Upper Respiratory Tract Infections (URTIs)

URTIs are infections involving the upper respiratory tract. It is one of the most frequent illnesses that affects people of all ages. This is one of the common causes to visit primary care physicians.

UPPER RESPIRATORY TRACT ORGANS
·    Nose
·    Throat (including larynx and pharynx)
·    Tonsils
·    Trachea
·    Sinuses

3 KNOWN ORGANISMS NOTED
·    Viruses – most common
·    Bacteria
·    Fungi - rare

TYPES OF URTI
1.   Common cold (acute coryza) – the highly infectious illness comprises a mild systemic upset and prominent nasal symptoms.
2.   Influenza
3.   Rhinitis – inflammation of the nasal lining. It can be further divided into seasonal and perennial rhinitis
4.   Pharyngitis – inflammation of the pharynx
5.   Tonsillitis – inflammation of the tonsils
6.   Laryngitis/pharyngitis – inflammation of the larynx (voice box)
7.   Sinusitis – inflammation of the paranasal sinuses
8.   Epiglottitis – inflammation of the cartilage that covers the trachea
9.   Tracheitis – inflammation of the trachea

SYMPTOMS
·    Fever
·    Cough
·    Sneezing
·    Nasal discharge or watery rhinorrhoea
·    Blocked nose
·    Sore throat
·    Watery eyes
·    Headache
·    Weakness and lethargy
·    Body ache

ACUTE SIGNS
Should any of these signs present, you should seek medical attention immediately.
·    High grade fever
·    Wheezing
·    Noisy breathing (stridor)
·    Severe headache
·    Fast breathing (abnormal movement of the chest wall might present)
·    Shortness and difficulty of breathing
·    Chest pain – usually followed by frequent and severe cough
·    Haemoptysis – coughing up blood
·    Drowsiness or confusion
·    Persistent cough more than 3 weeks – more severe lung infections like pulmonary tuberculosis and pneumonia need to be ruled out
·    Recurrence of URTI

COMPLICATIONS
·    Otitis media (ear infection)
·    Dehydration – this usually occur due to low fluid intake
·    Bronchitis/bronchiolitis (lower respiratory tract infection)
·    Febrile convulsion
·    Pneumonia – inflammation of the substance of the lungs.
·    Sepsis – Occur when bacteria and fungi multiplying in the blood
·    Meningitis – inflammation of the meninges ( the lining of the brain)
·    Acute rheumatic fever- this is a systemic febrile illness caused by Group A ?-haemolytic streptococcus that may result in permanent damage of the heart valves.
·    Exacerbation of asthma or chronic obstructive pulmonary disease
·    Sudden airway obstruction that might lead to death

TREATMENT
·    Most are self limiting and improve with time
·    Your doctor will prescribe some medications for symptomatic relief to reduce temperature. Paracetomol usually will be the drug of choice. Oral or topical decongestants will be a great help.
·    Get enough rest and fluid to prevent exhaustion and dehydration.
·    Antibiotic therapy will be prescribed to patients with bacterial infections. Seek your doctor advice before taking any antibiotic to prevent antibiotic resistant.

References:
1.   Clinical medicine by kumar and Clark. 4^th edition. 1998.
2.   Oxford handbook of clinical specialties. 5^th edition. 2001.
3.   http://www.emedicine.com (Meneghetti A.2006)
4.   Teng CL. Asia Pac Fam Med. 2004;3:38-45
5.   http://www.patient.co.uk (upper respiratory tract infection)
6.   Pfizer health fact sheet.