Upper respiratory infection: Difference between revisions

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==Background==
==Background==
*Rhinovirus is most common cause
*Infection and inflammation of the upper respiratory tract, typically self-limiting
**Other causes include: coronavirus, adenovirus.
**May involve any portion of the upper airway, thus causing rhinitis, sinusitis, pharyngitis, or laryngitis, etc
*A variety of viruses and bacteria can cause an URI
**Rhinovirus is most common cause<ref>Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011</ref>
**Other causes include: [[coronavirus]], [[adenovirus]], [[influenza]], [[Respiratory syncytial virus]], [[adenovirus]], [[enterovirus]], [[parainfluenza]]
*Pathophys: Aerosolized (droplet and airborne) transmission, deposition in the nasopharyngeal mucosa, hours-days incubation period, host inflammatory response leading to symptoms
**Although aerosol transmission predominates, contact (ex. hand to eye) transmission is also common


==Clinical Features==
==Clinical Features==
*Common cold
*Common cold<ref>Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011</ref>
**Sore throat
**[[Sore throat]]
**Malaise
**Malaise
**Low-grade fever
**Low-grade [[fever]]
**Cough (usually 24-48 hrs later)
***Fevers are more common in pediatrics than adults
**Rhinorrhea
**[[Cough]] (usually 24-48 hrs later)
***Postinfectious cough can last for weeks after other symptoms have resolved
**[[Rhinorrhea]]
**Nasal congestion
**Nasal congestion
**Sx peak by day 3 or 4, resolve by day 7
**[[Sneezing]]
**[[Myalgia]]
**Hoarse voice
*Depending on the organism, typically symptoms peak by day 3 or 4, resolve by day 7


==Differential Diagnosis==
==Differential Diagnosis==
*[[Influenza]]
{{ILI DDX}}
*[[Severe Acute Respiratory Syndrome]]
*[[Bronchitis]]


==Diagnosis==
{{Cough DDX}}
 
==Evaluation==
*Clinical diagnosis
*Depending on provider preference, can send viral panels, but this often doesn't change management
**Exceptions: Tamiflu for flu, paxlovid for COVID, etc
*Rule out other serious causes of this presentation, such as [[pneumonia]], bacterial sinusitis, epiglottitis, etc


==Management==
==Management==
*Supportive care and symptomatic relief are the mainstays of management
*Analgesics, including [[ibuprofen]] and [[acetaminophen]]<ref>Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2015 Sep 21;2015(9):CD006362. doi: 10.1002/14651858.CD006362.pub4. PMID: 26387658; PMCID: PMC10040208.</ref>
*Nasal decongestants<ref>Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi: 10.1002/14651858.CD009612.pub2. PMID: 27748955; PMCID: PMC6461189.</ref>
**Oral decongestants such as [[pseudoephedrine]] may be used, but contraindicated in systemic [[hypertension]]
**Topical decongestants: Nasal saline spray and [[oxymetazoline]] spray can reduce nasal passageway resistance
***Avoid oxymetazoline use in children due to risk of unintended a2-agonism; limit number of days to <3 to prevent rhinitis medicamentosa
*Antitussives have equivocal evidence but may be trialed for symptomatic relief<ref>Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD001831. doi: 10.1002/14651858.CD001831.pub5. PMID: 25420096; PMCID: PMC7061814.</ref>
**Cough suppressants: [[Dextromethorphan]] or Benzonatate; avoid in young children
**Cough expectorant: Guaifenesin
*Topical anesthetics for sore throat: [[Benzocaine]], menthol lozenges
*Avoid prescribing antibiotics<ref>Choosing Wisely. Infectious Diseases Society of America. http://www.choosingwisely.org/clinician-lists/infectious-diseases-society-antbiotics-for-upper-respiratory-infections/</ref>
*Mucolytics: little evidence to support usage
*[[Bronchodilators]] if [[wheezing]] present


==Disposition==
==Disposition==
*Outpatient


==See Also==
==See Also==


==External Links==
==External Links==


==References==
==References==
<references/>
<references/>
[[Category:ID]]

Latest revision as of 06:37, 11 December 2023

Background

  • Infection and inflammation of the upper respiratory tract, typically self-limiting
    • May involve any portion of the upper airway, thus causing rhinitis, sinusitis, pharyngitis, or laryngitis, etc
  • A variety of viruses and bacteria can cause an URI
  • Pathophys: Aerosolized (droplet and airborne) transmission, deposition in the nasopharyngeal mucosa, hours-days incubation period, host inflammatory response leading to symptoms
    • Although aerosol transmission predominates, contact (ex. hand to eye) transmission is also common

Clinical Features

  • Common cold[2]
    • Sore throat
    • Malaise
    • Low-grade fever
      • Fevers are more common in pediatrics than adults
    • Cough (usually 24-48 hrs later)
      • Postinfectious cough can last for weeks after other symptoms have resolved
    • Rhinorrhea
    • Nasal congestion
    • Sneezing
    • Myalgia
    • Hoarse voice
  • Depending on the organism, typically symptoms peak by day 3 or 4, resolve by day 7

Differential Diagnosis

Influenza-Like Illness

Cough

Acute (< 3 wks)

Chronic (> 8 wks)

Evaluation

  • Clinical diagnosis
  • Depending on provider preference, can send viral panels, but this often doesn't change management
    • Exceptions: Tamiflu for flu, paxlovid for COVID, etc
  • Rule out other serious causes of this presentation, such as pneumonia, bacterial sinusitis, epiglottitis, etc

Management

  • Supportive care and symptomatic relief are the mainstays of management
  • Analgesics, including ibuprofen and acetaminophen[3]
  • Nasal decongestants[4]
    • Oral decongestants such as pseudoephedrine may be used, but contraindicated in systemic hypertension
    • Topical decongestants: Nasal saline spray and oxymetazoline spray can reduce nasal passageway resistance
      • Avoid oxymetazoline use in children due to risk of unintended a2-agonism; limit number of days to <3 to prevent rhinitis medicamentosa
  • Antitussives have equivocal evidence but may be trialed for symptomatic relief[5]
    • Cough suppressants: Dextromethorphan or Benzonatate; avoid in young children
    • Cough expectorant: Guaifenesin
  • Topical anesthetics for sore throat: Benzocaine, menthol lozenges
  • Avoid prescribing antibiotics[6]
  • Mucolytics: little evidence to support usage
  • Bronchodilators if wheezing present

Disposition

  • Outpatient

See Also

External Links

References

  1. ↑ Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011
  2. ↑ Tallman TA. Acute Bronchitis and Upper Respiratory Tract Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011
  3. ↑ Kim SY, Chang YJ, Cho HM, Hwang YW, Moon YS. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2015 Sep 21;2015(9):CD006362. doi: 10.1002/14651858.CD006362.pub4. PMID: 26387658; PMCID: PMC10040208.
  4. ↑ Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi: 10.1002/14651858.CD009612.pub2. PMID: 27748955; PMCID: PMC6461189.
  5. ↑ Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD001831. doi: 10.1002/14651858.CD001831.pub5. PMID: 25420096; PMCID: PMC7061814.
  6. ↑ Choosing Wisely. Infectious Diseases Society of America. http://www.choosingwisely.org/clinician-lists/infectious-diseases-society-antbiotics-for-upper-respiratory-infections/
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