What is URTI ? | Symptoms and treatment | 2019

HI EVERYONE hopes you all are well. today's topic is a very common problem of everyone that is cold, so here I m presenting you a blog about upper respiratory tract infection in simple and short form hope you will get benefits from this blog and please share and comments your opinion.

UPPER RESPIRATORY TRACT INFECTION

Upper respiratory tract infection is the most common infection in OPD and most common transmission of URTI is through inhalation and direct contact.

The virus is the commonest etiology of URTI but bacterial infection also causes URTI.

There are Four (4) type of Upper respiratory tract infection.

1) COMMON COLD & INFLUENZA

Common cold and influenza caused by a virus and it's most common in URTI. Influenza means a severe form of the common cold caused by the influenza virus. There is a new virus which is taken in the form of pandemic (swine flu).

The virus that is causing common cold infection.

1) Influenza virus

2) Picornaviruses

3) Respiratory syncytial virus

4) Parainfluenza virus

5) Adenovirus

Clinical feature: - Sing and symptoms

• Sneezing, rhinorrhoea, nasal congestion
• Sore throat
• Non-productive cough
• Headache and pain in the eye
• Fever
• Conjunctivitis, laryngitis
• Skin rash
• Postnasal discharge
• Erythema around nose
• Pharynx congested
• Tonsillitis
• Lymph node enlarges and tender

Diagnosis

1. Nasal pharyngeal swab
2. Throat swab
3. Real-time polymerase chain reaction
4. Culture test

Management

The common cold is usually treated by symptomatic and supportive treatment

Bed rest and adequate fluid

• Anti-cholinergic spray (ipratropium)
• Nasal decongested (xylometazoline)
• Saline nasal drop
• In the case of influenza
• The household spread of disease should be controlled
• Isolation of pt. in well ventilated isolation room
• Anti-viral drug e.g. Oseltamivir should start to treat and prevent severe illness
• Anti-viral prophylaxis should be provided to a health care professional
• 
  
• Supportive therapy

1. Intravenous fluid
2. Parenteral nutrition
3. Oxygen therapy
4. Ventilator support ( if need)
5. Anti-biotic for secondary infection
6. Vasopressor for shock
7. Aspirin and salicylate medication is contraindicated in influenza(Reyes syndrome)
8. Pt. should monitor for secondary bacterial infection

2)RHINITIS

Rhinitis is defined as inflammation of the membranous lining of the nose.

There are two types of rhinitis

1. Allergic rhinitis
2. Non allergic rhinitis

1) Allergic rhinitis is occurring when contact allergen and due to contact of allergen there will be an inflammation of the membranous lining of the nose. Inflammation is due to immunoglobulin E mediate.

After exposed to allergen pt. has symptoms of sneezing, itching, clear rhinorrhoea, nasal congestion, obstruction appears after 4 to 6 hour of exposure.

The main cause of acute infectious rhinitis is a virus. If acute infectious rhinitis is not treated then there will be an increasing chance of secondary bacterial infection in which pt. have mucopurulent nasal discharge, facial pain and fever may present.

2)Nonallergic rhinitis is inflammation of the inner part of the nose that is not caused by an allergen and without infection

Sing and symptoms are as follow

• Nasal obstruction
• Rhinorrhoea
• Exacerbated by certain alcohol, spicy food and emotion.
• Environmental factor such as temperature, barometric pressure, bright light can aggravate

MANAGEMENT

1. Anti-histamine for itching and sneezing (cetirizine/fexofenadine)
2. Corticosteroids
3. WHO recommended using a combination of anti-histamine and anti-leukotriene
4. Topical corticosteroids (such as budesonide, mometasone and beclomethasone provide relief to pt.
5. Rhinorrhoea relieving drug may cause sedation due to systemic absorption.

3)Pharyngitis

Pharyngitis is inflammation of the pharynx, hypopharynx, uvula, and tonsil due to virology. Pharyngitis caused by a group of Alfa-beta hemolytic streptococci. Most common in children (4 to 6 years)

Clinical feature

1. Throat discomfort
2. Odynophagia
3. Cough
4. Fever, headache, malaise, and myalgia
5. Tonsillopharyngeal erythema
6. Foul smelling
7. Swollen and tender cervical lymph node
8. Conjunctivitis and maculopapular rash

Diagnosis: -  Throat swab culture reviled the viral infection or bacterial. Serological test also help.

MANAGEMENT

• Viral pharyngitis is self-limiting diseases which resolve spontaneously.
• Anti-viral may require in some case
• Symptomatic treatment

4)SINUSITIS

Sinusitis is defined as inflammation of Paranasal sinuses

CAUSES OF SINUSITIS

1. Anatomic abnormalities of osteomas complex(e.g. deviated nasal septum, concha bullosa, and bone spurs)
2. Allergic rhinitis
3. Nasal polyps
4. Nasotracheal, nasogastric intubation
5. Tumour causing obstruction
6. Dental surgery
7. Recurrent URTI
8. Cystic fibrosis
9. Tobacco smoking

Clinical feature

• Symptoms of sinusitis are frequent and persistence even after the common cold subsides.
• Nasal congestion
• Headache fever
• Facial pain
• Headache is increasing when bending forward
• In chronic sinusitis pain and fever are rarely present
• Nasal obstruction, purulent nasal discharge, postnasal drip
• Chronic cough

Diagnosis of sinusitis

1. Nasal Endoscopy
2. Radiography of Paranasal sinus
3. CT scan

Management of sinusitis

• Controlling of predisposing factor
• Symptomatic treatment
• Antibiotic
• Nasal decongestant(xylometazoline)
• Surgery is recommended for chronic sinusitis, recurrent sinusitis, large obstructive polyp, and tumor.

DR. AMIN BAYAD

BHMS