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upper respiratory tract infection (URI, common cold)

Etiology: 1) viral infection 1) rhinovirus 2) parainfluenza virus 3) adenovirus 4) respiratory syncytial virus (RSV) 5) coxsackie virus A21 (summer & autumn) 2) risk factors - sleep deprivation [7] Epidemiology: 1) 83% of all infections 2) 50% of individuals have a URI during December-February Genetics: - telomere length in leukocytes predicts susceptibility to upper respiratory tract infections in young adults [16] Clinical manifestations: 1) cough - resolves within 10 days in 50% of children & within 25 days in 90% [18] 2) nasal congestion, rhinorrhea 3) may have tenderness to sinus palpation 4) sore throat, laryngitis - generally resolves within 2-7 days [18] 5) may have fluid behind tympanic membrane 6) fever < 38.3 C (102 F) lasting < 72 hours 7) symptoms (excepting perhaps cough) generally resolve within 10 days in 50% of children & within 15 days in 90% [18] Complications: - temporary interference with mucociliary clearance may increase risk of other infections - lower respiratory tract infection - treat as complication of influenza Differential diagnosis: 1) Streptococcal pharyngitis a) fever b) tonsillar exudates c) tender anterior cervical lymphadenopathy d) absence of cough 2) peritonsillar abscess a) trimus b) unilateral tonsillar swelling c) deviation of uvula 3) sinusitis a) purulent nasal discharge for >= 7 days b) unilateral sinus pain or tenderness c) maxillary toothache 4) epiglottitis a) severe sore throat b) dyspnea, drooling, stridor b) lateral neck X-ray: enlarged epiglottis 'thumb sign' 5) infectious mononucleosis (Epstein-Barr virus) a) posterior cervical lymphadenopathy b) sore throat & fever of weeks duration c) splenomegaly, hepatomegaly, atypical lymphocytosis 6) influenza a) symptoms may be severe b) high fever c) myalgias Management: 1) supportive therapy a) cold & flu self-care kit b) decongestant: 1] nasal decongestant 2] vapor rub at night of benefit for children [13] 3] systemic decongestant for sinus & inner ear symptoms - pseudoephedrine, phenylepinephrine c) antihistamine: chlorpheniramine, climastine, brompheniramine d) inhaled beta-adrenergic agonist (albuterol) for productive cough e) intranasal ipratropium for rhinorrhea & sneezing f) saline nasal spray may reduce illness duration & antibiotic use [25] g) ibuprofen or naproxen for sore throat, fever h) acetaminophen as effective as ibuprofen & safer [17] i) steam of no benefit [17] 2) intranasal siRNA show promise [2] 3) avoid unsafe medications in pregnancy [4] 4) avoid unneccessary medications, especially in children [6] a) routine antibiotics not indicated [10,22] b) antitussives (cough suppressants) not effective [10] c) avoid prescribing antibiotics since most URIs are due to viral infection [20] 5) adequate sleep, > 7 hours [7] 6) honey outperforms diphenhydramine, similar to dextromethorphan.[24] 7) other herbal medications or vitamins with marginal benefit a) vitamin D b) vitamin C c) American ginseng d) Echinacea [14] e) Lactobacillus probiotics f) zinc [15,21], especially zinc acetate & zinc gluconate (Zicam) may be of benefit; NNT = 5 for lesser symptoms at 7 days 8) placebo before bedtime of benefit in treatment of cough, congestion, & rhinorrhea due to common cold in children [19]

Related

cold & flu self-care kit coxsackievirus parainfluenza virus respiratory syncytial virus (RSV) Rhinovirus

Specific

acute upper respiratory tract infection chronic upper respiratory tract infection common cold; acute nasopharyngitis; viral rhinosinusitis laryngotracheitis peritonsillar abscess throat infection; pharyngeal infection; laryngeal infection tracheitis

General

respiratory tract infection upper respiratory tract disease

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 794
  2. Journal Watch 25(4):29, 2005 Bitko V, Musiyenko A, Shulyayeva O, Barik S. Inhibition of respiratory viruses by nasally administered siRNA. Nat Med. 2005 Jan;11(1):50-5. Epub 2004 Dec 26. PMID: 15619632 Zhang W, Yang H, Kong X, Mohapatra S, Juan-Vergara HS, Hellermann G, Behera S, Singam R, Lockey RF, Mohapatra SS. Inhibition of respiratory syncytial virus infection with intranasal siRNA nanoparticles targeting the viral NS1 gene. Nat Med. 2005 Jan;11(1):56-62. Epub 2004 Dec 26. PMID: 15619625
  3. Prescriber's Letter 13(11): 2006 Delaying Antibiotics in Uncomplicated Upper Respiratory Tract Infection Detail-Document#: 221107 (subscription needed) http://www.prescribersletter.com
  4. Prescriber's Letter 13(11): 2006 Cough and Cold Medication use In Pregnancy Detail-Document#: 221112 (subscription needed) http://www.prescribersletter.com
  5. Prescriber's Letter 13(12): 2006 Changes to OTC cough and Cold products Detail-Document#: 221207 (subscription needed) http://www.prescribersletter.com
  6. Prescriber's Letter 14(11): 2007 Detail-Document#: 231106 Concerns about OTC Cough and Cold Products in Children (subscription needed) http://www.prescribersletter.com
  7. Cohen S et al. Sleep habits and susceptibility to the common cold. Arch Intern Med 2009 Jan 12; 169:62. PMID: 19139325
  8. Prescriber's Letter 15(11): 2008 Detail-Document#: 241113 Cautions with Pediatric Cough and Cold Products (subscription needed) http://www.prescribersletter.com
  9. Prescriber's Letter 16(3): 2009 Detail-Document#: 250322 Vicks VapoRub Safety and Children (subscription needed) http://www.prescribersletter.com
  10. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 18. American College of Physicians, Philadelphia 2006, 2012, 2018
  11. National Center for Complementary & Integrative Health Flu and Colds: In Depth https://www.nccih.nih.gov/health/flu-and-colds-in-depth
  12. Prescriber's Letter 16(11): 2009 COMMENTARY: Supplements for Prevention and Treatment of Colds and Influenza CONTINUING EDUCATION: Natural Medicines in the Clinical Management of Colds and Flu Detail-Document#: 251112 (subscription needed) http://www.prescribersletter.com
  13. Paul IM et al Vapor Rub, Petrolatum, and No Treatment for Children with Nocturnal Cough and Cold Symptoms Pediatrics, published online Nov 8, 2010 PMID: 21059712 http://pediatrics.aappublications.org/cgi/reprint/peds.2010-1601v1
  14. Barrett B et al. Echinacea for treating the common cold: A randomized trial. Ann Intern Med 2010 Dec 21; 153:769. PMID: 21173411 http://www.annals.org/content/153/12/769.long
  15. Science M et al. Zinc for the treatment of the common cold: A systematic review and meta-analysis of randomized controlled trials. CMAJ 2012 May 7 PMID: 22566526 http://www.cmaj.ca/content/early/2012/05/07/cmaj.111990
  16. Cohen S et al. Association between telomere length and experimentally induced upper respiratory viral infection in healthy adults. JAMA 2013 Feb 20; 309:699. PMID: 23423415
  17. Little P et al Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ 2013;347:f6041 PMID: 24162940 http://www.bmj.com/content/347/bmj.f6041
  18. Thompson M et al Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027 PMID: 24335668 http://www.bmj.com/content/347/bmj.f7027
  19. Paul IM et al Placebo Effect in the Treatment of Acute Cough in Infants and Toddlers. A Randomized Clinical Trial. JAMA Pediatr. Published online October 27, 2014 PMID: 25347696 http://archpedi.jamanetwork.com/article.aspx?articleid=1913623 - Taylor JA, Opel DJ Using the Placebo Effect to Treat Cold Symptoms in Children. JAMA Pediatr. Published online October 27, 2014 PMID: 25347413 http://archpedi.jamanetwork.com/article.aspx?articleid=1913621
  20. Choosing Wisely. Feb 23, 2015 Infectious Diseases Society of America Five Things Physicians and Patients Should Question http://www.choosingwisely.org/doctor-patient-lists/infectious-diseases-society-of-america/
  21. The NNT: Zinc for the Common Cold http://www.thennt.com/nnt/zinc-for-common-cold/ - Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev. 2013 Jun 18;6:CD001364. PMID: 23775705
  22. Harris AM, Hicks LA, Qaseem A et al Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. Published online 19 January 2016 PMID: 26785402 http://annals.org/article.aspx?articleid=2481815
  23. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013 Jun 4;6:CD000247. Review. PMID: 23733381
  24. Abuelgasim H, Albury C, Lee J Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis BMJ Evidence-Based Medicine Published Online First: 18 August 2020. PMID: 32817011 https://ebm.bmj.com/content/early/2020/07/28/bmjebm-2020-111336
  25. Little P, Vennik J, Rumsby K et al Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: a randomised, controlled, open-label, parallel-group trial Lancet Respir Med. 2024 Jul 11:S2213-2600(24)00140-1. PMID: 39004091 Free article https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00140-1/fulltext