| Upper respiratory tract infection | |
|---|---|
| Classification and external resources | |
 Conducting passages. | |
| ICD-10 | J00-06., J30-39. |
| ICD-9 | 465.9 |
Contents
|
Definitions
Common URI terms are defined as follows:- Rhinitis - Inflammation of the nasal mucosa
- Rhinosinusitis or sinusitis - Inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid
- Nasopharyngitis (rhinopharyngitis or the common cold) - Inflammation of the nares, pharynx,hypopharynx, uvula, and tonsils
- Pharyngitis - Inflammation of the pharynx, hypopharynx, uvula, and tonsils
- Epiglottitis (supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area
- Laryngitis - Inflammation of the larynx
- Laryngotracheitis - Inflammation of the larynx, trachea, and subglottic area
- Tracheitis - Inflammation of the trachea and subglottic area
Signs and symptoms
Acute upper respiratory tract infections include rhinitis, pharyngitis/tonsillitis and laryngitis often referred to as a common cold, and their complications: sinusitis, ear infection and sometimes bronchitis (though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of the symptoms usually begins 1–3 days after the exposure to a microbial pathogen. The illness usually lasts 7–10 days.Group A beta hemolytic streptococcal pharyngitis/tonsillitis(strep throat) typically presents with a sudden onset of sore throat, pain with swallowing and fever. Strep throat does not usually cause runny nose, voice changes or cough.
Pain and pressure of the ear caused by a middle ear infection (Otitis media) and the reddening of the eye caused by viral Conjunctivitis are often associated with upper respiratory infections.
| Symptoms | Allergy | URI | Influenza |
|---|---|---|---|
| Itchy, watery eyes | Common | Rare (conjunctivitis may occur with adenovirus) | Soreness behind eyes, sometimes conjunctivitis |
| Nasal discharge | Common | Common | Common |
| Nasal congestion | Common | Common | Sometimes |
| Sneezing | Very common | Very common | Sometimes |
| Sore throat | Sometimes (postnasal drip) | Very common | Sometimes |
| Cough | Sometimes | Common (mild to moderate, hacking) | Common (dry cough, can be severe) |
| Headache | Uncommon | Rare | Common |
| Fever | Never | Rare in adults, possible in children | Very common (100-102°F (or higher in young children), lasting 3–4 days; may have chills) |
| Malaise | Sometimes | Sometimes | Very common |
| Fatigue, weakness | Sometimes | Sometimes | Very common, can last for weeks, extreme exhaustion early in course |
| Muscle pain | Never | Slight | Very common, often severe |
Cause
Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.[2]Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").[3]
Influenza (the flu) is a more severe systemic illness which typically involves the upper respiratory tract. Influenza is a relatively uncommon cause of influenza-like illness.
Treatment
Treatment depends on the underlying cause. There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of illness.[4] Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.[5]There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise.[6] Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.[7]
Antibiotics
Judicious use of antibiotics can decrease unnecessary adverse effects of antibiotics as well as out-of-pocket costs to the patient. But more importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteria, which is now a growing problem in the world. Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses.[8] Some have advocated a delayed antibiotic approach to treating URIs which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. Most studies show no difference in improvement of symptoms between those treated with antibiotics right away and those with delayed prescriptions.[9] Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. A strategy of "no antibiotics" results in even less antibiotic use than a strategy of "delayed antibiotics". However, in certain higher risk patients with underlying lung disease, such as chronic obstructive pulmonary disease (COPD), evidence does exist to support the treatment of bronchitis with antibiotics to shorten the course of the illness and decrease treatment failure.[10]Decongestants
According to a Cochrane review single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults; however, "there is insufficient data on the use of decongestants in children." Therefore decongestants are not recommended for use in children under 12 years of age with the common cold.[11] Oral decongestants are, also, contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.[12][13]Alternative medicine
The use of Vitamin C in the inhibition and treatment of upper respiratory infections has been suggested since the initial isolation of vitamin C in the 1930s. Some evidence exists to indicate that it could be justified in persons exposed to brief periods of severe physical exercise and/or cold environments.[14]The benefits versus risk of nasal irrigation are currently unclear and therefore is not recommended. [15]
Epidemiology
no data
less than 10
10-30
30-60
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90-120
120-150
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180-210
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more than 300
In United States URIs are the most common infectious illness in the general population. URIs are the leading reasons for people missing work and school. URI is the leading diagnosis in the office setting.[17]
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