upper respiratory tract infection,coryza

The majority of upper respiratory tract infections are due to infection with picornaviruses of the rhinovirus group. However other viruses such as adenoviruses, coronaviruses, coxsachie viruses, echoviruses, influenza viruses, para-influenza viruses and the respiratory syncytial virus (RSV) can cause upper respiratory tract infections.

RSV, the influenza viruses, parainfluenza viruses I and II and adenoviruses can also cause acute infection of the larynx, trachea and major bronchi.

The common cold is a very common infection caused by rhinoviruses, and also by other respiratory viruses and some enteric viruses.

Influenza, Parainfluenza, picorna, respiratory syncytial viruses and adenoviruses have all been implicated.

There is usually an acute onset with sneezing, dry sore throat, rhinorrhoea and headache. The condition is generally self-limiting although complications such as otitis media, sinusitis and, very occasionally, pneumonia may occur.

coryza 

This is discharge from the mucous membrane of the nose.

Symptoms of coryza which occur frequently during the summer are generally due to allergy rather than recurrent, or persistent, viral infection.

Sneezing is the process where air is expelled forcibly and spasmodically through the nose and mouth. It is usually involuntary, sudden, violent and often audible. Sneezing is a symptom often associated with rhinitis.

Rhinitis is inflammation of the lining of the nose.

Allergy is a common cause but it is not the only one.

Symptoms vary from the itching, sneezing and watery nasal discharge classically associated with allergy to the dry, crusting, and over-patent airway seen in atrophic rhinitis.

As the lining of the nose and paranasal sinuses are continuous, it is rare for inflammation to affect one without the other. As such, the description rhinosinusitis is often more appropriate.

Allergic rhinitis is generally managed with one or more of:

• nasal decongestants
• oral antihistamines
• steroids
  • topical steroids
  • short courses of oral steroids may occasionally be used
• topical anticholinergics

Additionally, in allergic rhinitis, an additional and very important principle, is identification and avoidance of the allergen if possible.

The main distinction is between allergic and non-allergic rhinitis. The former may be seasonal or perennial; the latter, infective or non-infective.

Allergic rhinitis may be:

• seasonal (also called "hay fever")
  • caused by grass, tree pollen allergens, symptoms can seen during the same time each year
• perennial
  • caused by house dust mites, symptoms occur right throughout the year
• occupational
  • caused by allergens at workplace e.g.- flour allergy in a baker(1)

Allergic rhinitis can also be divided according to the severity and persistence of symptoms:

• mild intermittent
• moderate severe intermittent
• mild persistent
• moderate severe persistent 

It is characterized by

• rhinorrhoea
• nasal blockage
• sneezing attacks for longer than 1 hour per day lasting longer than 2 weeks
• itching - eyes, nose
• watery eyes
• fatigue
• malaise
• headache 
• wheezing
• shortness of breath

Allergic rhinitis may coexist with asthma, eczema, or chronic sinusitis. It occurs when an individual, previously exposed to an antigen, has made IgE to that antigen. The IgE is incorporated into the cell membranes of mast cells, and upon subsequent exposure to that antigen the mast cells degranulate, releasing inflammatory mediators such as histamine and slow reacting substance of anaphylaxis (SRS-A).

non-infective rhinitis. This includes:

• hyperreactive or vasomotor rhinitis
• rhinitis medicamentosa
• anatomical or mechanical rhinitis
• tumours causing rhinitis:
• benign
• malignant:
• primary
• secondary
• non-healing granulomas

NICE guidance - antibiotic prescribing for self-limiting respiratory tract infections

A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for patients with the following conditions:

• acute otitis media
• acute sore throat/acute pharyngitis/acute tonsillitis
• common cold
• acute rhinosinusitis
• acute cough/acute bronchitis

Depending on clinical assessment of severity, patients in the following subgroups can also be considered for an immediate antibiotic prescribing strategy (in addition to a no antibiotic or a delayed antibiotic prescribing strategy):

• bilateral acute otitis media in children younger than 2 years
• acute otitis media in children with otorrhoea
• acute sore throat/acute pharyngitis/acute tonsillitis when three or more Centor criteria are present

For all antibiotic prescribing strategies, patients should be given:

• advice about the usual natural history of the illness, including the average total length of the illness (before and after seeing the doctor):
  • acute otitis media: four days
  • acute sore throat/acute pharyngitis/acute tonsillitis: one week
  • common cold: one and a half weeks
  • acute rhinosinusitis: two and a half weeks
  • acute cough/acute bronchitis: three weeks
• When the no antibiotic prescribing strategy is adopted, patients should be offered:
  • reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, diarrhoea, vomiting and rash
  • a clinical review if the condition worsens or becomes prolonged
• When the delayed antibiotic prescribing strategy is adopted, patients should be offered:
  • reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, diarrhoea, vomiting and rash
  • advice about using the delayed prescription if symptoms are not starting to settle in accordance with the expected course of the illness or if a significant worsening of symptoms occurs
  • advice about re-consulting if there is a significant worsening of symptoms despite using the delayed prescription. A delayed prescription with instructions can either be given to the patient or left at an agreed location to be collected at a later date