upper respiratory tract infection

upper respiratory tract infection.

See respiratory tract infection.

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upper respiratory tract infection

URI Infectious disease A nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx, and larynx, the prototypic URI is the common cold; flu/influenza is a systemic illness involving the URT and is differentiated from other URIs Clinical 1–3 days after exposure to pathogen, nasal congestion, sneezing, sore throat, conjunctivitis–with adenovirus infections; sore throat with pain on swallowing, fever, absence of cough, and exposure to a person with streptococcal pharyngitis in the prior 2 wks support Dx of GABHS-related pharyngitis; Pts with acute sinusitis often have fever for > 1 wk, facial pain–especially unilateral, maxillary toothache, headache, and excessive purulent nasal discharge; hoarseness suggests laryngitis; difficulty in swallowing oral secretions and stridor should raise suspicion for epiglottitis or pharyngeal abscess; influenza presents as a sudden illness characterized by high fever, severe headache, myalgia, dry cough, with lingering fatigue and malaise; elderly patients may also present with confusion and somnolence Physical exam Common cold–nasal voice, macerated skin over the nostrils, inflamed nasal mucosa; GABHS-related pharyngitis–pharyngeal erythema/exudate, palatal petechiae–popularly, “doughnut lesions,” tender anterior cervical lymphadenopathy, and occasionally a scarlatiniform rash; pharyngeal or palatal vesicles and ulcers (herpangina) suggest enteroviral or herpetic pharyngitis; pharyngeal exudates are most common in GABHS-related pharyngitis, but can be seen with infectious mononucleosis due to EBV, acute retroviral syndrome, candidal infections, diphtheria; swelling, redness, and tenderness overlying affected sinuses and abnormal transillumination are specific for, but not commonly seen in acute sinusitis; generalized lymphadenopathy with sore throat, fever, and rash should raise the possibility of a systemic viral infection–eg, EBV, CMV, HIV; Pts with influenza appear toxic and may have pulmonary rhonchi and diffuse myalgias Types Pharyngitis, sinusitis, laryngitis/epiglottitis, otitis Diagnosis Because viruses cause most URIs, the diagnostic role of lab and radiologic studies is limited; rapid antigen detection of influenza virus on a nasopharyngeal swab is indicated in cases where specific antiviral therapy is recommended; a rapid antigen detection test is also available for adenovirus, RSV, and parainfluenza virus; serologic tests for viruses that can cause a mononucleosis-type illness should be done in the correct clinical setting; influenza serologies have only epidemiologic value and should not be used for clinical care; pharyngeal swab for rapid antigen detection of GABHS is 80% to 95% sensitive and should be considered in all patients in whom GABHS-related pharyngitis is suspected; pharyngeal culture remains the gold standard for diagnosis and should be done if GABHS-related pharyngitis is highly likely on clinical grounds but in which the rapid antigen detection test is negative; cultures obtained by paranasal sinus puncture should be reserved for only severely ill patients with acute sinusitis and intracranial or orbital complications; blood cultures should be done in severely ill Pts or in those with epiglottitis or a pharyngeal abscess Management Symptomatic to relieve the most prominent Sx; rest, ↑ fluid intake are measures recommended for all URIs. Cf Acute laryngotracheobronchitis (croup.), Common cold, Epiglottitis, Otitis media. Viral URI