Upper Respiratory Tract Infection

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Contents 1 Etiology 2 Epidemiology 3 Clinical-manifestations 4 Complications 5 Differential-diagnosis 6 Management 7 More General Terms 8 Additional Terms 9 References

Etiology

• viral
• rhinovirus
• parainfluenza virus
• adenovirus
• respiratory syncytial virus ( RSV)
• coxsackie virus A21 (summer & autumn)
• risk factors

• sleep deprivation [7]

Epidemiology

• 83% of all infections
• 50% of individuals have a URI during December-February

Clinical-manifestations

• cough
• nasal congestion, rhinorrhea
• may have tenderness to sinus palpation
• sore throat, laryngitis
• may have fluid behind tympanic membrane
• fever < 38.3 C (102 F) lasting < 72 hours

Complications

• temporary interference with mucociliary clearance may increase the risk of other infections

Differential-diagnosis

• Streptococcal pharyngitis

• fever
• tonsillar exudates
• tender anterior cervical lymphadenopathy
• absence of cough

• peritonsillar abscess

• trimus
• unilateral tonsillar swelling
• deviation of uvula

• sinusitis

• prurulent nasal discharge for >= 7 days
• unilateral sinus pain or tenderness
• maxillary toothache

• epiglottitis

• severe sore throat
• dyspnea, drooling, stridor
• lateral neck X-ray: enlarged epiglottis 'thumb sign'

• infectious mononucleosis ( Epstein-Barr virus)

• posterior cervical lymphadenopathy
• sore throat & fever of weeks duration
• splenomegaly, hepatomegaly, atypical lymphocytosis

• influenza

• symptoms may be severe
• high fever
• myalgias

Management

• supportive therapy

• cold & flu self-care kit
• decongestant:

• nasal decongestant
• vapor rub at night of benefit for children [13]
• systemic decongestant for sinus & inner ear symptoms

• pseudoephedrine, phenylepinephrine

• antihistamine: chlorpheniramine, climastine, brompheniramine
• inhaled beta-adrenergic agonist ( albuterol) for productive cough
• intranasal ipratropium for rhinorrhea & sneezing
• ibuprofen or naproxen for sore throat, fever

• intranasal siRNA show promise [2]
• avoid unsafe medications in pregnancy [4]
• avoid unneccessary medications, especially in children [6]
• adequate sleep, > 7 hours [7]
• herbal medications or vitamins with marginal benefit

• vitamin D levels
• vitamin C
• American ginseng
• Echinacea [14]
• Lactobacillus probiotics

More General Terms

• upper respiratory tract disease
• infection (infectious disease)

Additional Terms

• cold & flu self-care kit
• coxsackievirus
• parainfluenza virus
• respiratory syncitial virus (RSV)
• rhinovirus

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 794
2. Journal Watch 25(4):29, 2005 Bitko V, Musiyenko A, Shulyayeva O, Barik S. Inhibition of respiratory viruses by nasally administered siRNA. Nat Med. 2005 Jan;11(1):50-5. Epub 2004 Dec 26. PMID: [1] Zhang W, Yang H, Kong X, Mohapatra S, Juan-Vergara HS, Hellermann G, Behera S, Singam R, Lockey RF, Mohapatra SS. Inhibition of respiratory syncytial virus infection with intranasal siRNA nanoparticles targeting the viral NS1 gene. Nat Med. 2005 Jan;11(1):56-62. Epub 2004 Dec 26. PMID: [2]
3. Prescriber's Letter 13(11): 2006 Delaying Antibiotics in Uncomplicated Upper Respiratory Tract Infection Detail-Document#: [3] (subscription needed) [4]
4. Prescriber's Letter 13(11): 2006 Cough and Cold Medication use In Pregnancy Detail-Document#: [5] (subscription needed) [6]
5. Prescriber's Letter 13(12): 2006 Changes to OTC cough and Cold products Detail-Document#: [7] (subscription needed) [8]
6. Prescriber's Letter 14(11): 2007 Detail-Document#: [9] Concerns about OTC Cough and Cold Products in Children (subscription needed) [10]
7. Cohen S et al. Sleep habits and susceptibility to the common cold. Arch Intern Med 2009 Jan 12; 169:62. PMID: [11]
8. Prescriber's Letter 15(11): 2008 Detail-Document#: [12] Cautions with Pediatric Cough and Cold Products (subscription needed) [13]
9. Prescriber's Letter 16(3): 2009 Detail-Document#: [14] Vicks VapoRub Safety and Children (subscription needed) [15]
10. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
11. Common Cold: NIH Institute and Center Resources [16]
12. Prescriber's Letter 16(11): 2009 COMMENTARY: Supplements for Prevention and Treatment of Colds and Influenza CONTINUING EDUCATION: Natural Medicines in the Clinical Management of Colds and Flu Detail-Document#: [17] (subscription needed) [18]
13. Paul IM et al Vapor Rub, Petrolatum, and No Treatment for Children with Nocturnal Cough and Cold Symptoms Pediatrics, published online Nov 8, 2010 <PubMed> PMID: [19] <Internet> [20]
14. Barrett B et al. Echinacea for treating the common cold: A randomized trial. Ann Intern Med 2010 Dec 21; 153:769. <PubMed> PMID: [21] <Internet> [22]

upper respiratory tract infection (URI, common cold)