Upper Respiratory Tract Infection - Causes, Symptoms and Treatment

What Is an Upper Respiratory Tract Infection?

An upper respiratory tract infection affects the upper part of our respiratory system, including the sinuses, larynx, pharynx, nasal passages, and throat. Upper respiratory tract infection includes:

1. Common cold.

2. Laryngitis (inflammation of the larynx).

3. Epiglottitis (inflammation of an upper portion of the larynx, epiglottis).

4. Pharyngitis - sore throat (inflammation of pharynx, uvula, and tonsils).

5. Sinusitis (sinus infection).

6. Rhinitis (inflammation of the nasal cavity).

What Causes Upper Respiratory Tract Infections?

The primary cause of upper respiratory infection is viruses and bacteria. The most common virus is the rhinovirus.

Viruses:

• Rhinovirus.

• Coxsackievirus.

• Adenovirus.

• Respiratory syncytial virus.

• Parainfluenza virus.

• Human metapneumovirus.

Bacteria:

• Group A beta-hemolytic streptococci.

• Group C beta-hemolytic streptococci.

• Chlamydia pneumoniae (chlamydia).

• Corynebacterium diphtheriae (diphtheria).

• Neisseria gonorrhoeae (gonorrhea).

What Are the Types of Acute Upper Respiratory Infection?

The type of upper respiratory infection is classified based on the parts of the upper respiratory tract involved in the disease. Other types of upper respiratory infections include -

1. Sinusitis:

Sinusitis is the inflammation or swelling of the tissue lining the sinuses (cavity around the nasal passages). There are four paired cavities (sinuses) in the head connected by narrow channels. Thin mucus is produced in the sinuses that are drained out through the channels of the nose. This drainage clears the bacteria from the nasal cavity. But, if sinuses are blocked with fluid, bacteria can grow inside and cause bacterial infection.

What Are The Types of Sinusitis?

Sinusitis is classified as acute and chronic.

• Acute Sinusitis: Acute sinusitis refers to the sudden onset of cold symptoms such as runny nose, facial pain, and stuffy nose that may resolve on its own most of the time in a few days. However, it responds well to antibiotics and decongestants.

• Chronic Sinusitis: This term refers to a condition of symptoms with nasal congestion, facial pain, drainage, and decreased sense of smell that persists for at least 12 weeks.

• Subacute Sinusitis: Subacute sinusitis refers to the condition with sinusitis symptoms that last for about four to twelve weeks.

• Recurrent Acute Sinusitis: This term refers to when the sinusitis symptoms occur four or more times in one year and last less than two weeks.

What Are the Causes of Sinusitis?

Viruses, bacteria, or fungus are responsible for causing sinusitis which results in swelling and blocking the sinuses. Causes include:

• Nasal and seasonal allergies.

• Polyps (abnormal tissue growth on the mucous membrane).

• Common cold.

• Compromised or weak immune system.

• A deviated septum- the septum is the line of cartilage that separates or divides the nose into two cavities.

What Are the Signs and Symptoms of Sinusitis?

The most common signs and symptoms of sinusitis include:

• Postnasal drip (mucus drips down the throat).

• Nasal discharge (usually thick yellowish or greenish discharge from the nose) or stuffy nose.

• Halitosis (bad breath).

• Facial pressure.

• Cough.

• Fever.

• Tiredness.

2. Laryngitis:

Laryngitis refers to the larynx inflammation caused most commonly due to viral infection and irritation or overuse of the voice box (larynx). It can be easily contagious, self-treatable, and resolves within days to weeks. Laryngitis is of acute and chronic nature.

What Are the Causes of Acute and Chronic Laryngitis?

Acute Laryngitis: Acute laryngitis has an abrupt onset and resolves within three weeks. Most acute laryngitis is temporary, and the condition improves with treating underlying conditions. Causes of laryngitis include:

• Viral infection.

• Vocal strain is caused by overuse.

• Bacterial infections are less common.

• Rarely, laryngitis results from an autoimmune condition such as rheumatoid arthritis, sarcoidosis, and relapsing polychondritis.

• Chronic Laryngitis: Chronic laryngitis refers to the laryngitis symptoms that persist for more than three weeks. It involves a longer duration of symptoms and takes a long term to develop. Causes of chronic laryngitis include:

• Environmental factors such as cigarette smoke or polluted air.

• Irritation from asthma inhalers.

• GERD (gastrointestinal esophageal reflux) - stomach acid moves up into the esophagus, irritating the throat.

• Vocal misuse.

• Other conditions such as bronchitis, allergies, vocal cord cysts, and pneumonia results in chronic laryngitis.

What Are the Signs and Symptoms of Acute Laryngitis?

• The most common symptom is dysphonia (hoarseness and loss of voice).

• Dry cough.

• Fever or malaise.

• Congestion or rhinorrhea (running nose).

• Sleeping difficulty.

• Swollen lymph nodes.

• Persistent hoarseness is an indication of a more serious underlying medical condition.

• Tickling sensation and rawness in your throat.

• Dysphagia (difficulty swallowing).

• Dyspnea (difficulty or shortness of breath).

• Sore throat.

What Are the Symptoms of Chronic Laryngitis?

Common symptoms of chronic laryngitis include:

• Swollen lymph nodes in the neck.

• Dry cough.

• Dysphagia (difficulty in swallowing).

• Fever.

• Irritated throat.

• Hoarseness or loss of voice.

3. Common Cold:

The common cold is an upper respiratory tract infection of the nose and throat, including the sinuses and trachea. It is easily contagious (spreads easily from person to person) and commonly seen. More than 200 different viruses can cause colds, but the rhinovirus is the most common causative virus.

What Are the Causes of the Common Cold?

Though many viruses can cause colds, the rhinovirus is the most common cause, accounting for about 50 % of cases. A cold virus can spread through droplets in the air when a healthy individual contacts sick people's coughs, sneezes, or talks.

What Are the Risk Factors of the Common Cold?

The following factors can increase the chances of getting a cold:

• Age: Infants and young children are at the most significant risk, especially in common childcare places.

• Smoking: Persons who smoke or people exposed to secondhand smoke are more likely to catch a cold.

• Weakened Immune System: Having a chronic illness or weakened immune system is a greater risk.

• Exposure: Public places such as schools, airports, and other common places are more likely to have been exposed to common cold viruses, which can quickly spread among crowds.

What Are the Symptoms of Common Cold?

Symptoms appear after one to three days after getting exposed to the virus. Symptoms include:

• Runny nose.

• Cough.

• Sore throat.

• Mild headache.

• Congestion.

• Sneezing.

• Low-grade fever.

• Tiredness.

• Sneezing.

• Slight body aches.

• Ear pain.

• Difficulty in breathing.

• Lack of appetite.

4. Pharyngitis: Pharyngitis is characterized by pain or irritation in the throat with or without swelling, accompanied by an infection.

What Are the Causes of Pharyngitis?

Various viral and bacterial agents can cause pharyngitis. They include:

• Adenovirus is one of the causes of the common cold.

• Group A Streptococcus.

• Chickenpox.

• Whooping cough.

• Measles.

• Viral infections such as influenza, common cold, influenza, or mononucleosis are responsible for pharyngitis infection.

• Rarely bacterial infection causes pharyngitis. Strep throat is most commonly caused by group A Streptococcus. Bacterial pharyngitis is caused by chlamydia, gonorrhea, and corynebacterium.

What Are the Symptoms of Pharyngitis?

The symptoms of pharyngitis include:

• Fatigue.

• Body aches.

• Chills.

• Sore, dry, or scratchy throat.

• Headache.

• Cough.

• Sneezing.

• Runny nose.

• Fever.

In addition to sore throat, symptoms of mononucleosis include:

• Severe fatigue.

• Fever.

• Muscle pain.

• General malaise.

• Rashes.

• Loss of appetite.

• Swollen lymph nodes.

Strep throat can also cause:

• Nausea.

• Swollen lymph nodes.

• Unusual taste in the mouth.

• General malaise.

• Chills.

• Fever.

• Red throat with white or gray patches.

5. Rhinitis:

Rhinitis refers to the irritation or inflammation of the nasal mucous membrane. It is usually caused by the common cold or a seasonal allergy and is characterized by a runny or stuffy nose. It is classified as allergic and non-allergic.

What Is Allergic Rhinitis?

Allergic rhinitis refers to the body’s reaction to the environmental trigger. Both year-round allergies and seasonal allergies can cause allergic rhinitis.

What Are the Causes for Allergic Rhinitis?

The most common environmental triggers that are responsible for causing allergic rhinitis include:

• Dust.

• Molds.

• Grasses.

• Trees.

• Pollen.

• Animals.

What Are the Symptoms of Allergic Rhinitis?

Common symptoms include:

• Sneezing.

• Itching.

• Stuffiness.

• Runny nose.

• Itchy and watery eyes.

• Headache.

• Swollen eyelids.

• Cough.

• Wheezing.

Non-Allergic Rhinitis:

• Non-allergic rhinitis can be classified into acute and chronic.

Acute Viral Rhinitis:

• Several viruses are responsible for causing acute viral rhinitis, usually the common cold.

• The most common symptoms of acute viral rhinitis are congestion, postnasal drip, cough, sneezing, runny nose, and a low-grade fever.

• Nasal sprays can be used for only three to four days; when the drug effect wears off, the swelling of the mucous membrane occurs even more than before, and this phenomenon is called rebound congestion.

Chronic Rhinitis:

• Chronic rhinitis is usually an exacerbation or extension of rhinitis caused by a viral infection or inflammation.

• These are rarely associated with certain diseases such as tuberculosis, rhinoscleroma, rhinosporidiosis (an infection in the nose with bleeding polyps), blastomycosis, leprosy, and histoplasmosis.

• Both airborne irritants and low humidity are responsible for causing chronic rhinitis.

• Chronic rhinitis is characterized by nasal obstruction, frequent bleeding, crusting, foul-smelling and pus-filled discharge from the nose.

6. Epiglottitis:

Epiglottitis refers to the swelling and inflammation of the epiglottis (which acts as a valve to prevent food or drink from entering the windpipe), which results in blocking up the airway. It is potentially a life-threatening condition.

What Causes Epiglottitis?

• The most common bacteria involved is Haemophilus influenzae type B, through infected persons.

• Streptococcus pneumoniae commonly causes bacterial pneumonia.

• In addition, viruses that cause shingles and chickenpox, along with respiratory infections, also result in epiglottitis.

• Fungi, which cause yeast infections, are also responsible for causing inflammation of the epiglottis.

• Other causes include:

• Swallowing a foreign object.

• Inhaling chemicals and smoking crack cocaine.

• Throat injury due to trauma.

What Are the Symptoms of Epiglottitis?

Common symptoms include:

• Sore throat.

• A high fever.

• Hoarse voice.

• Painful swallowing.

• Restlessness.

• Breathing through mouth.

How to Diagnose Upper Respiratory Tract Infection?

1. Common Cold: The presence of rhinovirus infection, coupled with the absence of signs of a bacterial infection or respiratory illness, is sufficient to diagnose the common cold. It is a clinical diagnosis where diagnostic testing is not necessary. In the case of influenza, specimens are obtained as close to symptom onset as possible. Therefore, nasal aspirants and swabs are the best specimens to test.

2. Sinusitis: Proper medical history and physical examination aid in diagnosis. Sinusitis examination is done on the ears, nose, and throat for swelling, drainage, or blockage. An endoscope (a small lighted optical instrument) to check the inside of the nose. If necessary, computed tomography is recommended.

3. Laryngitis: A culture is taken in case of exudate in the oropharynx or overlying vocal folds. Direct or indirect laryngoscopy (a method used to view the larynx, including vocal cords) can be taken to view the larynx. Analysis of vocal fold movement to check asymmetry and aperiodicity with reduced mucosal waves and incomplete vibratory closure.

4. Bacterial Pharyngitis: In bacterial pharyngitis, rapid strep swabs can be used to rule it out.

5. Rhinitis: In case of any underlying infection, a culture examination is carried out to rule out whether the infection is caused due to bacteria or fungi. If symptoms persist due to severe conditions of the disease, a biopsy is taken to diagnose cancer.

6. Epiglottitis: A throat examination is carried out using a fiber-optic tube. The throat and blood culture to determine the cause of infection. X- rays of the throat and chest are taken to determine the severity of inflammation and infection.

How to Treat Upper Respiratory Tract Infections?

1. Common Cold:

Certain drugs and antibiotics can cure common colds.

• Decongestants: Decongestants help to relieve congestion, swelling, and runny nose. The active ingredient is pseudoephedrine or phenylephrine. Pseudoephedrine can help in drying and clearing nasal passages. Decongestant nasal sprays (Afrin) can also help.

• Analgesics: Analgesics are used to get relief from pain. Painkillers and antipyretic medicines treat common colds associated with fever and body pain.

• Cough Medicines: Cough suppression medications are used to block the cough reflex. Some may thin and loosen the mucus, making it easier to clear the airways.

• Antihistamines: Antihistamines are drugs used to treat allergic rhinitis, common cold, influenza, and other allergies.

2. Sinusitis:

Simple sinusitis is treated with :

• Decongestants - to relieve congestion.

• Nasal saline irrigation.

• Drinking fluids.

• Over-the-counter cold and allergy medications.

If symptoms persist:

• Antibiotics (seven days in adults and ten days in children).

• Oral or topical decongestants.

• Intranasal steroid sprays.

In untreatable cases, surgery is needed to correct structural problems depending on the computed tomography scan results.

3. Pharyngitis:

In case of strep throat, Amoxicillin and Penicillin are prescribed. It is necessary to complete the entire course of antibiotics to prevent infection from worsening or recurring. The complete course lasts for about seven to ten days.

4. Laryngitis:

Antibiotics are prescribed for bacterial infections. For chronic laryngitis, antihistamines, pain relievers, and glucocorticoids are prescribed. In the case of vocal cord dysfunction, surgery is indicated. Vocal cord polyp removal is the most common procedure carried out in patients.

Avoiding excess alcohol consumption and quitting smoking are necessary to lower the risk of inflammation.

5. Rhinitis:

Decongestants may relieve symptoms. Decongestants such as Oxymetazoline and Phenylephrine are used in the form of nasal spray, whereas Pseudoephedrine is taken orally. Antibiotics are not effective in case of acute rhinitis. Antihistamines control runny noses, but some cause drowsiness and some other problems in older people.

6. Epiglottitis:

Administration of antibiotics is done to treat bacterial infection. In severe cases, a cricothyroidotomy procedure is carried out. This procedure allows air into the lungs while bypassing the larynx.

Conclusion:

Upper respiratory tract infections may vary from the common cold to life-threatening illnesses like acute epiglottitis. These infections most commonly occur during the winter season and, if left untreated, can result in serious complications. An interprofessional team approach best manages and helps in achieving positive outcomes. Patients should be encouraged to be at rest, drink ample fluids, quit smoking, and continue with the prescribed medications. A proper diagnosis and timely approach aid in a better prognosis of the condition.