Upper respiratory tract infections are characterized by self-limited irritation and swelling of the upper airways together with a cough that does not indicate pneumonia, does not have a coexisting medical condition that could be the cause of the patient's symptoms, and does not have a history of chronic bronchitis, emphysema, or COPD. Presentation gives an overview on "Upper Respiratory Tract Infections", including causes, symptoms, diagnosis, and Treatment to cure. For more information, please contact us: 9779030507.

1. Upper Respiratory Tract
Infections
Surinder K. Jindal
(Emeritus Professor & Ex-Head, Pulm Med, PGIMER,
Chandigarh)
Medical Director, Jindal Clinics, Chandigarh
www.jindalchest.com

3. Defense mechanisms of respiratory tract
Anatomical site
A. Conducting zone (Nose,
Nasopharynx, Larynx,
Tracheobronchial region
excluding respir bronchioles)
B. Gas exchange region Alveolar
macrophages
(Terminal or respir bronchioles
and alveoli)
• NALT: Nasopharynx-Associated
Lymphoid Tissue; BALT: Bronchus-
Associated Lymphoid Tissue
Defense mechanism
• Mechanical barrier
• Lymphoid tissue: adenoids, tonsils,
Waldeyer’s ring
• NALT, BALT
• Mucociliary mechanism
• Secretory IgA
• Sneeze and cough reflex
• Immunoglobulins (humoral
immunity)
• Cell-mediated immunity
• Polymorphonuclear granulocytes

4. Risk factors for a URTI
• Close contact with children: both day-cares and schools increase the risk fo
URI
• Medical disorder: People with asthma and allergic rhinitis are more likely to
develop URI
• Smoking - a common risk factor for URI
• Immunocompromised individuals including those with cystic fibrosis, HIV,
use of corticosteroids, transplantation, and post-splenectomy
• Anatomical anomalies including facial dysmorphic changes or nasal polyposis
also increase the risk of URI

5. Transmission
• URIs spread from one person to another through aerosol droplets and direct
hand-to-hand contact.
• Risk is increased in these situations:
i. Sneezing or coughing without covering the nose & mouth
ii. In a closed-in area or crowded conditions
iii. Hospitals, institutions, schools, and day care
centers have increased risk -close contact.
• Touch of nose or eyes. Infection occurs when the infected secretions come in
contact with nose or eyes. Viruses can live on objects, such as doorknobs.
• Seasonal: when people are more likely to be inside.
• Indoor heating favors survival of many viruses
• Weakened immune system.

6. Clinical Symptoms
Symptoms usually begins one to three days after exposure;
lasts 7–10 days, and can persist up to 3 weeks
Respiratory
• Cough: Wet or dry
• Sore throat
• Sneezing
• Chest or nasal congestion
• Pressure in the ears and sinuses
• Runny nose
• Watery discharge from the nose
thickens and turns yellow or
green, mild
General Constitutional
• Fatigue, Malaise, Myalgias
• Body aches.
• Headache
• Low-grade fever
• Facial pressure
• Burning eyes
• Chills
• Achy muscles and bones

7. Microbial Causes of URTI
Both viruses and bacteria can cause acute URIs
Viruses
• Rhinovirus
• Adenovirus
• Corona virus
• Coxsackievirus
• Parainfluenza
• Respiratory Syncytial
Virus
• Human
metapneumovirus
Bacteria
• Group A beta-hemolytic
streptococci
• Group C beta-hemolytic
streptococci
• Corynebacterium
diphtheriae (diphtheria)
• Neisseria
gonorrhoeae (gonorrhea)
• Chlamydia
pneumoniae (chlamydia)

8. Diagnosis
• Tests of nasopharyngeal specimens for specific pathogens such as Rapid antigen detection/
cultures
i. When targeted therapy depends on the results (eg, group A streptococcal infection,
gonococcus, pertussis).
ii. When patients are immunocompromised
iii. During outbreaks
iv. To provide specific therapy to contacts.
• General hematological and biochemical tests
• Imaging: Warranted in patients with suspected mass lesions (eg, peritonsillar abscess,
intracranial suppurative lesions).
Chest X-ray; Neck X-ray (Lat. view); CT scan: (PNS)
• Blood cultures are typically appropriate only in hospitalized patients with suspected systemic
illness.

9. Common Cold
• Responsible pathogens: rhinovirus, adenovirus, parainfluenza virus, respiratory
syncytial virus, enterovirus, and coronavirus.
Rhinovirus is the most common cause in up to 80% of all respiratory infections:
Dozens of rhinovirus serotypes and frequent antigenic changes make identification,
characterization, and eradication complex.
• Symptoms: Appear as soon as 10 to 12 hours after inoculation.
The mean duration of symptoms is 7 to 10 days, but can persist
for as long as 3 weeks.
Vasodilation and increased vascular permeability
Nasal obstruction and rhinorrhea
Mucus production and sneezing due to cholinergic stimulation

10. Common Cold -Differential Diagnosis
• Common Cold
• Allergic rhinitis
• Sinusitis
• Tracheobronchitis
• Pneumonia
• Influenza
• Atypical Pneumonia
• Pertussis
• Epiglottitis
• Streptococcal
Pharyngitis/Tonsillitis
• Infectious Mononucleosis
• Common cold- a clinical diagnosis:
i. Classical features for rhinovirus
infection
ii. absence of signs of bacterial
infection or serious respiratory
illness
Diagnostic testing is not necessary.
When testing for influenza; obtain
specimens as close to symptom onset
as possible.
Nasal aspirates and swabs are the best
specimens. Rapid strep swabs can be
used to rule out bacterial pharyngitis

11. Viral Nasopharyngitis
• Usually referred as the common cold
• Paucity of clinical findings despite notable subjective discomfort.
• Findings may include the following:
Nasal mucosal erythema and edema
Nasal discharge: Profuse discharge
i. more characteristic of viral than bacterial
infections
ii. initially clear secretions typically become cloudy white,
yellow, or green over several days
• Foul breath
• Fever: Less common in adults; may be present in children

12. Influenza
• The incubation period for influenza:1 to 4 days
• Time interval between symptom onset is estimated to be 3 to 4 days. Viral shedding
can occur 1 day before the onset of symptoms.
• Influenza can be transferred among humans by direct contact, indirect contact,
droplets, or aerosolization. Short distances (<1 meter) are generally required for
contact and droplet transmission to occur between the source person and the
susceptible individual.
• Airborne transmission may occur over longer distances (>1 m). Most evidence-
based data suggest that direct contact and droplet transfer are the predominant
modes of transmission for influenza.

13. Group A streptococcal infection
Pharyngitis
• Erythema, swelling, or exudates
of the tonsils or pharynx
• Temperature of 38.3°C (100.9°F)
or higher
• Tender anterior cervical nodes (≥1
cm)
• Absence of conjunctivitis, cough
and rhinorrhea, which are
symptoms that may suggest viral
illness
Laryngotracheitis and
laryngotracheobronchitis
• Nasopharyngitis often precedes
laryngitis and tracheitis by several
days
• Swallowing may be difficult or
painful
• Patients may experience a globus
sensation of a lump in the throat
• Hoarseness or loss of voice is a
key manifestation of laryngeal
involvement

14. Acute bacterial rhinosinusitis
In children, acute bacterial sinusitis is defined as a URI with any of the following :
• Persistent nasal discharge (any type) or cough lasting 10 days or more without
improvement
• Worsening course (new or worse nasal discharge, cough, fever) after initial
improvement
• Severe onset (fever of 102° or greater with nasal discharge) for at least 3
consecutive days.
• In older children and adults, symptoms (eg, pain, pressure) tend to localize to
the affected sinus.

15. Acute Sinusitis
The most common bacterial agents:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Other organisms: Staphylococcus aureus, Streptococcus pyogenes, Gram-
negative organisms and anaerobes
Signs and symptoms:
- Nasal blockade, discharge
- Fever, other constitutional symptoms
- Facial pressure, pain
- Headache

16. Epiglottitis
• More often found in children aged 1-5 years, who present with a sudden
onset of the following symptoms:
- Sore throat
- Drooling, difficulty or pain during swallowing
- Globus sensation of a lump in the throat
- Muffled dysphonia or loss of voice
- Dry cough or no cough, dyspnea
• Fever, fatigue or malaise (may be seen with any URI)
• Tripod or sniffing posture
• May sometimes prove to be fatal – upper respiratory obstruction

17. Whooping cough (Pertussis)
• The classic whoop sound - an inspiratory gasping squeak that
rises in pitch, typically interspersed between hacking coughs
• The whoop is more common in children
• Coughing often comes in paroxysms of a dozen coughs or more
at a time and is often worst at night
• The 3 classic phases of whooping cough:
- Catarrhal (7-10 days) predominantly URI symptoms
- Paroxysmal (1-6 weeks) with episodic cough
- Convalescent (7-10 days) of gradual recovery

18. COVID-19
• Caused by novel corona virus
(SARS-CoV2), which is currently
responsible for a global pandemic.
•
• Starts with involvement of upper
respiratory tract (nose, sinuses,
pharynx and larynx).
• Most (around 80%) starts
with flu-like symptoms:
i. Fever
ii. Headache
iii. Cough, usually dry
iv. Others: myalgias
(especially back pain),
loss of smell, anorexia,
fatigue, nausea (usually
without vomiting)
v. Abdominal discomfort;
Occasionally, diarrhoea.

19. Diagnosis of specific disorders
Group A streptococcal
infection:
• Clinical findings or a history
of exposure to a case
• Results of rapid-detection
assays
• Cultures (positive rapid
antigen detection tests do
not necessitate a backup
culture)
Acute bacterial
rhinosinusitis
• Laboratory studies are
generally not indicated
• Computed tomography
scanning or other sinus
imaging-
i. if symptoms persist
despite therapy
ii. complications (eg,
extension of disease into
surrounding tissue

20. Other specific infections
• Influenza: Rapid tests have over 70% sensitivity and more than 90%
specificity
• Mononucleosis: Antibody testing (eg, Monospot)
• Herpes simplex virus infection: Cell culture or polymerase chain reaction
(PCR) assay
• Pertussis: Rapid tests; culture of a nasopharyngeal aspirate (criterion
standard)
• Epiglottitis: Direct visualization by laryngoscopy, performed by an
otorhinolaryngologist
• Gonococcal pharyngitis: Throat culture for Neisseria gonorrhoeae
• Tubercular laryngitis

21. COMPLICATIONS
Spread to Lower Respiratory Tract
• Epiglottitis: dangerous because it can
block the flow of air into the trachea.
• Laryngitis: inflammation of the
larynx or voice box.
• Tracheitis
• Bronchitis: Inflammation of the
bronchi – both central and peripheral
• Bronchiolitis
• Pneumonia: Inflammation of the
lung alveoli
• ARDS – Respiratory Failure

22. Secondary Bacterial Infection
Warning signs that cold has progressed from a viral infection to a bacterial
infection :
• Symptoms lasting longer than 10–14 days.
• A fever higher than 100.4 degrees.
• A fever that gets worse a couple of days into the illness, rather than getting
better.
• White pus-filled spots on the tonsils
Small amounts of white mucus may be coughed up if the bronchitis is viral.
If the color of the mucus changes to green or yellow, it may be a sign that a
bacterial infection has also set in. The cough is usually the last symptom to
clear up and may last for weeks.

23. Summary
1. URTI is the most common acute illness evaluated in the outpatient setting.
2. URTI commonly include: Common cold —typically a mild, self-limited,
catarrhal syndrome of the nasopharynx, mild flu, tonsillitis, laryngitis,
epiglottitis and sinusitis
3.Specific infections constitute a distinctly separate category
4. Most common causes: Viral; Bacterial
5. Progression can occur from a viral to a bacterial infection
6. Generally self-limiting; can lead to serious complications such as pneumonias
and respiratory failure
7. Diagnosis: Mostly based on clinical features

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