UPPER

RESPIRATORY
TRACT INFECTION
Presented by; Gift Ugochi Emmanuel
 Case report
• Name: John Doe
• Age: 32 years
• Gender: Male
• Occupation: Office worker
• Medical History: No significant past medical history. Non-smoker, no known drug allergies. Vaccinated against COVID-
19 and influenza.
• Chief Complaint: Patient presents to the clinic with a sore throat, runny nose, and mild cough for the past three days.
• History of Presenting Illness
• Onset: Symptoms started 3 days ago, with mild throat discomfort, which later progressed to nasal congestion and a cough.
There was no sudden onset.
• Course: The sore throat has persisted, accompanied by clear nasal discharge and mild fatigue. His symptoms seem to
worsen in the morning and late evening. He also has a low-grade fever (around 100°F) and occasional headaches.
• Associated symptoms: Slight ear discomfort, but no ear discharge.
• No difficulty breathing, chest pain, or wheezing.
• No gastrointestinal symptoms (nausea, vomiting, diarrhea).
• Medications: Patient admits taking over-the-counter acetaminophen for fever and sore throat, which provided temporary relief.
• Social Hx: Occasionally drinks. Moderate physical activity and a healthy diet.
• Physical Examination
• General appearance: Mild discomfort, no acute distress, afebrile (current temperature 98.8°F).
• Vital signs:
• BP: 120/80 mmHg
• HR: 84bpm
• RR: 18 bpm
• Temp: 98.8°F
• HEENT: Mild erythema of the pharynx, no tonsillar exudates or swelling.
• Congested nasal mucosa, no sinus tenderness. Mildly tender, palpable
anterior cervical lymph nodes.
• Chest: Clear lung fields, no crackles or wheezing.
• Cardiovascular: Normal heart sounds, no murmurs.
• Abdomen: Soft, non-tender, no abnormalities.
• Extremities: NROM × 4
 Introduction
• The upper respiratory tract refers to the portion of the respiratory system that includes the
nose, nasal cavity, sinuses, pharynx (throat), and larynx (voice box). It is responsible for
filtering, warming, and humidifying the air we breathe before it reaches the lower respiratory
tract, which includes the trachea, bronchi, and lungs.
• Roles of the Upper Respiratory Tract:
• Protection: trapping dust, pathogens, and other particles in mucus and cilia to prevent them
from reaching the lungs.
• Humidification: moistening the air before it moves deeper into the respiratory system.
• Warming: adjusting the temperature of inhaled air to body temperature.
• Speech: the larynx (voice box) houses the vocal cords, which allow for sound production.
 Epidemiology
• Upper Respiratory Tract Infection (URTI) refers to infections that affect the
nose, throat, and airways above the lungs. These are usually caused by viruses,
though bacteria can also be responsible.
• Common examples of URTIs include:
• Common Cold: Characterized by sneezing, sore throat, nasal congestion, runny
nose, and cough. Adults typically have 2-4 colds per year, while children, especially
under the age of 5, can have up to 6-10 per year.
• Sinusitis: Inflammation of the sinuses, leading to headaches, facial pain, and nasal
congestion. Acute viral sinusitis is far more common than bacterial sinusitis.
• Pharyngitis: Inflammation of the throat (pharynx), often causing a sore
throat. Around 30-40% of sore throat cases are caused by viruses, with
group A Streptococcus responsible for a smaller percentage (bacterial
pharyngitis).
• Laryngitis: Inflammation of the larynx, resulting in a hoarse voice or loss
of voice.
• Tonsillitis: Inflammation of the tonsils, causing a sore throat and difficulty
swallowing.
• Causative Agents:
• Viruses: Most URTIs are viral, with the most common being rhinoviruses, coronaviruses, adenoviruses, influenza, and parainfluenza
viruses.
• Bacteria: Although less common, bacterial pathogens such as Streptococcus pyogenes (group A strep) and Haemophilus influenzae can
cause bacterial URTIs.

• Age Distribution:
• Children: Have higher incidence rates due to less developed immune systems and more frequent exposure in settings like daycares and
schools.
• Adults: While adults experience fewer URTIs, they still encounter episodes, especially if they have exposure to young children or
immunocompromised individuals.
• Elderly: Older adults, particularly those with underlying chronic conditions, are at risk for complications from URTIs, such as pneumonia.
• Seasonal Patterns:
• Winter and early spring: URTIs peak during these seasons in temperate climates due to increased indoor
crowding and drier air, which may facilitate virus transmission.
• Year-round: In tropical climates, URTIs can occur year-round but may increase during the rainy season.

• Transmission:
• Direct contact: URTIs spread via contact with respiratory secretions from infected individuals, such as
through handshakes or touching contaminated surfaces.
• Airborne: They can also be spread through aerosols and droplets expelled during coughing, sneezing, or
talking.
 Etiology
• Causative Agents:
• Viruses: Most URTIs are viral, with the most common being rhinoviruses, coronaviruses,
adenoviruses, influenza, and parainfluenza viruses.
• Bacteria: Although less common, bacterial pathogens such as Streptococcus pyogenes
(group A strep) and Haemophilus influenzae can cause bacterial URTIs.
• Fungi (Rare in URTIs, usually in immunocompromised individuals).
• Other factors: Allergens, environmental factors (Tobacco smoke, pollution, and chemical
fumes).
• Mixed Infections: In some cases, URTIs can be polymicrobial, meaning they are caused by
more than one pathogen.
 Risk factors
• Age
• Exposure to infected individuals
• Compromised immunity
• Chronic conditions: Asthma, chronic obstructive pulmonary disease
(COPD), and allergies can increase susceptibility to URTIs.
• Crowded environments
 Pathophysiology
• The pathophysiology of the upper respiratory tract involves the mechanisms by which
diseases or dysfunctions occur in these areas.
• Infectious Pathophysiology:
• a. Viral infections (e.g., common cold, influenza): Viruses can enter the nasal mucosa and
replicate in epithelial cells. This leads to inflammation and an immune response, causing
symptoms like nasal congestion, rhinorrhea (runny nose), sneezing, and sore throat. The
inflammation may also cause vasodilation and increased mucus production.
• Bacterial infections (e.g., sinusitis, pharyngitis): Bacterial pathogens can colonize after a
viral infection or due to exposure. They trigger a strong immune response, with
inflammation that results in swelling, pus production, and pain.
• Allergic Rhinitis: Allergens (e.g., pollen, dust mites) trigger an immune-
mediated hypersensitivity reaction. In susceptible individuals, this leads to the
release of histamine and other inflammatory mediators from mast cells.
• Inflammatory Conditions:
• a. Pharyngitis: caused by viruses, bacteria, or irritants (like smoke). It leads
to a sore throat, difficulty swallowing, and possibly fever.
• b. Laryngitis: Often results from overuse or infection. It leads to hoarseness
or loss of voice, and in severe cases, can obstruct the airway.
• Immune Responses: Infections or irritants in the upper respiratory tract activate innate immune responses.
This involves activation of neutrophils, macrophages, and dendritic cells, which attempt to clear the
pathogen.
• Mucociliary Dysfunction: The mucociliary clearance system is a defense mechanism that traps and moves
pathogens out of the respiratory tract. In diseases like chronic sinusitis or exposure to irritants (e.g.,
smoking), this clearance is impaired, leading to mucus buildup, infection, and inflammation.
• Chronic Conditions:
• a. Chronic rhinosinusitis: Prolonged inflammation of the nasal passages and sinuses leads to persistent
symptoms like nasal congestion, facial pain, and reduced sense of smell. In some cases, bacterial
superinfection can occur, further worsening the condition.
• B. Asthma: (with upper respiratory involvement): In some individuals, asthma can be triggered by upper
respiratory tract inflammation, especially in cases of allergic rhinitis. This creates a connection between
upper airway inflammation and lower airway bronchospasm.
 Clinical features
• Nasal symptoms: nasal congestion, rhinorrhea (runny nose), sneezing,
• Postnasal drip: Sensation of mucus draining down the back of the throat, which can lead to throat irritation or cough.
• Throat symptoms: Sore throat (pharyngitis), Hoarseness ( laryngitis), Dry or scratchy throat: Irritation from postnasal drip or viral infectio n.
• Cough: Often dry and non-productive initially, but may become productive (with mucus) as the infection progresses.
• Fever (usually low-grade though high fever is more likely with bacterial infections or influenza).
• Malaise
• Headache
• Fatigue
• Myalgia
• Chills and sweating
• Facial Pressure or Pain (Sinusitis)
• Reduced loss or sense of smelling
• Ear problems: ear ache or pressure
• Lymphadenopathy (Especially at the neck region)
 Diagnosis
• Diagnosis of an Upper Respiratory Tract Infection (URTI) is primarily clinical, based on history, symptoms, and physical examination findings.
• A.) Clinical Evaluation:
• History: The healthcare provider will assess the patient’s symptoms, including onset, duration, and severity.
• - nasal congestion, rhinorrhea, sore throat, cough, fever, fatigue,

• Physical Examination:
• Inspection of the throat:
• Nasal inspection
• Lymph node inspection
• Chest auscultation
• Sinus tenderness

• C.) Common Tests (if necessary)

• Rapid Antigen Detection Test (RADT) for Streptococcus: Used in cases of suspected bacterial pharyngitis (particularly group A streptococcus). A throat swab is taken, and results are available within minutes.
• Throat Culture: For more definitive diagnosis of streptococcal pharyngitis if the RADT is negative but suspicion remains high..
• Nasopharyngeal Swab (PCR or Rapid Viral Testing): In cases of influenza or
COVID-19, nasopharyngeal swabs can detect specific viral infections using
polymerase chain reaction (PCR) or rapid antigen tests.
• Complete Blood Count (CBC): Not routinely done, but may be ordered if there
is suspicion of a bacterial infection or systemic involvement.
• Imaging Studies:
• a. Sinus X-ray or CT scan: A CT scan of the sinuses can provide detailed images
of the sinus cavities to check for fluid buildup or structural abnormalities.
 Differential Diagnosis
• Allergic rhinitis: Often presents with sneezing, nasal congestion, and clear
rhinorrhea, but typically lacks fever and systemic symptoms.
Bacterial sinusitis: include severe facial pain and purulent nasal discharge. Symptoms
last for more than 10 days.
Tonsillitis: severe throat pain, difficulty swallowing, and visible tonsillar exudate or
swelling.
Influenza: Sudden onset of high fever, body aches, and fatigue.
Covid-19: Symptoms may overlap with URTIs, but loss of taste or smell, along with
more severe systemic symptoms.
 Treatment
Treatment typically focuses on symptom relief and supportive care, as most URTIs are self-limiting
and do not require antibiotics.
. Symptomatic Treatment
Fever and pain relief: Acetaminophen (paracetamol) or ibuprofen can help reduce fever, headache, and muscle
aches.
Nasal congestion: Saline nasal sprays or rinses can help clear nasal passages.
Decongestants like phenylephrine can reduce nasal congestion but should be used short-term (not more than a
few days) to avoid rebound congestion.
Cough: Cough suppressants like dextromethorphan may help with a dry cough.
Sore throat: Gargling with warm salt water, throat lozenges, or sprays (containing local anesthetics like
benzocaine) can ease throat pain.
Rest and hydration: Drink plenty of fluids (water, herbal teas, broths) to stay hydrated and help loosen mucus.
Adequate rest is essential to support the body’s immune response.
Antiviral Medications
In cases of viral infections like influenza, antivirals (e.g., oseltamivir) may be prescribed if started within the first
48 hours of symptoms.
Antibiotics
Antibiotics are not effective for viral URTIs and should only be used if there is a confirmed bacterial infection
(e.g., bacterial sinusitis, strep throat).
 Management and Prevention
• Sinusitis: If symptoms persist or worsen after 10 days, or are severe (e.g., high fever, facial
pain), a bacterial cause may be suspected, and antibiotics may be considered.
• Pharyngitis: Streptococcal pharyngitis (strep throat) is a bacterial cause and may require
antibiotics like penicillin or amoxicillin after confirmation with a throat culture or rapid strep
test.
• Prevention
• Practice good hygiene (e.g., frequent handwashing) to prevent the spread of infections.
• Avoid close contact with sick individuals and use tissues or elbows when coughing/sneezing.
• Stay up to date with vaccines (influenza, COVID-19) to reduce the risk of viral infections.
 References
• https://my.clevelandclinic.org/health/articles/4022-upper-respiratory-
infection
• https://emedicine.medscape.com/article/302460-overview
• https://en.m.wikipedia.org/wiki/Upper_respiratory_tract_infection
• https://uhs.princeton.edu/health-resources/upper-respiratory-tract-
infections
• THANK YOU