Upper respiratory tract infection

Source: Wikipedia, the free encyclopedia.

Upper respiratory tract infection
Infectious disease
Frequency(2015)[1]
Deaths3,100[2]

An upper respiratory tract infection (URTI) is an illness caused by an acute

helminthic in origin, but these are less common.[7]
: 443–445 

In 2015, 17.2 billion cases of URTIs are estimated to have occurred.[1] As of 2016, they caused about 3,000 deaths, down from 4,000 in 1990.[8]

Signs and symptoms

Time line for cold symptoms

In uncomplicated colds, coughing and nasal discharge may persist for 14 days or more even after other symptoms have resolved.[6] Acute URTIs include

sneezing.[9]

Symptoms of rhinovirus in children usually begin 1–3 days after exposure. The illness usually lasts 7–10 more days.[6]

Color or consistency changes in

mucous discharge to yellow, thick, or green are the natural course of viral URTI and not an indication for antibiotics.[6]

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 a runny nose, voice changes, or cough.[citation needed]

Pain and pressure of the ear caused by a middle-ear infection (otitis media) and the reddening of the eye caused by viral conjunctivitis[10] are often associated with URTIs.

Cause

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. This allows the virus to gain access to tissues under the epithelial cells and initiate the innate and adaptive immune responses.[5]: 27 

Up to 15% of acute pharyngitis cases may be caused by bacteria, most commonly

group A streptococcus in streptococcal pharyngitis ("strep throat").[11] Other bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, Corynebacterium diphtheriae, Bordetella pertussis, and Bacillus anthracis[citation needed
].

Sexually transmitted infections have emerged as causes of oral and pharyngeal infections.[12]

Diagnosis

URI, seasonal allergies, influenza: symptom comparison
Symptoms Allergy URI (Common Cold) Influenza (Flu)
Itchy, watery eyes Common Rare (conjunctivitis may occur with adenovirus) Soreness behind eyes, sometimes conjunctivitis
Nasal discharge Common Common[6] Common
Nasal congestion Common Common Sometimes
Sneezing Very common Very common[6] Sometimes
Sore throat Sometimes (post-nasal drip) Very common[6] Sometimes
Cough Sometimes Common (mild to moderate, hacking)[6] Common (dry cough, can be severe)
Headache Uncommon Rare Common
Fever Never Rare in adults, possible in children[6] Very common
37.8–38.9 °C (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[6] Very common (often severe)

Classification

A URTI may be classified by the area inflamed.

tonsils generally. Without involving the nose, pharyngitis inflames the pharynx, hypopharynx, uvula, and tonsils. Similarly, epiglottitis (supraglottitis) inflames the superior portion of the larynx and supraglottic area; laryngitis is in the larynx; laryngotracheitis is in the larynx, trachea, and subglottic area; and tracheitis is in the trachea and subglottic area.[citation needed
]

Prevention

Vaccination against

Bacillus anthracis, and Bordetella pertussis may prevent them from infecting the URT or reduce the severity of the infection.[citation needed
]

Treatment

Upper respiratory infections deaths per million persons in 2012
  0
  1
  2
  3–29

Treatment comprises symptomatic support usually via

analgesics for headache, sore throat, and muscle aches.[13] Moderate exercise in sedentary subjects with a naturally acquired URTI probably does not alter the overall severity and duration of the illness.[14] No randomized trials have been conducted to ascertain benefits of increasing fluid intake.[15]

Antibiotics

Prescribing antibiotics for laryngitis is not a suggested practice.

penicillin V and erythromycin are not effective for treating acute laryngitis.[16] Erythromycin may improve voice disturbances after a week and cough after 2 weeks, but any modest subjective benefit is not greater than the adverse effects, cost, and the risk of bacteria developing resistance to the antibiotics.[16] Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common URTIs because antibiotic usage does not significantly reduce recovery time for these viral illnesses.[16] A 2017 systematic review found three interventions which were probably effective in reducing antibiotic use for acute respiratory infections: C-reactive protein testing, procalcitonin-guided management, and shared decision-making between physicians and patients.[17] The use of narrow-spectrum antibiotics has been shown to be just as effective as broad-spectrum alternatives for children with acute bacterial URTIs, and has a lower risk of side effects in children.[18] Decreased antibiotic usage may also help prevent drug-resistant bacteria. Some have advocated a delayed antibiotic approach to treating URTIs, which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. A Cochrane review of 11 studies and 3,555 participants explored antibiotics for respiratory tract infections. It compared delaying antibiotic treatment to either starting them immediately or to no antibiotics. Outcomes were mixed depending on the respiratory tract infection; symptoms of acute otitis media and sore throat were modestly improved with immediate antibiotics with minimal difference in complication rate. Antibiotic usage was reduced when antibiotics were only used for ongoing symptoms and maintained patient satisfaction at 86%.[19] In a trial involving 432 children with a URTI, amoxicillin was no more effective than placebo, even for children with more severe symptoms such as fever or shortness of breath.[20][21]

For sinusitis while at the same time discouraging overuse of antibiotics the CDC recommends:

Cough medicine

No good evidence exists for or against the effectiveness of over-the-counter

cough medications for reducing coughing in adults or children.[22] Children under 2 years old should not be given any type of cough or cold medicine due to the potential for life-threatening side effects.[23] In addition, according to the American Academy of Pediatrics, the use of cough medicine to relieve cough symptoms should be avoided in children under 4 years old, and the safety is questioned for children under 6 years old.[24]

Decongestants

Disability-adjusted life year for URTIs per 100,000 inhabitants in 2002:[25]
  no data
  less than 10
  10–30
  30–60
  60–90
  90–120
  120–150
  150–180
  180–210
  210–240
  240–270
  270–300
  more than 300

According to a Cochrane review, a single oral dose of nasal decongestant in the common cold is modestly effective for the short-term relief of congestion in adults; however, data on the use of decongestants in children are insufficient. Therefore, decongestants are not recommended for use in children under 12 years of age with the common cold.[19] Oral decongestants are also contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.[26][27]

Mucolytics

Mucolytics such as acetylcysteine and carbocystine are widely prescribed for upper and lower respiratory tract infection without chronic broncho-pulmonary disease. However, in 2013 a Cochrane review reported their efficacy to be limited.[28] Acetylcystine is considered to be safe for the children older than 2 years.[28]

Alternative medicine

Routine supplementation with vitamin C is not justified, as it does not appear to be effective in reducing the incidence of common colds in the general population.[29] 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.[29] Given that vitamin C supplements are inexpensive and safe, people with common colds may consider trying vitamin C supplements to assess whether they are therapeutically beneficial in their case.[29]

Some low-quality evidence indicates the use of

saline solution may alleviate symptoms in some people.[30] Also, saline nasal sprays can be of benefit.[citation needed
]

Epidemiology

Children typically have two to nine viral respiratory illnesses per year.[6] In 2013, 18.8 billion cases of URTIs were reported.[31] As of 2014, they caused about 3,000 deaths, down from 4,000 in 1990.[8] In the United States, URTIs are the most common infectious illness in the general population, and are the leading reasons for people missing work and school.[citation needed]

Dietary research

Weak evidence suggests that probiotics may be better than a placebo treatment or no treatment for preventing upper respiratory tract infections.[32]

See also

References

  1. ^
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  5. ^
    ISBN 978-3-319-17458-7
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  6. ^ a b c d e f g h i j k l "Rhinitis Versus Sinusitis in Children" (PDF). Centers for Disease Control and Prevention. Archived (PDF) from the original on 16 February 2017. Retrieved 19 December 2016. Public Domain This article incorporates text from this source, which is in the public domain.
  7. ISBN 978-0-87553-018-5
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  8. ^
    S2CID 1541253
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  9. PMID 21413304
    . Retrieved 10 July 2021 – via National Center for Biotechnology Information, U.S. National Library of Medicine.
  10. ^ "Conjunctivitis". The Lecturio Medical Concept Library. 23 July 2020. Retrieved 10 July 2021.
  11. PMID 11172144
    .
  12. ^ "Human papillomavirus (HPV) and Oropharyngeal Cancer, Sexually Transmitted Diseases". Centers for Disease Control and Prevention. 4 November 2016. Archived from the original on 16 December 2016. Retrieved 19 December 2016.
  13. ^ "Common Cold: Treatments and Drugs". Mayo Clinic. Archived from the original on 12 February 2010. Retrieved 9 January 2010.
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  16. ^
    PMID 26002823
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  19. ^
    PMID 37791590
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  20. PMID 37436003
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  21. doi:10.3310/nihrevidence_60506
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  23. ^ Center for Drug Evaluation and Research. "Special Features – Use Caution When Giving Cough and Cold Products to Kids". Food and Drug Administration. Archived from the original on 12 January 2017. Retrieved 23 January 2017.
  24. PMID 20176183
    .
  25. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002. Archived from the original on 16 January 2013.
  26. OCLC 56446842
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  27. OCLC 52895543
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  28. ^
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  29. ^
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  30. PMID 25892369
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External links
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