resulting in 7 million annual visits by adults alone. Acute bacterial sinusitis develops in 0.5% to 2% of cases of viral URIs. Approximately 20 million cases of acute sinusitis occur annually in the United States. About 12 million cases of acute tracheobronchitis are diagnosed annually, accounting for one third of patients presenting with acute cough. The estimated economic impact of non-influenza-related URIs is $40 billion annually.
Influenza epidemics occur every year between November and March in the Northern Hemisphere. Approximately two thirds of those infected with influenza virus exhibit clinical illness, 25 million seek health care, 100,000 to 200,000 require hospitalization, and 40,000 to 60,000 die each year as a result of related complications.5 The average cost of each influenza epidemic is $12 million, including the direct cost of medical care and indirect cost resulting from lost work days. Pandemics in the 20th century claimed the lives of more than 21 million people. A widespread H5N1 pandemic in birds is ongoing, with threats of a human pandemic. It is projected that such a pandemic would cost the United States $70 to $160 billion.Symptoms:Common symptoms of upper respiratory infection generally include:Nasal congestion.
- Runny nose (rhinorrhea).
- Sore or scratchy throat.
- Painful swallowing (odynophagia).
- Cough (from laryngeal swelling and post nasal drip).
- Fever (more common in children).
The diagnosis of upper respiratory infection is typically made based on review of symptoms, physical examination, and occasionally, laboratory tests.
In physical examination of an individual with upper respiratory infection, a doctor may look for swollen and redness inside wall of the nasal cavity (sign of inflammation), redness of the throat, enlargement of the tonsils, white secretions on the tonsils (exudates), enlarged lymph nodes around the head and neck, redness of the eyes, and facial tenderness (sinusitis). Other signs may include bad breath (halitosis), cough, voice hoarseness, and fever.
Laboratory testing is generally not recommended in the evaluation of upper respiratory infection. Because most upper respiratory infections are caused by viruses, specific testing is not required as there is typically no specific treatment for different types of viral upper respiratory infections.
X-rays of the neck may be done if suspected case of epiglottitis. Although the finding of swollen epiglottis may not be diagnostic, its absence can rule out the condition. CT scans can sometimes be useful if symptoms suggestive of sinusitis last longer than 4 weeks or are associated with visual changes, copious nasal discharge, or protrusion of the eye. CT scan can determine the extent of sinus inflammation, formation of abscess, or the spread of infection into adjacent structures (cavity of the eye or the brain).Treatment:A main aim of treatment is to ease symptoms whilst your immune system clears the infection. The most useful treatments are:Take paracetamol, ibuprofen, or aspirin to reduce fever (high temperature), and to ease any aches, pains and headaches.
- Have lots to drink if you have a fever, to prevent mild dehydration.
- If you smoke, you should try to stop for good. URTIs and serious lung diseases are more common in smokers.
There are several measures that can reduce the risk of infections in general. Smoking cessation, reducing stress, adequate and balanced diet, and regular exercise are all measures that can improve the immune system and reduce the overall risk of infections.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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