Upper Respiratory Tract Infections
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General Goal: To know the major cause(s) of these diseases, how they are transmitted, and the major manifestations of each disease.

Specific Educational Objectives: The student should be able to:

1. recite the common cause(s) of these disease.

2. describe the common means of transmission.

3. describe the major manifestations of this infection.

4. describe how you diagnose, treat and prevent this infection.

Reading: DL Kasper and AS Fauci, 2013. Harrison's Infectious Diseases, Chapter 17. 2nd Edition. Pg. 192-206 McGraw Hill Education, New York

Lecture: Dr. Neal R. Chamberlain


OVERVIEW

The respiratory tract is divided into three different sections in this handout: upper respiratory tract infections, respiratory airway infections, and lower respiratory tract infections. This section of the handout will discuss infections of the upper respiratory tract and includes infections of the nasal passages, paranasal sinuses, and the pharynx. The diseases that are included in this section are the common cold, summer grippe, rhinosinusitis, pharyngitis and diphtheria. Viruses are the most common cause of all of these diseases except for diphtheria.

I. The Common Cold (Nonspecific upper respiratory tract infections; nonspecific URI) and SUMMER GRIPPE)

The common cold is caused by a multitude of organisms; about 90% of cases are due to viruses. Colds usually do not cause a fever and are most common in the winter months. This disease has a variety of names that include nonspecific URI, infective rhinitis, acute coryza, acute nasal catarrh, or acute rhinopharygitis/nasopharyngitis. The summer grippe is also caused by several different viruses. Summer grippe results in the patient having a fever and as its name implies it is most common in the summer months.

 

Etiology

Common Cold- Usually caused by rhinoviruses; there are at least 100 immunologically distinct rhinoviruses. Other causes of the common cold are listed in Table URI-1.

 

Table URI-1. Some Infectious Agents that Cause the Common Cold

Agents*

Human Serotypes

Other unique symptoms in addition to coryza

Myxoviruses

 

Influenza

A, B, C

Myalgia and fatigue

Parainfluenza

1, 2, 3, 4

Myalgia and fatigue

Respiratory syncytial virus

1 (possibly 2)

 

Human metapneumovirus

1

 

Coronaviruses

1

 

Picornaviruses

 

Rhinoviruses (most common cause)

> 100 types

 

Coxsackievirus A

24

Conjunctivitis,

Summer grippe occurs in summer early fall

Coxsackievirus B

6

Conjunctivitis,

Summer grippe occurs in summer early fall

Echoviruses

31 (only types 11, 20, and 25 may cause respiratory illnesses)

Conjunctivitis,

Summer grippe occurs in summer early fall
Enteroviruses (non-polio, non-Coxsackievirus and non-Echovirus) 4 or more serotypes

Conjunctivitis,

Summer grippe occurs in summer early fall

Adenoviruses

34 (types 1, 2, 3, 5, 7, 14, and 21 are responsible for respiratory illnesses)

Conjunctivitis

Mycoplasma pneumoniae

1

 

*Nonbacterial agents are responsible for > 90% of upper respiratory infections in humans.

Summer Grippe- is caused by various enteroviruses (Enterovirus, Coxsackievirus, Echovirus).

 Manifestations

Common Cold

Initially, the common cold begins with nasal stuffiness, sneezing, and headache. Rhinorrhea then occurs with increasing severity. General malaise, lacrimation, sore throat, slight fever, and anorexia are common in moderate to severe cases. If organisms enter the trachea and bronchi, a tracheobronchitis develops and there may be a cough and a feeling of substernal discomfort. Usually the common cold occurs in the winter months.

 

Summer Grippe

Summer grippe is a nonspecific febrile illness. Manifestations include fever, malaise, and headache. Patients’ symptoms usually last 3-4 days. Most patients feel well again within a week’s time. Occasionally they may also have upper respiratory symptoms (e.g., coryza, sneezing), and some cases may include nausea and vomiting.

Epidemiology

Pathogenesis

Common Cold

The rhinovirus infects the nasal passages following direct contact of contaminated surfaces or via inhalation of infectious droplets. It then infects the cells lining the nasal passages and the pharynx following attachment to intercellular adhesion molecule-1 (i.e., ICAM-1) on the host cells. Inflammatory changes occur with hyperemia, edema, and leukocyte inflammation. The ciliated columnar epithelial cells are destroyed and slough off.

 

The pathology reaches its peak by days 2 to 5. Regeneration of the cells begins rapidly, with new cells formed by about the day 14. The acute phase of the illness begins with a runny nose, when copious amounts of clear mucoid nasal secretions are produced. After 1 to 2 days, a secondary bacterial infection by the normal flora causes the secretions to become mucopurulent. If severe, blockage of the sinus ostia or the eustachian tubes can occur, resulting in paranasal sinusitis (acute rhinosinusitis) or otitis media. Complications are usually related to the infection extending to the lower respiratory tract and resulting in bronchitis.

 

Summer Grippe

Enteroviruses- The virus is ingested and then infects the epithelial cells lining the gastrointestinal tract. They then infect the gut associated lymphoid tissue. The viruses then enter the bloodstream causing a viremia. Fever, malaise, and headache usually follow the viremia.

 

Diagnosis

Diagnosis of the common cold and summer grippe is dependent on the patient’s symptoms, localization of the disease process, time of year, and afebrile or febrile course. Laboratory culture of the viruses and serologic testing is rarely performed.

 

Therapy and Prevention

Treatment of the common cold and summer grippe involves supportive therapy to ease the patient’s discomfort.

 

The following was obtained from a review article by J. Fashner, K. Ericson and S. Werner. Treatment of the Common Cold in Children and Adults. 2012. American Family Physician. 86:153-160.

 

In children with the common cold the following have been shown to have some benefit; Vapor rub (relief of symptoms), zinc sulfate syrup or tablets (taken within first 24 hr of symptoms decreased duration of symptoms), Pelargonium sidoides extract (resolution of cough and sputum production; geranium extract; Umcka Coldcare), buckwheat honey (cough relief; don’t use in children less than 1 year of age), and nasal irrigation with saline (improve nasal breathing).

 

In children the following have a potential for harm and do NOT benefit the child with the common cold: antibiotics, OTC antihistamines, antihistamines with decongestant, antitussives, antitussives with bronchodilators, low dose inhaled corticosteroids/oral prednisone (in children without asthma), and Echinacea products. Increasing fluid intake in children with no signs of dehydration can result in hyponatremia, therefore increasing fluid intake in these children is NOT advised.

 

In adults with the common cold the following have been shown to have some benefit; oral/topical decongestants (short-term relief of symptoms), pseudoephedrine/phenylephrine (improve air intake), antihistamines with decongestant (nasal symptoms), anticholinergics (ipratropium; for rhinorrhea and sneezing), dextromethorphan/guaifenesin (for cough), nonsteroidal anti-inflammatory drugs (headache, myalgia, and arthralgia), Pelargonium sidoides extract (resolution of cough and sputum production; geranium extract; (Umcka Coldcare), Andrographis paniculata (Kalmcold), early use of Echinacea purpurea (shortens duration), and early use of zinc lozenges (acetate or gluconate; shortens duration).

 

In adults the following do NOT benefit an adult with the common cold: antibiotics, antihistamine monotherapy, codeine, Echinacea angustifolia, intranasal corticosteroids, nasal irrigation with hypertonic or normal saline, and vitamin C.

 

Prophylaxis to prevent the common cold

 

In children the following maybe helpful if taken regularly to prevent the common cold; probiotics (Lactobacillus acidophilus NCFM alone or with Bifidobacterium animalis), vitamin C (1 g daily), zinc sulfate, Chizukit (contains Echinacea 50 mg, propolis 50 mg, and vitamin C 10 mg), nasal saline irrigation.

 

In adults the following maybe helpful if taken regularly to prevent the common cold; garlic and vitamin C (2 g daily).

 

Handwashing and disinfecting contaminated objects can help to prevent acquisition of the common cold and the summer grippe. Benzalkonium chloride-based hand sanitizers that foam and leave a residue are effective in preventing the spread of the common cold. Antibacterial soaps compared to nonantibacterial soaps do NOT give better protection from spread of the common cold. Alcohol hand sanitizers are less effective than soap in preventing spread of the common cold. Avoiding contact with others during the common cold season can also be helpful.


Send comments and mail to Dr. Neal R. Chamberlain, nchamberlain@atsu.edu
Revised 8/21/14
©2010-2014 Neal R. Chamberlain, Ph.D., All rights reserved.