UPPER RESPIRATORY TRACT INFECTION
Introduction
- Upper respiratory tract infections (URTIs) are acute conditions caused by viral or bacterial infection affecting the upper respiratory tract, including the nose, paranasal sinuses, pharynx, larynx and middle ear.
- IVRS constitute the most frequent reason for consultation in outpatient practice, which
is divided between pharyngitis, rhinosinusitis and non-specific infections. - In the general population, adults develop an average of 2-3 episodes of URTI per year while preschool children have 5-7.
- The vast majority of IVRS are of viral origin and caused by more than 200 different viruses, while less than 10% are of bacterial origin.
- IVRS are transmitted between humans through respiratory secretions of
infected individuals who can spread the infectious agent through sneezing , coughing and hands.
DEFINITION / CLASSIFICATION
IVRS can be classified according to the predominant symptom:
1. Non-specific IVRS: infectious symptoms at several levels, without predominance
2. Acute pharyngitis: predominance of sore throat
3. Acute rhinosinusitis: predominance of nasal symptoms
4. Acute otitis media: predominance of ear pain
5. Influenza: predominance of general symptoms and notion of epidemic
- Aspecific IVRS
- Aspecific IVRS are of viral origin, have a benign clinical course and resolve spontaneously in 7-10 days on average but can last up to 14 days.
- Diagnosis
A nonspecific IVRS is clinically manifested by symptoms revealing involvement
at multiple levels, none of which is clearly predominant: - Rhinorrhea initially clear then often purulent with nasal obstruction and sneezing, which are the most frequent symptoms, present from the beginning and predominant on the 2nd and 3rd days
• Sore throat with moderate odynophagia and hoarseness, predominant on the 1st day and
disappearing rapidly
• Dry or productive cough and becoming bothersome on the 4th and 5th days
• General symptoms including fever, fatigue and myalgia, which are generally moderate except in cases of influenza where they are more severe.
- On examination, clinical signs are usually absent or minimal with nasal congestion and pharyngeal hyperemia
- Acute pharyngitis
- independently associated clinical signs:
- reported or measured fever ≥ 38°C, absence of cough, tonsillar exudate and painful anterior cervical adenopathy.
UPPER RESPIRATORY TRACT INFECTION
Acute rhinosinusitis
- Acute rhinosinusitis is an infection of the mucous membranes of the nose and sinuses lasting less than 4 weeks.
- In the vast majority of cases, acute rhinosinusitis is of viral origin, most often due to a rhinovirus, influenza virus or parainfluenza.
- Only 0.5-2% of patients have rhinosinusitis of bacterial origin, most commonly caused by Streptococcus pneumoniae (41%), Haemophilus influenza (35%) Moraxellacatarrhalis (4%).
- Bacterial rhinosinusitis most often results from superinfection of viral rhinosinusitis and can also be caused by allergy,
mechanical nasal obstruction or immunodeficiency. - The diagnosis of acute rhinosinusitis is based on clinical symptoms and signs, the most characteristic of which are: purulent rhinorrhea , nasal congestion or obstruction , facial pain , often aggravated by tilting the head forward.
- Other symptoms and signs are more inconsistent: maxillary dental pain , fever , fatigue , cough , hyposmia or anosmia, headaches, pain or pressure in the ear, halitosis.
- Viral rhinosinusitis usually resolves within 7-10 days , as do a minority of
bacterial rhinosinusitis.
Acute otitis media
- Diagnosis of acute otitis media is easy by history and otoscopy.
- The anamnesis reveals acute otalgia , hearing loss , fever , purulent discharge from the ear canal if there is perforation of the eardrum and sometimes the notion of an IVRS in the previous days.
- During otoscopy, we can observe at the level of the eardrum: erythema , bulging , loss of reflex , transparent fluid level , sometimes a discharge and a perforation
- The flu
- Influenza A and B viruses cause seasonal influenza epidemics that typically occur in the winter, most commonly from late December to March. Diagnosis
Clinically, influenza is difficult to distinguish from other URTIs. - The diagnosis of influenza should be suspected during an epidemic and when the clinical picture
shows a sudden onset with severe general symptoms.
Incubation: 1-4 days
Sudden onset
Severe general symptoms:
fever 38-40°C, chills, malaise, myalgia, arthralgia, headache
Moderate general symptoms:
Fever 37-38.5°, chills, malaise, myalgia,
arthralgia, headache
UPPER RESPIRATORY TRACT INFECTIONUPPER RESPIRATORY TRACT INFECTION
Treatment
- Symptomatic treatment is recommended for all patients with suspected influenza, including the same options as for non-specific IVRS:
• analgesics to reduce fever, myalgia and pain
• Nasal vasoconstrictor in cases of viral rhinosinusitis only - an H1 antihistamine
- In case of bacterial superinfection
- 1st choice:
o or Amoxycillin 2 x 500 mg/day PO for 5-7 days
o or Amoxyciline-clavulanic acid 2 x 1 g/day PO for 5-7 days - Cefuroxime 2 x 500 mg/day PO for 5-7 days
• 2nd choice if allergic to penicillin:
o Clarithromycin 2 x 250 mg/day PO for 5-7 days
o or Azithromycin 1 x 500 mg/day PO for 3 days
- Four measures can be recommended to prevent IVRS:
• Hand washing or disinfection to reduce the transmission of IVRS viruses.
• Influenza vaccine (see Vaccination Strategy). 19
• Antiviral prophylaxis to reduce the risk of influenza and complications in
high-risk individuals who have not been vaccinated for 2 weeks while waiting for the
vaccination to take effect and if the risk of exposure to the virus is high.19
• Pneumococcal vaccine (see Vaccination Strategy).
• Smoking cessation for smokers who have a 1.5 times higher risk of IVRS that could
be reduced by smoking cessation.
Vertigo s:
The organs of balance are
The inner ear or labyrinth
The cerebellum
Causes: the most common are inner ear disorders.
Visual disturbances
Pressure in the brain; tumors
UPPER RESPIRATORY TRACT INFECTION
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.