Upper Respiratory Tract Infection (URTI)
Overview
Clinical Features
Management
Problem Representation
- A 30-year-old adult presents with a 4-day history of nasal congestion, runny nose, sore throat, and mild cough. The patient also reports low-grade fever, headache, and generalised malaise. Physical examination reveals nasal mucosal swelling and erythema in the pharynx.
Epidemiology
- Age: Affects individuals of all ages, but more common in children and adults under 50.
- Seasonality: More frequent in autumn and winter months.
- Prevalence: One of the most common reasons for primary care visits, highly prevalent.
Temporal Pattern
- Onset: Gradual onset over 1-2 days.
- Duration: Symptoms typically last 7-14 days.
- Course: Self-limiting, with gradual resolution of symptoms; complications are rare but can include secondary bacterial infections.
Mechanism
- Pathophysiology: Inflammation of the upper respiratory tract mucosa, most commonly due to viral infection (e.g., rhinovirus, coronavirus, adenovirus).
- Transmission: Respiratory droplets or contact with contaminated surfaces.
Predisposing Conditions
- Environmental: Close contact with infected individuals (e.g., in households, schools, or workplaces).
- Personal: Smoking, allergic rhinitis, and exposure to air pollution or dry air.
Key Features (Clinical Presentation)
- Major Symptoms:
- Nasal congestion
- Runny nose (rhinorrhoea)
- Sore throat
- Cough (usually dry)
- Low-grade fever (if present, typically <38°C)
- Physical Examination:
- Nasal Mucosa: Swollen, erythematous, and possibly with clear to purulent discharge.
- Pharynx: Mild erythema, no significant exudate.
- Sinuses: May be tender to palpation if sinusitis is suspected.
- Associated Symptoms:
- Headache
- Malaise and fatigue
- Ear discomfort or fullness
- Post-nasal drip leading to throat clearing
Differential Diagnosis
- Allergic Rhinitis: Clear nasal discharge, sneezing, itchy eyes, typically seasonal or related to allergen exposure.
- Sinusitis: Persistent nasal congestion, facial pain/pressure, purulent nasal discharge.
- Influenza: Sudden onset of high fever, myalgia, and severe fatigue.
- Streptococcal Pharyngitis: Severe sore throat, absence of cough, higher fever.
Investigations
- Usually Clinical Diagnosis: Based on history and physical examination.
- Viral Testing: Rarely indicated unless specific viral identification is necessary (e.g., during outbreaks).
- Sinus Imaging: Consider if sinusitis is suspected and symptoms persist or worsen after initial treatment.
Management
- Supportive Care:
- Analgesics and antipyretics (e.g., paracetamol, ibuprofen)
- Decongestants (e.g., pseudoephedrine, oxymetazoline)
- Hydration and rest
- Saline nasal sprays or steam inhalation for nasal congestion
- Antibiotics:
- Not routinely indicated: As URTIs are primarily viral. Consider only if secondary bacterial infection is strongly suspected.
- Consider Referral:
- If symptoms persist beyond 10-14 days or if complications such as sinusitis or otitis media develop.
- Recurrent or severe URTIs requiring further investigation.
Complications
- Acute: Sinusitis, otitis media, secondary bacterial infections.
- Chronic: Recurrent URTIs, chronic rhinosinusitis.
Prognosis
- Typical URTI: Self-limiting, with full recovery in 1-2 weeks.
Prevention
- Good hand hygiene and respiratory etiquette.
- Avoid close contact with infected individuals.
- Annual influenza vaccination may reduce the risk of some viral URTIs.