UPPER RESPIRATORY TRACT INFECTIONS

INTRODUCTION Upper respiratory tract infection (URI) is a nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi. The prototype is the illness known as the common cold in addition to pharyngitis, sinusitis, and tracheobronchitis. So it commonly includes:

Tonsillitis Pharyngitis Laryngitis Sinusitis Otitis media Common cold

CAUSES OF URTIs: 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, Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat")

Epidemiology: 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.

Upper Respiratory Infection Risk Factors Not everybody exposed to or who comes into direct contact with an ill person will "catch" their cold. People are especially susceptible if there is a decrease in the body's immune system so that the virus can begin to spread and cause symptoms in the body. Upper Respiratory Infection Symptoms Symptoms of the common cold may include: Stuffiness (nasal congestion), runny nose, low grade fever and cough. The cough is usually dry. With post-nasal drip, the cough may bring up some of the nasal secretions that have dripped into the back of the throat. Sinusitis symptoms such as fullness in the face, increased nasal drainage, and occasionally pain and fever. Onset of the symptoms usually begins 13 days after the exposure to a microbial pathogen. The illness usually lasts 710 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 Symptoms Itchy, watery eyes Allergy Common URI Rare (conjunctivitis may occur with adenovirus Common Common Very common Very common Common (mild to moderate, hacking) Rare Rare in adults, possible in children Influenza Soreness behind eyes, sometimes conjunctivitis Common Sometimes Sometimes Sometimes Common (dry cough, can be severe) Common Very common (100-102F (or higher in young children), lasting 34 days; may have chills) Very common Very common, can last for weeks, extreme exhaustion early in course Very common, often severe

Nasal discharge Nasal congestion Sneezing Sore throat Cough

Common Common Very common Sometimes (postnasal drip) Sometimes

Headache Fever

Uncommon Never

Malaise Fatigue, weakness

Sometimes Sometimes

Sometimes Sometimes

Myalgias

Never

Slight

Treatment Medication Medications are usually not prescribed for upper respiratory infections. Antibiotics are not effective in fighting viral infections. However, antibiotics are appropriate if

the health care practitioner suspects that a bacterial infection exists, for example in cases of otitis media (ear infections), bacterial sinusitis, and strep throat. In some cases, where there is significant inflammation of the upper airways, for example croup in infants and children, corticosteroid medications such as prednisone or dexamethasone may be prescribed to decrease that inflammation. Use of Vitamin C in the inhibition and treatment of upper respiratory infections has been suggested, it could be justified in persons exposed to brief periods of severe physical exercise and/or cold environments. Upper Respiratory Infection Complications Most colds resolve on their own with few complications. Sometimes, the inflammation caused by the upper respiratory infection may cause drainage problems within the sinuses or the middle ear, which can create the potential of secondary bacterial infections such as sinusitis or otitis media. If not enough fluid is taken, dehydration is always a potential complication of infection. Prevention Upper respiratory infection prevention includes:

avoiding people who are ill; if you are ill, remain at home until you are no longer contagious; avoid touching your nose, eyes, and mouth; cover the cough and sneeze; sneezes and coughs should be covered with the elbow or sleeve - not the hand; and wash your hands often, and properly (20 seconds or more with soap and warm water). Lifestyle modifications such as smoking cessation and stress management may decrease your susceptibility to "catching" the common cold.

COMMON COLD

INTRODUCTION: The common cold is a viral infection of upper respiratory tract. It generally involves a runny nose, nasal congestion, and sneezing. Common colds are caused by viruses, while seasonal allergies are immune system responses triggered by exposure to an allergen. The common cold is also known as: Nasopharyngitis Acute viral rhinopharyngitis Acute coryza or a cold Causes of common cold: The common cold is a viral infection of the upper respiratory tract. The most commonly implicated virus is a rhinovirus (3050%). Others include: Coronavirus (1015%). Influenza (515%). Human parainfluenza viruses. Human respiratory syncytial virus. Adenoviruses. Enteroviruses. Metapneumovirus. Children in preschool and elementary school can have 3 to 12 colds per year while adolescents and adults typically have 2 to 4 colds per year. The common cold is the

most frequently occurring illness in the world. Colds can occur at any time of the year, but they are most common in the winter or rainy seasons. Symptoms Cold symptoms usually occur within 2 or 3 days after you came in contact with the virus, although it could take up to a week. Symptoms mostly affect the nose. The most common cold symptoms are:

Nasal congestion Runny nose Scratchy throat Sneezing

Adults and older children with colds generally have a low fever or no fever. Young children often run a fever around 100-102F. Depending on which virus caused your cold, you may also have:

Cough Decreased appetite Headache Muscle aches Postnasal drip Sore throat

Sometimes this may be accompanied by: conjunctivitis (pink eye) muscle aches fatigue shivering loss of appetite Many people with a cold feel tired and achy. There is currently no known cure; however The common cold usually resolves spontaneously in 7 to 10 days, but some symptoms can last for up to 3 weeks. In children the cough lasts for more than 10 days.

Spread of common cold: The common cold is usually spread o by direct hand-to-hand contact with infected secretions OR o from contaminated surfaces For example, if a person with a cold blows or touches their nose and then touches someone else, that person can subsequently become infected with the virus. Additionally, a cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects. Progression: The viral replication begins 8 to 12 hours after initial contact. Symptoms usually begin 2 to 5 days after initial infection but occasionally occur in as little as 10 hours. Symptoms peak 23 days after symptom onset. Symptoms may be more severe in infants and young children, and in these cases it may include fever and hives. Upper respiratory viruses may also be more severe in smokers.

Physiology:
The nose contains shelf-like structures called turbinates, which help trap particles entering the nasal passages. Material deposited in the nose is transported by ciliary action to the back of the throat in 10-15 minutes. Cold viruses are believed to be carried to the back of the throat where they are deposited in the area of the adenoid. The adenoid is a lymph gland structure that contains cells to which cold viruses attach.

Pathophysiology:
A cold virus is deposited into the front of the nasal passages by contaminated fingers or by droplets from coughs and sneezes. Small doses of virus (1-30 particles) are sufficient to produce infection. The virus is then transported to the back of the nose and onto the adenoid area by the nose itself.

The virus then attaches to a receptor (ICAM-1) which is located on the surface of nasal cells. The receptor fits into a docking port on the surface of the virus. Large amounts of virus receptor are present on cells of the adenoid.

After attachment to the receptor, virus is taken into the cell where it starts an infection. New virus particles are produced in the infected cell. The infected cell eventually dies and ruptures, releasing newly made cold virus to infect other cells in the nose and start the process over again. The virus is much smaller than the cell. Small doses of virus (1-30 virus particles) when introduced into the nose are sufficient to reliably produce infection.

From the time a cold virus enters the nose, it takes 8-12 hours for the viral reproductive cycle to be completed and for new cold virus to be released in nasal secretions. This interval is called the incubation period. Cold symptoms can also begin shortly after virus is first produced in the nose (1012 hours). The time from the beginning of the infection to the peak of symptoms is typically 36-72 hours.

Risk factors:
Cold viruses are almost always present in the environment. But the following factors can increase your chances of getting a cold: Age. Infants and preschool children are especially susceptible to common colds because they haven't yet developed resistance to most of the viruses that cause them. But an immature immune system isn't the only thing that makes kids vulnerable. They also tend to spend lots of time with other children and frequently aren't careful about washing their hands and covering their mouth and nose when they cough and sneeze. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose. Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You'll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses or have a weakened immune system. All of these factors increase your risk of a cold. Time of year. Both children and adults are more susceptible to colds in fall and winter. That's because children are in school, and most people are spending a lot of time indoors. In places where there is no winter season, colds are more frequent in the rainy season.

Prevention:
No vaccine has been developed for the common cold, which can be caused by many different viruses. But you can take some common-sense precautions to slow the spread of cold viruses:

 Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys periodically. Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouths without using their hands. Don't share. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold. Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold. Choose your child care center wisely. Look for a child care setting with good hygiene practices and clear policies about keeping sick children at home.

Treatment:
Common cold can be treated by: Older antihistamines ("first generation"): Antihistamines work by preventing histamine from attaching to a cellular receptor, H1. Attachment to this receptor is necessary for histamine activity to occur. The first generation antihistamines also block the activity of a part of the nervous system, the parasympathetic system, that stimulates mucus glands secretion. Nonsteroidal antinflammatory drugs (NSAIDs): There has been interest in the use of NSAIDs to treat other cold symptoms, especially cough. However, only a few clinical trials have been published on the use of NSAIDs for treating colds.

Decongestants (vasoconstrictors): Decongestants, such as pseudoephedrine, are in the category of "alphaadrenergic agonists." These drugs open the nasal passages by shrinking blood vessels in the mucus membrane of the nose, which is the primary cause of the nasal obstruction of colds. Decongestants may be taken by mouth or applied directly on the nasal mucus membrane in the form of nose drops and sprays.

Cough suppressants (narcotics): Cough suppressants are natural narcotics, like codeine, and synthetic narcotics, like dextromethorphan (DM). Cough suppressants act on the brain to depress the cough reflex center. Their effectiveness in patients with chronic cough has been demonstrated in controlled trials but there is little published information on their effectiveness in coughs associated with colds.

Anticholinergics (ipratropium): Anticholinergics are a class of drugs that block the action of the parasympathetic nervous system on mucus gland secretion, thereby reducing nasal discharge. A common cold is a two step process: The first step is virus infection of nasal cells. The second step is the activation of the inflammatory mediators which directly cause the cold symptoms. Ideally, it is desirable to treat both parts of the process but currently drugs for treating the virus infection (antivirals) are not commercially available.

Difference between common cold and influenza: Many people confuse the flu with a bad cold. The following table highlights the differences between influenza and the common cold:
Symptom Fever Headache Aches and pains Fatigue and weakness Extreme exhaustion Stuffy nose Sneezing Sore throat Flu Usually present, high (102F to 104F or 38C to 41C); lasts 3 to 4 days Very common (can be severe) Common and often severe Starts early, can be severe, and can last up to 14 to 21 days Very common at the start Sometimes Sometimes Sometimes Cold Uncommon Uncommon Slight Mild Never Common Common Common Mild to moderate, hacking cough Can lead to sinus congestion or earache

Chest discomfort, Common cough Complications Can lead to pneumonia or respiratory failure; can worsen a current chronic condition; can be lifethreatening