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Upper respiratory tract infection

Medicine > Infection

Background knowledge 🧠

Definition

  • Upper respiratory tract infections (URTI) affect the components of the upper respiratory tract, including the nasal passages, pharynx, and larynx.

Common Pathogens

  • Viruses: Rhinovirus, coronavirus, adenovirus, influenza virus, parainfluenza virus, respiratory syncytial virus.
  • Bacteria: Less common, includes Streptococcus pyogenes.

Clinical Features 🌡️

Symptoms

  • Rhinorrhoea (runny nose) or nasal congestion.
  • Sore throat.
  • Cough (typically dry).
  • Fever and malaise (more common in children).
  • Hoarseness or loss of voice (laryngitis).

Differential Diagnoses

  • Influenza: Sudden onset, higher fever, muscle aches.
  • Epiglottitis: Rapid onset, high fever, drooling, difficulty swallowing.
  • Tonsillitis: Throat pain, swollen tonsils, possible exudates.
  • Mononucleosis: Fatigue, lymphadenopathy, atypical lymphocytes.

Investigations 🧪

Tests

  • Mostly clinical diagnosis; investigations not routinely needed.
  • Combined nose and throat swab: PCR for virus detection if influenza suspected.
  • FBC: Atypical lymphocytes, lymphocytosis if mononucleosis suspected.

Management 🥼

Management

  • Primarily symptomatic: Rest, hydration, and over-the-counter pain relievers (e.g., paracetamol).
  • Antibiotics are generally not indicated unless bacterial aetiology is confirmed or suspected.
  • Nasal decongestants can be used for short-term relief.
  • Avoid antibiotics to prevent resistance and unnecessary side effects unless specifically indicated.

Complications

  • Otitis media (middle ear infection).
  • Sinusitis.
  • Laryngitis.
  • Lower respiratory tract infections such as bronchitis or pneumonia, especially in immunocompromised individuals.

Prognosis

  • Most URTIs are self-limiting and resolve within 7-10 days.
  • Seek medical attention for severe symptoms or if symptoms persist beyond expected duration.

Prevention

  • Hand hygiene and respiratory etiquette (e.g., covering mouth/nose during coughing/sneezing).
  • Avoidance of close contact with sick individuals.
  • Regular cleaning of surfaces.

Key Points

  • URTIs are commonly caused by viral infection and are generally self-limiting.
  • They are characterised by a runny or congested nose, cough and sore throat.
  • Diagnosis is primarily through clinical judgement, and it is important to be aware of the differential diagnoses.
  • Management is supportive with symptomatic treatment and antibiotics are often not required.

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Infection