UPPER RESPIRATORY TRACT

INFECTIONS
BY DR BERNARD BASSEY AKPU
SENIOR REGISTRAR, INTERNAL
MEDICINE DEPARTMENT, UUTH, UYO.
 INTRODUCTION
• URTI is an infectious process of any of the
components of the upper airway including the
nose, sinuses, pharynx or larynx.

• Examples include nasal obstruction, sore throat,

tonsillitis, pharyngitis, laryngitis, otitis media and
common cold.

• Most infections are caused by virus though bacteria

have also been implicated.
• Upper respiratory tract infections are one of the most
important reasons for doctor visits.

• They are the most common illness resulting in missed work

or school,

• Upper respiratory tract infections are caused by viruses and

are self-limited.

• Antibiotics are rarely needed for treatment unless bacterial

infection is suspected.
 ETIOLOGY
• Most URTI are viral in origin. The following
viruses have been implicated:
• Rhinoviruses
• Coronaviruses
• Adenoviruses
• Coxsackieviruses
 PATHOPHYSIOLOGY
• URTIs involve direct invasion of the mucosa
lining of the upper airways.
• Inoculation of bacteria or viruses occurs when
a person’s hand comes in contact with
pathogens and the person the touches the
nose or mouth or when a person directly
inhales respiratory droplets from an infected
person who is coughing or sneezing.
• After inoculation, viruses and bacteria
encounter several barriers, including physical,
mechanical, humoral and cellular immune
defenses.
• Infection becomes established when these
barriers are bypassed.
• Suboptimal immune function also increases
the risk of one contracting URTI.
 COMMON COLD (ACUTE CORYZA)
• Is the most common of URTI.
• It’s highly infectious and commonly caused by
rhinoviruses. Coronaviruses and adenoviruses are
also implicated.
• Onset is rapid and clinical features include sore
throat, sneezing, watery nasal discharge, cough ,
slight fever.
• Treatment is usually not required. Paracetamol and
nasal decongestant can be given. Antibiotics not
necessary if uncomplicated.
 SINUSITIS
• Is an infection of the paranasal sinuses that either is
bacterial (mainly strep pneumonia and Haemophilus
influenza) or is occasionally fungal.
• Has association with asthma.
• Symptoms include frontal headache, purulent
rhinorrhoea, facial pain with tenderness and fever.
• Treatment: nasal decongestant e.g xylometazoline,
broad spectrum antibiotics e.g co-amoxicillin, anti-
inflammatory therapy e.g steroids (nasal spray) and
steam inhalation.
 PHARYNGITIS
• Commonly caused by adenoviruses of which
there are about 32 serotypes.
• Endemic adenovirus infection causes the
common sore throat.
• Clinical features include hoarse voice, painful
and unproductive cough, stridor (esp in children)
• Treatment: rest voice, paracetamol, steam
inhalation, antibiotics not necessary if
uncomplicated.
 ACUTE LARYNGOTRACHEOBRONCHITIS
(CROUP)
• Is a childhood condition involve the larynx,
trachea and bronchus.
• Symptoms include barking cough, hoarse
voice, difficulty breathing, stridor.
• Cyanosis and asphyxia can occur.
• Treatment : Nebulization with adrenaline,
steroid therapy, oxygen therapy, fluids.
 ACUTE EPIGLOTTITIS
• Mostly affects children and caused by H.
Influenza type b (Hib).
• Clinical features include fever, sore throat,
stridor and dysphagia.

• Treatment: IV co-amoxiclav or chloramphenicol.

Urgent endotracheal intubation or
tracheostomy may be necessary.
• Immunization
 INFLUENZA
• Influenza virus belongs to the orthomyxovirus group and
exists in two main forms A and B.
• Influenza B is associated with localized outbreaks of mid
disease whereas influenza A causes worldwide pandemics.
• Incubation period of influenza is 1 – 3 day. Symptoms include
sudden onset fever with generalized aching, headache,
anorexia, nausea, vomiting and harsh unproductive cough.
• Treatment: bed rest, paracetamol, antivirals (zanamivir,
oseltamivir) .
• Vaccination
 FOREIGN BODY INHALATION
• Inhalation of foreign bodies is common in children than
adults.
• In adults, it occurs after excess alcohol or under general
anaesthesia.
• More often impaction occurs in the right right main
bronchus and produces choking, persistent monophonic
wheeze, persistent suppurative pneumonia, lung abscess.
• Larger foreign body may impact in the trachea.

• Treatment: Emergency – Heimlich’s manoevre

Non emergency – Rigid bronchoscopy
 RHINITIS
• Is defined clinically as sneezing attacks, nasal discharge or
blockage occuring for more than an hour on most days.
• Allergic rhinitis or hay fever may be seasonal or perennial.
• Seasonal allergic rhinitis occurs in particular during pollen
seasons.
• Perennial allergic rhinitis occurs throughout the year.
• Symptoms include sneezing, rhinorrhea, itching, nasal
congestion.

• Treatment : allergen avoidance, anti histamines,

decongestant, steroids.
 CONCLUSION
• URTI is an infection of any of the components
of the upper airway including the nose,
sinuses, pharynx or larynx.

• Examples include nasal obstruction, sore

throat, tonsillitis, pharyngitis, laryngitis, otitis
media and common cold.
•THANKS FOR YOUR
ATTENTION