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.
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
Treatment for a Viral Upper Respiratory Infection focuses on relieving symptoms, as there is no cure for the virus itself. Over-the-counter medications such as decongestants, antihistamines, and pain relievers can help alleviate symptoms. Rest, hydration, and maintaining a healthy diet are also important for recovery. In some cases, a doctor may recommend antiviral medications if the infection is caused by specific viruses like influenza.
Prognosis
The prognosis for a Viral Upper Respiratory Infection is generally good. Most people recover fully within a week to ten days without any complications. However, individuals with weakened immune systems, young children, and the elderly may experience more severe symptoms or complications, such as sinusitis or bronchitis.
Etiology
Viral Upper Respiratory Infections are caused by a variety of viruses, with rhinoviruses being the most common culprits. Other viruses that can cause VURIs include coronaviruses, adenoviruses, and respiratory syncytial virus (RSV). These viruses are spread through respiratory droplets when an infected person coughs or sneezes, or by touching contaminated surfaces.
Epidemiology
Viral Upper Respiratory Infections are among the most common illnesses worldwide, affecting people of all ages. They are more prevalent during the fall and winter months, although they can occur at any time of the year. Children tend to experience more frequent infections due to their developing immune systems and close contact in school settings.
Pathophysiology
The pathophysiology of a Viral Upper Respiratory Infection involves the invasion of the respiratory tract by viruses. Once the virus enters the body, it attaches to the cells lining the respiratory tract and begins to replicate. This triggers an immune response, leading to inflammation and the characteristic symptoms of a cold, such as congestion and sore throat.
Prevention
Preventing Viral Upper Respiratory Infections involves practicing good hygiene. Regular handwashing with soap and water, avoiding close contact with infected individuals, and covering the mouth and nose when coughing or sneezing can reduce the risk of infection. Vaccines are available for some viruses, like influenza, which can help prevent certain types of VURIs.
Summary
Viral Upper Respiratory Infections are common, contagious illnesses caused by various viruses. They primarily affect the nose, throat, and airways, leading to symptoms like a runny nose, sore throat, and cough. While generally mild, they can cause discomfort and inconvenience. Treatment focuses on symptom relief, and most people recover within a week to ten days. Good hygiene practices are key to prevention.
Patient Information
If you suspect you have a Viral Upper Respiratory Infection, it's important to rest and stay hydrated. Over-the-counter medications can help manage symptoms, but they won't cure the infection. Most people recover without complications, but if symptoms persist or worsen, consult a healthcare professional. Practicing good hygiene can help prevent the spread of the virus to others.
References
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- Heikkinen T, Järvinen A. The common cold. Lancet. 2003;361(9351):51–59.
- 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.
- 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.
- Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults Cochrane Database Syst Rev. 2007;(2): CD004783.
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- Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. 2008;122(8):818–823.
- 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.
- Chonmaitree T. Viral and bacterial interaction in acute otitis media. Pediatr Infect Dis J. 2000;19(5 suppl):S24–S30.
- Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006; 4(55):1-94.
- 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.