Viral upper respiratory tract infections
Introduction
Upper respiratory tract infections involve the mucosa of the nasal cavity, sinuses, nasopharynx, oropharynx and larynx.
Epidemiology
- Incidence: 30000.00 cases per 100,000 person-years
- Peak incidence: 1-5 years
- Sex ratio: 1:1
| Condition | Relative incidence |
|---|---|
| Viral upper respiratory tract infections | 1 |
| Acute bronchitis | 0.15 |
| Acute sinusitis | 0.08 |
| Allergic rhinitis | 0.07 |
| Acute tonsillitis | 0.02 |
| Pneumonia | 0.02 |
| Croup | 0.01 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Pathophysiology
Many viruses can cause infection at this site, the most common of which are rhinoviruses (50-80%) and corona viruses. Other viruses include adenoviruses, influenza, parainfluenza, respiratory syncytial virus and enteroviruses. Terms which are often used to describe URTIs include 'cold' which is a non-specific term used by the general public usually to describe an illness with the main symptom of nasal discharge and sneezing, and 'coryzal symptoms' which is usually used by medical professionals and encompasses a wider range of symptoms as detailed below.
Clinical features
Symptoms
Signs
Assessment
Useful criteria for assessment
- The most common symptoms are nasal discharge, nasal obstruction, sore throat, headache, cough, tiredness and general malaise. Other symptoms include facial pain, earache, hoarseness and nausea.
Signs
- Erythema or injection of the back of the throat
- Nasal discharge
- Tender cervical lymphadenopathy
- Mild fever
Assessment
- Examination of throat, ears and cervical lymph nodes
- Respiratory examination to exclude pneumonia, significant wheeze etc
- Assess hydration status, especially in young children and the elderly
- Basic observations (heart rate, blood pressure, respiratory rate, temperature, oxygen saturations) - if significantly abnormal may need to consider other causes e.g. sepsis
Useful criteria for assessment
- Children under 5 - NICE fever traffic light system
- FeverPAIN score - used to assess likelihood of Strep infection in adult with sore throat and guide decision making re antibiotic usage
Investigations
Investigations
- Generally not needed in healthy adults
- May be required in less straightforward cases where more serious infections may present with similar symptoms e.g. baby/infant with fever, immunocompromised adult
- Viral throat swabs may be needed in certain cases e.g. adult with suspected influenza being admitted to hospital for infection control purposes
Management
Management
- Supportive management only is usually sufficient
- Admission for supportive care may be required in frail or elderly patients with low physiological reserve or multiple comorbidities
- An uncomplicated cold in a healthy adult usually resolves in 7-10 days but may last up to 3 weeks
- Provide reassurance that condition is self-limiting and recovery will not be aided by antibiotics
- Advise paracetamol, fluids, rest and over the counter remedies if appropriate