Upper respiratory tract infection

Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting

URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx— to life-threatening illnesses such as epiglottitis

Signs and symptoms

Details of the patient’s history aid in differentiating a common cold from conditions that require targeted therapy, such as group A streptococcal pharyngitis, bacterial sinusitis, and lower respiratory tract infections.

Clinical manifestations of these conditions, as well as allergy, show significant overlap.

گلو درد و عفونت های مجاری فوقانی

عفونت راه های هوایی تنفسی فوقانی شایع ترین علت بیماری های حاد در بیماران سرپایی است که این بیماری ها از یک سرماخوردگی ساده که خود محدود شونده است تا بعضی از بیماری های تهدید کننده حیاط و خطرناک مانند اپی گلوتیت متفاوت استشایع ترین میکروب هایی که موجب این حالت ها میشوند شامل استرپتوکوک گروه A و ویروس ها میباشند که از نظر بروز علائم در بسیاری از شرایط مشابه آلرژی می باشد.

سرما خوردگی

یک مجموعه ای از علائم خودمحدود شونده و خوش خیم است که به وسیله گروهی از خانواده ویروس ها ایجاد میشود و شایع ترین بیماری در کل جهان است

درمان سرماخوردگی :

بیماران با علائم خفیف که به صورت احتقان و ترشح بینی عطسه، گلودرد، تب خفیف، سردرد و بیحالی بروز می کند نیاز به درمان خاصی ندارد و صرفا درمان های علامتی و استراحت و مصرف مایعات کافی موجب بهبود بیماری بعد از سه تا پنج روز می شود در موارد شدید تر نیازمند درمان های سرپایی است مانند ضد درد ها و ضد احتقان و شربت دکسترومتارفان

common cold

The common cold is a benign, self-limited syndrome representing a group of diseases caused by members of several families of iruses.

It is the most frequent acute illness in the United States and throughout the industrialized world .

Viral nasopharyngitis

Patients with the common cold may have notable subjective discomfort[ nasal congestion and discharge (rhinorrhea), sneezing, sore throat, cough, low-grade fever, headache, and
malaise] despite a paucity of clinical findings .

Nasal mucosal erythema and edema are common

Nasal discharge: Profuse discharge is more characteristic of viral infections than bacterial infections; initially clear secretions typically become cloudy white, yellow, or green
over several days, even in viral infections

Foul breath
Fever: Less common in adults but may be present in children with rhinoviral infections

PROGNOSIS

For most people and most colds, symptoms are selflimited.

The common cold is usually an uncomplicated illness.

occasionally, patients may develop complications (eg, sinusitis, lower respiratory tract disease, asthma exacerbations, acute otitis media).

Treatment

MILD SYMPTOMS — Most patients with mild symptoms do not require any symptomatic therapies.

MODERATE TO SEVERE SYMPTOMS — Symptomatic therapy remains the mainstay of common cold treatment.

Analgesics may be used to relieve associated symptoms (eg, headache, ear pain, muscle and joint pains, malaise).

Symptomatic treatments for nasal symptoms that have moderate evidence of efficacy include a combination product containing an antihistamine and decongestant, intranasal/inhaled cromolyn sodium, or intranasal ipratropium bromide.

Antihistamine use alone in patients with the common cold, is of minimal benefit and frequently results in troublesome side effects.

Topical decongestant use should be limited to two to three days because rebound rhinitis can occur after 72 hours of use.

Dextromethorphan can be used as symptomatic treatment for cough suppression.

Acute pharyngitis

Acute pharyngitis is one of the most common conditions encountered in outpatient clinical practice.

The most common causes of acute pharyngitis are respiratory viruses and group A Streptococcus (GAS).

Less common causes include herpes viruses such as Epstein-Barr virus

Most patients with pharyngitis present with nonspecific symptoms such as a sore throat that worsens with swallowing and cervical lymphadenopathy

Group A streptococcal pharyngitis

The following physical findings suggest a high risk for group A streptococcal disease [1] :

Erythema, swelling, or exudates of the tonsils or pharynx
Temperature of 38.3°C (100.9°F) or higher
Tender anterior cervical nodes (≥1 cm)
Absence of conjunctivitis, cough, and rhinorrhea, which are symptoms that may suggest viral illness .

The majority of patients presenting to clinical care with acute pharyngitis can be clinically diagnosed with respiratory viral syndrome and/or test negative for GAS.
These patients typically recover within five to seven days without specific treatment.
Patients with GAS pharyngitis usually recover soon, often within 24 to 72 hours of starting antibiotics.
Penicillin is the treatment of choice for GAS pharyngitis due to its efficacy, safety, narrow spectrum, and low cost.
The goals of antibiotic therapy for GAS pharyngitis include symptom relief, preventing complications, and preventing transmission to others.

Acute rhinosinusitis

Acute rhinosinusitis (ARS) is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks.
The term “rhinosinusitis” is preferred to “sinusitis” since inflammation of the sinuses rarely occurs without concurrent inflammation of the nasal mucosa.

The most common etiology of ARS is a viral infection associated with the common cold.
Viral rhinosinusitis is complicated by acute bacterial infection in only 0.5 to 2.0 percent of episodes.
Uncomplicated acute viral rhinosinusitis (AVRS) typically resolves in 7 to 10 days.
Acute bacterial rhinosinusitis (ABRS) also is most commonly a self-limited disease, with 75 percent of cases resolving without treatment in one month.
Rarely, patients with untreated bacterial disease may develop serious complications.

CLINICAL MANIFESTATIONS

Symptoms of acute rhinosinusitis include nasal congestion and obstruction, purulent nasal discharge, maxillary tooth discomfort, and facial pain or pressure that is worse when bending forward .
Other signs and symptoms include fever, fatigue, cough, hyposmia or anosmia, ear pressure or fullness, headache, and halitosis.

Symptoms do not accurately distinguish viral from bacterial infection.
ABRS is suggested by :
persistent symptoms or signs of ARS lasting ≥10 days without clinical improvement,

onset of severe symptoms or signs (high fever, purulent nasal discharge, or facial pain) for at least three to four consecutive days at the beginning of illness, or
initially symptom improvement followed by worsening symptoms or signs.

Indications for urgent referral

The finding of any of the following should lead to urgent referral to a specialist or emergency department for the possibility of complications of sinusitis, including intracranial and orbital extension:
Abnormal vision (diplopia, blindness)
Change in mental status
Periorbital edema

DIAGNOSIS

The diagnosis of acute rhinosinusitis (ARS) is based upon clinical signs and symptoms. Diagnostic testing is not indicated in the initial evaluation in the absence of signs suggesting complicated disease.

Patients with high fevers (>39°C or 102°F) and severe headache warrant immediate evaluation and probable imaging.

APPROACH TO TREATMENT

The goals of treatment for acute rhinosinusitis (ARS) are different, depending on whether the source of infection is viral or bacterial.
Management of acute viral rhinosinusitis (AVRS) aims to relieve symptoms of nasal obstruction and rhinorrhea;
Treatment for acute bacterial rhinosinusitis (ABRS) includes antibiotics to eliminate the infection and prevent complications.

Treatment
Most cases of acute rhinosinusitis, including mild and moderate bacterial sinusitis, resolve without antibiotics.

SYMPTOMATIC THERAPY

Analgesics
Saline irrigation — Mechanical irrigation with buffered, physiologic, or hypertonic saline may reduce the need for pain medication and improve overall patient comfort.
Topical glucocorticoids — Theoretic ally can decrease mucosal inflammation and improve sinus drainage.
Studies of topical glucocorticoids have demonstrated some benefit for the relief of symptoms in ARS, both viral and bacterial.
Intranasal glucocorticoids are likely to be most beneficial for patients with underlying allergic rhinitis.

SYMPTOMATIC THERAPY

Topical decongestants :
subjective sense of improved nasal patency.
No more than three consecutive days to avoid rebound congestion.
Little effect as adjunctive therapy to antibiotics in the treatment of ABRS.
Oral decongestants :
reduce edema and facilitate drainage.
When eustachian tube dysfunction is a significant confounding factor in
AVRS, a short course (three to five days) may be warranted.
oral decongestants are not helpful in patients with ABRS.
Antihistamines :
symptom relief due to their drying effects.
over-drying of the mucosa may lead to further discomfort.
Side effects (drowsiness, xerostomia),
Their use for the treatment of acute sinusitis is not recommended.

ACUTE BACTERIAL RHINOSINUSITIS

Patients who are diagnosed with ABRS should be treated with antimicrobial therapy.

Give first-line antibiotics for 5-7 days in most adults; for 10-14 days in children
Begin treatment with an agent that most narrowly covers likely pathogens, including Streptococcus pneumoniae, nontypeable H influenzae, and Moraxella catarrhalis
Initial first-line options include moxicillin/clavulanate
Alternatives in penicillin-allergic patients are doxycycline and respiratory fluoroquinolones.

Epiglottitis

Epiglottitis is inflammation of the epiglottis and adjacent supraglottic structures.
This condition is more often found in children aged 1-5 years.
Epiglottitis may be caused by a number of bacterial, viral, and fungal pathogens .
In the otherwise healthy child, most cases are bacterial.

Young children with epiglottitis classically present with:
fever, fatigue or malaise,
Sore throat,
drooling, difficulty or pain during swallowing, globus sensation of a lump in the throat
Muffled dysphonia or loss of voice,
stridor,, respiratory distress, anxiety, and
the characteristic Tripod or sniffing posture ,
but the presentation may be more subtle.

Upper respiratory tract infection