Upper respiratory tract infection
Classification and external resources
Conducting passages.
ICD-10	J00-06., J30-39.
ICD-9	465.9

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.

[edit] Definitions

Common URI terms are defined as follows:

• Rhinitis - Inflammation of the nasal mucosa
• Rhinosinusitis or sinusitis - 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
• Pharyngitis - Inflammation of the pharynx, hypopharynx, uvula, and tonsils
• Epiglottitis (supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area
• Laryngitis - Inflammation of the larynx
• Laryngotracheitis - Inflammation of the larynx, trachea, and subglottic area
• Tracheitis - Inflammation of the trachea and subglottic area

[edit] Etiology

Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.^[1]

Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").^[2]

Influenza (the flu) is a more severe systemic illness which typically involves the upper respiratory tract.

[edit] Epidemiology

Disability-adjusted life year for upper respiratory infections per 100,000 inhabitants in 2002.^[3]

     no data      less than 10      10-30      30-60      60-90      90-120      120-150      150-180      180-210      210-240      240-270      270-300      more than 300

Transmission is via respiratory droplets or by virus-contaminated hands. Upper respiratory tract (nose, throat, sinuses) mucosa inflammation causes increased secretions, rhinorrhea 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.^[4]

[edit] Signs and symptoms

Acute upper respiratory tract infections include rhinitis, 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 the symptoms usually begins 1-3 days after the exposure to a microbial pathogen. 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.

URI, Seasonal Allergies, Influenza - Symptom Comparison

[edit] Treatment

There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of illness. ^[5] Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches. ^[6]

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 bacteria, 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.^[7] 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.^[8] Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. It should be noted that 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.^[9]

Having said that, it is important to distinguish between strep and a viral sore throats because strep is caused by a bacterial infection -- Group A Streptococcus -- and a simple sore throat may be caused by other types of bacteria or viruses. Without the right antibiotics, the strep bug may enter the bloodstream and travel to the heart or other vital organs. Though rare, this can cause serious illness.^[10]

Bacterial complications of the viral URIs are also treated with antibiotics. These include sinusitis and otitis media.

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. ^[11] Oral decongestants are, also, contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.^[12][13]

The use of Vitamin C 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. ^[14]

There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. In fact, 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.^[15]

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.^[16]

[edit] References

• Park, David J. "Evidence Based Approach to Upper Respiratory Infections." December 10, 2006. Touro University Nevada College of Osteopathic Medicine

[edit] External links

• The Flu and Cold: Tips on Prevention and Feeling Better
• Upper Respiratory Tract Infection from Cleveland Clinic Online Medical Reference

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Upper respiratory tract infection".