Upper respiratory tract infection
Encyclopedia
Upper respiratory tract infections (URI or URTI) are the illnesses caused by an acute infection
which involves the upper respiratory tract
: nose
, sinuses
, pharynx
or larynx
. This commonly includes: tonsillitis, pharyngitis
, laryngitis
, sinusitis
, otitis media
, and the common cold
.
Common URI terms are defined as follows:
, pharyngitis
/tonsillitis
and laryngitis
often referred to as a common cold
, and their complications: sinusitis
, ear infection and sometimes bronchitis
(though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough
, sore throat
, runny nose, nasal congestion
, headache
, low grade fever
, facial pressure and sneezing. Onset of symptoms usually begins 1–3 days after exposure. The illness usually lasts 7–10 days.
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 runny nose, voice changes or cough.
Pain and pressure of the ear caused by a middle ear infection (Otitis media
) and the reddening of the eye caused by viral Conjunctivitis
are often associated with upper respiratory infections.
. Other viruses include the coronavirus
, parainfluenza virus, adenovirus, enterovirus
, and respiratory syncytial virus.
Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").
Influenza
(the flu) is a more severe systemic illness which typically involves the upper respiratory tract. Influenza is a relatively uncommon cause of influenza-like illness
.
There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise. Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection. Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.
, which is now a growing problem in the world. Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses. Some have advocated a delayed antibiotic approach to treating URIs which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. Most studies show no difference in improvement of symptoms between those treated with antibiotics right away and those with delayed prescriptions. Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. A strategy of "no antibiotics" results in even less antibiotic use than a strategy of "delayed antibiotics". However, in certain higher risk patients with underlying lung disease, such as chronic obstructive pulmonary disease
(COPD), evidence does exist to support the treatment of bronchitis
with antibiotics to shorten the course of the illness and decrease treatment failure.
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.
The benefits versus risk of nasal irrigation
are currently unclear and therefore is not recommended.
and results in sneezing, and coughing facilitating the spread.
In United States URIs are the most common infectious illness in the general population. URIs are the leading reasons for people missing work and school. URI is the leading diagnosis in the office setting.
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
which involves the upper respiratory tract
Respiratory tract
In humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...
: nose
Human nose
The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
, sinuses
Paranasal sinus
Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity , above and between the eyes , and behind the ethmoids...
, pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
or larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
. This commonly includes: tonsillitis, pharyngitis
Pharyngitis
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
, laryngitis
Laryngitis
Laryngitis is an inflammation of the larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds . Dysphonia is the medical term for a vocal disorder, of which laryngitis is one cause....
, sinusitis
Sinusitis
Sinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...
, otitis media
Otitis media
Otitis media is inflammation of the middle ear, or a middle ear infection.It occurs in the area between the tympanic membrane and the inner ear, including a duct known as the eustachian tube. It is one of the two categories of ear inflammation that can underlie what is commonly called an earache,...
, and the common cold
Common cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
.
Common URI terms are defined as follows:
- RhinitisRhinitisRhinitis , commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or...
- Inflammation of the nasal mucosa - Rhinosinusitis or sinusitisSinusitisSinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...
- Inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid - Nasopharyngitis (rhinopharyngitis or the common cold) - Inflammation of the nares, pharynx,hypopharynx, uvula, and tonsils
- PharyngitisPharyngitisPharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
- Inflammation of the pharynx, hypopharynx, uvula, and tonsils - EpiglottitisEpiglottitisEpiglottitis is an inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea . Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency...
(supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area - LaryngitisLaryngitisLaryngitis is an inflammation of the larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds . Dysphonia is the medical term for a vocal disorder, of which laryngitis is one cause....
- Inflammation of the larynx - LaryngotracheitisLaryngotracheitisLaryngotracheitis refers to the combination of the following two conditions:* laryngitis* tracheitis* It is also the common name for the poultry disease Gallid herpesvirus 1....
- Inflammation of the larynx, trachea, and subglottic area - TracheitisTracheitisTracheitis is an inflammation of the trachea.Although the trachea is usually considered part of the lower respiratory tract, in ICD-10 tracheitis is classified under "Acute upper respiratory infections".-Bacterial tracheitis:...
- Inflammation of the trachea and subglottic area
Signs and symptoms
Acute upper respiratory tract infections include rhinitisRhinitis
Rhinitis , commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or...
, pharyngitis
Pharyngitis
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
/tonsillitis
Tonsillitis
Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of viral tonsillitis, bacterial causes are treatable with antibiotics...
and laryngitis
Laryngitis
Laryngitis is an inflammation of the larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds . Dysphonia is the medical term for a vocal disorder, of which laryngitis is one cause....
often referred to as a common cold
Common cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
, and their complications: sinusitis
Sinusitis
Sinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...
, ear infection and sometimes bronchitis
Bronchitis
Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...
(though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
, sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
, runny nose, nasal congestion
Nasal congestion
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.Nasal congestion has many causes and can range from a...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, low grade fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, facial pressure and sneezing. Onset of symptoms usually begins 1–3 days after exposure. The illness usually lasts 7–10 days.
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 runny nose, voice changes or cough.
Pain and pressure of the ear caused by a middle ear infection (Otitis media
Otitis media
Otitis media is inflammation of the middle ear, or a middle ear infection.It occurs in the area between the tympanic membrane and the inner ear, including a duct known as the eustachian tube. It is one of the two categories of ear inflammation that can underlie what is commonly called an earache,...
) and the reddening of the eye caused by viral Conjunctivitis
Conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
are often associated with upper respiratory infections.
| Symptoms | Allergy | URI | Influenza |
|---|---|---|---|
| Itchy, watery eyes | Common | Rare (conjunctivitis may occur with adenovirus) | Soreness behind eyes, sometimes conjunctivitis |
| Nasal discharge | Common | Common | Common |
| Nasal congestion | Common | Common | Sometimes |
| Sneezing | Very common | Very common | Sometimes |
| Sore throat | Sometimes (postnasal drip) | Very common | Sometimes |
| Cough | Sometimes | Common (mild to moderate, hacking) | Common (dry cough, can be severe) |
| Headache | Uncommon | Rare | Common |
| Fever | Never | Rare in adults, possible in children | Very common (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 Myalgia Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections... |
Never | Slight | Very common, often severe |
Cause
Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirusRhinovirus
Human rhinoviruses are the most common viral infective agents in humans and are the predominant cause of the common cold. Rhinovirus infection proliferates in temperatures between 33–35 °C , and this may be why it occurs primarily in the nose...
. Other viruses include the coronavirus
Coronavirus
Coronaviruses are species in the genera of virus belonging to the subfamily Coronavirinae in the family Coronaviridae. Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. The genomic size of coronaviruses ranges from approximately 16 to 31...
, parainfluenza virus, adenovirus, enterovirus
Enterovirus
Enteroviruses are a genus of ssRNA viruses associated with several human and mammalian diseases. Serologic studies have distinguished 66 human enterovirus serotypes on the basis of antibody neutralization tests. Additional antigenic variants have been defined within several of the serotypes on the...
, and respiratory syncytial virus.
Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").
Influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...
(the flu) is a more severe systemic illness which typically involves the upper respiratory tract. Influenza is a relatively uncommon cause of influenza-like illness
Influenza-like illness
Influenza-like illness , also known as acute respiratory infection and flu-like syndrome, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms, with SARI referring to Severe Acute Respiratory Infection.Symptoms commonly include fever, shivering, chills,...
.
Treatment
Treatment depends on the underlying cause. There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of the illness. Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness. Based on these findings, it was concluded that previously sedentary people who have acquired a URI and who have initiated an exercise program may continue to exercise. Getting plenty of sleep; however, is advisable since even mild sleep deprivation has been shown to be associated with increased susceptibility to infection. Increasing fluid intake, or "drinking plenty of fluids" during a cold is not supported by medical evidence, according to a literature review published in the British Medical Journal.
Antibiotics
Judicious use of antibiotics can decrease unnecessary adverse effects of antibiotics as well as out-of-pocket costs to the patient. But more importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteriaDrug resistance
Drug resistance is the reduction in effectiveness of a drug such as an antimicrobial or an antineoplastic in curing a disease or condition. When the drug is not intended to kill or inhibit a pathogen, then the term is equivalent to dosage failure or drug tolerance. More commonly, the term is used...
, which is now a growing problem in the world. Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses. Some have advocated a delayed antibiotic approach to treating URIs which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. Most studies show no difference in improvement of symptoms between those treated with antibiotics right away and those with delayed prescriptions. Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. A strategy of "no antibiotics" results in even less antibiotic use than a strategy of "delayed antibiotics". However, in certain higher risk patients with underlying lung disease, such as chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
(COPD), evidence does exist to support the treatment of bronchitis
Bronchitis
Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...
with antibiotics to shorten the course of the illness and decrease treatment failure.
Decongestants
According to a Cochrane review single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults; however, "there is insufficient data on the use of decongestants in children." Therefore decongestants are not recommended for use in children under 12 years of age with the common cold. Oral decongestants are, also, contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.Alternative medicine
The use of Vitamin CVitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
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.
The benefits versus risk of nasal irrigation
Nasal irrigation
Nasal irrigation or nasal lavage or nose douche is the personal hygiene practice in which the nasal cavity is washed to flush out excess mucus and debris from the nose and sinuses. The practice is well-tolerated and beneficial with only minor side effects...
are currently unclear and therefore is not recommended.
Epidemiology
Transmission is via respiratory droplets or by virus-contaminated hands. Upper respiratory tract (nose, throat, sinuses) mucosa inflammation causes increased secretions, rhinorrheaRhinorrhea
Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. Rhinorrhea is a common symptom of allergies or certain diseases,...
and results in sneezing, and coughing facilitating the spread.
In United States URIs are the most common infectious illness in the general population. URIs are the leading reasons for people missing work and school. URI is the leading diagnosis in the office setting.
External links
- The Flu and Cold: Tips on Prevention and Feeling Better
- Upper Respiratory Tract Infection from Cleveland Clinic Online Medical Reference