respiratory tract infection
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Introduction
Includes:
Pathology
- when air is forced over moist respiratory mucosa, it will generate more virus-laden respiratory particles
- symptomatic patients are more likely to have active infection, more likely to have a large burden of virus, & more likely to be spreading virus into the surrounding air because they are coughing, sneezing, or breathing heavily
- respiratory emissions are densest closest to their source
- in poorly ventilated spaces, virus-laden aerosols can accumulate, leading to higher inocula & greater risk for infection even if distanced from source
- a longer time of exposure to virus-laden aerosols, increases probability of infection[7]
Clinical manifestations
- in older adults viral respiratory tract infections may present with nonspecific symptoms such as worsening fatigue
Laboratory
- in older adults with viral respiratory tract infections, complete blood count, comprehensive metabolic panel & urinalysis may be normal
- Respiratory virus antigen*
- Respiratory virus DNA+RNA*
* Loincs listed for 'Respiratory virus'; indication(s) unclear
Radiology
- in older adults with viral respiratory tract infections, chest X-ray is generally normal
Complications
- children's medical visits for respiratory tract infection (within 3 days) confer 12-fold increase in risk for ischemic stroke[2]*
* Editorialist not impressed. Absolute risk is very low, No evidence that attempt to treat would mitigate risk.[2]
Management
- delayed antibiotic prescription for outpatients is not associated with adverse outcomes[1]
- fewer antibiotic prescriptions associated with a small increase in cases of pneumonia, but not mastoiditis, empyema, meningitis, intracranial abscess, or Lemierre syndrome[3]
- association with peritonsillar abscess less clear[3]
- penicillin or amoxicillin as effective & associated with fewer adverse events than amoxicillin clavulanate or cephalosporins for treatment of acute respiratory tract infections (otitis media, group A streptococcal pharyngitis, or sinusitis) in children[5]
Comparative biology
- intranasal application of an ointment containing neomycin prevented aerosol transmission of respiratory viruses[8]
- intranasal neomycin induces expression of multiple interferon-stimulated genes important in containing viral infections
- this occurs independent of anti-bacterial effects of neomycin[8]
- in mice, activation of these genes has dose-dependent benefits for prevention & treatment of multiple variants of SARS-CoV2 & influenza A viruses[8]
- intranasal neomycin ointment (Neosporin) in healthy humans induces expression of multiple interferon-stimulated genes[8]
- intranasal neomycin induces expression of multiple interferon-stimulated genes important in containing viral infections
Notes
- 11% of patients with acute respiratory tract infections receive systemic glucocorticoids*[6]
* it is not known how many of these prescriptions may have been appropriate
More general terms
More specific terms
- COVID-19
- influenza
- lower respiratory tract infection (LRI)
- respiratory syncytial virus (RSV)
- upper respiratory tract infection (URI, common cold)
Additional terms
References
- ↑ Jump up to: 1.0 1.1 Little P et al Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ 2014;348:g1606 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24603565 <Internet> http://www.bmj.com/content/348/bmj.g1606
- ↑ Jump up to: 2.0 2.1 2.2 Hills NK et al Timing and number of minor infections as risk factors for childhood arterial ischemic stroke. Neurology. August 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25142897 <Internet> http://www.neurology.org/content/early/2014/08/20/WNL.0000000000000752
Marquardt L A common cold is no stroke of luck. Risk for cerebral ischemia in Children. Neurology. August 20, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25142898 <Internet> http://www.neurology.org/content/suppl/2014/08/20/WNL.0000000000000752.DC1/WNL.0000000000000760.pdf - ↑ Jump up to: 3.0 3.1 3.2 Gulliford MC, Moore MV, Little P et al Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016;354:i3410 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27378578
Del Mar C. Antibiotics for acute respiratory tract infections in primary care: Fresh reassurance that reducing prescribing is safe. BMJ 2016 Jul 5; 354:i3482 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27381415 - ↑ Loinc
- ↑ Jump up to: 5.0 5.1 Gerber JS, Ross RK, Bryan M et al Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA. 2017;318(23):2325-2336 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29260224 https://jamanetwork.com/journals/jama/article-abstract/2666503
- ↑ Jump up to: 6.0 6.1 Dvorin EL, Lamb MC, Monlezun DJ et al. High frequency of systemic corticosteroid use for acute respiratory tract illnesses in ambulatory settings. JAMA Intern Med 2018 Feb 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29482204
- ↑ Jump up to: 7.0 7.1 Klompas M, Baker M, Rhee C What Is an Aerosol-Generating Procedure? JAMA Surg 2020. Dec 15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33320188 https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2020.6643
- ↑ Jump up to: 8.0 8.1 8.2 8.3 8.4 Mao T, Kim J, Pena-Hernandez MA et al. Intranasal neomycin evokes broad-spectrum antiviral immunity in the upper respiratory tract. Proc Natl Acad Sci U S A 2024 Apr 30; 121:e2319566121. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38648490 PMCID: PMC11067057 Free PMC article https://www.pnas.org/doi/10.1073/pnas.2319566121