This document discusses upper respiratory tract infections (URTI). URTIs are commonly caused by viruses like rhinovirus, coronavirus, and influenza. They often involve the nose, sinuses, throat, and larynx, causing symptoms like nasal congestion, sore throat, cough. While most cases are viral, some bacterial infections like Streptococcus and Mycoplasma pneumoniae can also cause URTIs. Treatment involves rest, hydration, analgesics, and sometimes antibiotics for bacterial infections. Vaccines are recommended for influenza prevention.

1. PRESENTED BY:
Dr PRATYUSH KUMAR

2. INTRODUCTION
 URTI is a non specific term
used to describe acute
infections involving the
nose, paranasal sinuses,
pharynx or larynx.
 This commonly includes
tonsillitis, pharyngitis,
laryngitis, sinusitis, otitis
media and the common
cold.
 Influenza is a systemic
illness that involves the
upper respiratory tract and
should be differentiated from

4. ORGANISMS
 VIRUSES:
Rhinovirus (30-50%)
Coronavirus
Enterovirus
Adenovirus
Orthomyxovirus (including influenza A & B)
Paramyxovirus
Varicella, Rubella and rubeola infections may
manifest as nasopharyngitis before other classic
signs and symptoms develop.

5.  BACTERIAS:
Group A beta hemolytic streptococci (15% of all
cases of pharyngitis)
Group C beta hemolytic streptococcus
Corynebacterium diptheriae
Neisseria gonorrhoea
Mycoplasma pneumoniae
Arcanobacterium hemolyticum

6. TRANSMISSION
 It occurs by aerosol droplet or direct hand-to-
hand contact with infected secretions with
subsequent passage to the nares or eyes.

7. RISK FACTORS
 Physical or close contact with someone with a
upper respiratory infection
 Poor hand washing after contact with an
individual with upper respiratory infection
 Close contact with children in a group setting,
schools or daycare centers
 Contact with groups of individuals in a closed
setting such as travelling, health care facilities,
hospitals
 Smoking or second-hand smoke
 Immunocompromised state such as HIV, organ
transplant, congenital immune defects, long term
steroid use.

8. PATHOPHYSIOLOGY
Bacteria & viruses
Enters to the nose
Immune defenses
Hair lining filters and trap some pathogens
Trapped pathogens are coated by mucus
Cilliary action transport pathogens upto pharynx
Inflammatory response by the immune system
Swelling Erythema Increased mucus secretion

9. CLINICAL FEATURES

10. The Nasal cavity
 Pain and tenderness over sinuses
 Headache
 Mucopurulent nasal discharge
 Stuffy nose
 Facial pressure
 Fever

11. Sinusitis
 Specific for frontal sinus:
 Tender forehead
 Specific for maxillary
sinus:
 Aching upper jaw
 Aching teeth
 Tender cheeks
 Specific for ethmoid sinus:
 Swollen eyelids
 Pain between eyes
 Tenderness of sides of
nose
 Stuffy nose
 Specific for sphenoid
sinus:
 Earaches

12. Tonsillitis
 Pain in throat that may last
more than 48hrs and be
associated with difficulty in
swallowing.
 Tonsils are swollen and may
be coated or have white
spots on them.
 Fever
 Swollen lymphnodes under
the jaw and in neck.
 Headache
 Hoarseness of voice

13. Epiglottitis
 Sore throat
 Odynophagia or dysphagia
 Globus sensation of a lump in the
throat
 Muffled dysphonia or loss of voice
 Dry cough
 Dyspnoea
 Severe respiratory distress with
sternal and intercostal retractions,
nasal flaring, cyanosis and
tachycardia

14. INVESTIGATIONS
 CBC, ESR, ASO
 Sputum test(AFB, Culture and sensitivity)
 X-Ray of neck and paranasal sinuses
 CT Scan
 Nasal and throat swab for bacterial culture

15. Symptoms Allergy URI Influenza
Itchy, watery eyes Common Rare Soreness behind
eyes
Nasal discharge Common Common Common
Nasal congestion Common Common Sometimes
Sneezing Very common Very common Sometimes
Sore throat Sometimes(post-
nasal drip)
Very common Sometimes
Cough Sometimes Mild to moderate Dry cough, can be
severe
Headache Uncommon Rare Common
Fever Never Rare in adults,
possible in children
Very common,
lasting 3-4 days;
may have chills
Malaise Sometimes Sometimes Very common
Fatigue,
Weakness
Sometimes Sometimes Can last for weeks,
extreme exhaustion
early in course
DIFFERENTIAL DIAGNOSIS

16. INDICATIONS FOR
HOSPITALISATION
 Respiratory distress, PR >110, SaO2 <95%
 Toxic clinical picture
 History of rheumatic heart disease
 Peri-tonsillar abscess
 Epiglotitis
 Signs of meningitis
 Inability to swallow
 Peri-orbital involvement
 Visual or neurological disturbance
 Pneumonia
 Immunocompromised patients

17. MANAGEMENT
 Patients should be encouraged to drink fluids to
prevent dehydration and to thin the respiratory
secretions.
 Use of vaporization may promote further thinning
and loosening of respiratory secretions.
 Rest is generally recommended to allow patients
to cope with their illness. Voice rest is important
for patients with hoarseness.
 Analgesics: Paracetamol 500mg QID for
 NSAID: Ibuprofen 400mg oral QID

18.  Nasal decongestant: Oxymetazoline
hydrochloride 2-3 drops each nostril TID for 3
days
 Antibiotics:
 Amoxicillin/Clavulanate 625mg TID for adults,
325mg TID for children
 Ciprofloxacin 500mg BD for adults, 150mg BD for
children

19. ACUTE SINUSITIS
 Initial therapy:
 Amoxicillin 500mg TID or
Amoxicillin/Clavulanate 500/125mg TID or
875/125mg BD
 Penicillin allergy:
 Doxycycline 100mg BD or
Clindamycin 300mg TID
 Penicillin resistant Pneumococcus:
 Moxifloxacin 400mg BD

20. ACUTE PHARYNGITIS
 Initial therapy:
 Penicillin G 1.2 million units IM or
Penicillin VK 250mg orally QID or 500mg orally BD
or
Amoxicillin 500mg orally BD for 10days.
 Penicillin resistant:
 Azithromycin 500mg orally QID for 5 days or
Clindamycin 300mg orally TID for 10days or
Cephalexin 500mg orally BD for 10days

21. LARYNGITIS
 Usually treated with humidification and voice rest
alone.
 Antibiotics are not recommended except when
group A Streptococcus is cultured, in which case
Penicillin G 1.2 million units IM is the drug
of choice.
 The choice of therapy depends on the pathogen,
whose identification usually requires biopsy with
culture.

22. SURGICAL MANAGEMENT
 Rarely surgical procedures may be necessary in
cases of
 Complicated sinus infections
 Compressed airway with difficulty in breathing
 Peritonsillar abscess
 Mastoiditis etc

23. PREVENTION
 Frequent hand washing
 Covering the mouth and nose while sneezing or
coughiung with tissue napkin
 Aqueous iodine can prevent viral transmission
when applied to the hands of patients with viral
URIs.
 Antimicrobial treatment of sexual partner can
prevent reinfection in cases of gonococcal or
herpetic pharyngitis.
 Vitamin D plays a important role in maintaining
innate immunity. A recent study showed that lower
vitamin D levels correlated with higher risk of
URIs; particularly in patients with asthma and
chronic obstructive lung disease.

24. VACCINATION
 Center of Disease Control and Prevention(CDC)
recommends use of injectable influenza vaccines.
 Both Trivalent and Quadrivalent flu vaccines are
available.
 Vaccines available:
 Vaxigrib vaccine
 Fluzone vaccine
 Fluarix vaccine

25. SUMMARY
 Most URTIs are viral in origin.
 Diagnosis is mainly based on clinical manifestations.
 Adults with clinical findings suggestive of GABHS
pharyngitis should have a pharyngeal rapid
streptococcal antigen detection test before
considering antimicrobial therapy.
 Symptomatic treatment is the mainstay of treatment
for most URIs.
 Amoxicillin-clavulanate is the recommended first line
agent for treatment of suspected acute bacterial
rhinosinusitis.
 Antibiotics should be avoided in patients with a
common cold, mild acute rhinosinusitis but can be
given in cases of associated secondary bacterial
infection.