Upper Respiratory Infections (URIs)

Upper Respiratory Infections (URIs)

1. Pathophysiology

   • Rhinovirus (60% of cases)
     • R0=6
     • Case fatality = 0
   • Many other organisms
   • Transmission via direct contact
     • -Droplet spread -Aerosolized via cough/sneeze -Contact with tissues -Contact with fomites

2. Risk Factors

   • -Younger populations -Large group contact -Immunocompromised, stress, malnutrition -Smoking, second-hand smoke -Anatomic changes, facial dysmorphism, upper airway trauma, nasal polyposis

3. Presentation

   • Non-specific Presentation
     • Cough, sneezing, swollen nares (congestion), increase in mucus production (rhinorrhea)
   • Presentation in Children
     • May present with fever, wheezing, loss of appetite, fussiness, drowsiness, dehydration
   • Vital Signs
     • High temp, high HR, high RR, either high or low BP

4. Diagnostics

   • Dx usually based on signs, symptoms, PE findings
   • Test only for specific organisms ONLY ordered when therapy depends on result

5. Management

   • General Treatment
     • -"There is no cure for the common cold" -Reassurance -Education -Instructions for symptomatic home treatment -Antibiotics are CONTRAINDICATED for the common cold
   • Treatment for Congestion and Rhinorrhea
     • -Saline drops or spray -Humidification -OTC nasal decongestion or oral product -Bedtime 1st gen antihistamine
   • Treatment for Aches
     • -Warm showers or baths (reduces aching) -OTC analgesic prn for pain
   • Treatment for Fever
     • -NSAID or antipyretic  -No aspirin in children (REYES syndrome)
   • Treatment for Sore Throat
     • -Saline gargles every 4 hours -Local anesthetic sprays or lozenges (small tablet)
   • Treatment for Cough
     • -Dextromethorphan or guaifenesin -Local anesthetic sprays or lozenges

6. Prevention

   • Avoid close contacts, avoid touching mucous membranes, cover your nose while sneezing, dispose of dirty tissues, wash your hands, social distancing 

7. Complications

   • Initial infection may spread to adjacent structures -Sinusitis, otitis media, epiglottitis, laryngitis, tracheitis, bronchitis, pneumonia
   • Pharyngitis
     • -Throat culture for unimproved pts. -Use Centor score for pharyngitis/tonsilitis (absence of cough, anterior cervical lymphadenopathy, fever, tonsillar erythema or exudates, age)
   • Rhinosinusitis
     • -Symptomatic management -Radiology if complications are suspected (meningitis, orbital cellulitis, intracranial abscess) -Amoxicillin for severe or uncomplicated rhinosinusitis
   • Croup (Laryngotracheobronchitis)
     • -Steeple sign on CXR, inspiratory stridor -Corticosteroids -Nebulized epinephrine +/- cool mist nebulized saline
   • Epiglottitis
     • -Thumb sign on lateral CXR -Don't examine the throat  -Position for comfort -Have ETT/trach tube available if needed -Cool mist humidification -Oxygen -IV fluids -Antibiotics
   • Laryngitis
     • -Inhale humidified air to help clear secretions and exudate -Rest voice
   • Bronchiolitis and RSV
     • -Symptomatic treatment
   • Bronchitis
     • Symptomatic treatment
   • Red Flags
     • -Temp >100.4 F -Dyspnea or chest pain -Underlying chronic cardiopulmonary disease -Age <9 months or frail/elderly -Worsening/unresponsive to OTC medications -New symptoms suggesting complications

8. Prognosis

   • Typically mild and self-limited
   • Immunocompromised
     • Immunocompromised, elderly, and infants are more likely to have lethal complications