Makindo Medical Notes

URTI refers to acute infections of the nose, sinuses, pharynx, or larynx. They are among the most common conditions seen in primary care, usually viral and self-limiting, but occasionally complicated by bacterial superinfection or lower respiratory tract involvement.

📖 Introduction & Pathophysiology

• URTIs are usually caused by viruses (rhinovirus, coronavirus, adenovirus, RSV, influenza, parainfluenza).
• Transmission is via droplets or direct contact with contaminated surfaces.
• Virus infects the respiratory epithelium, causing inflammation, oedema, and increased mucus production.
• The inflammatory response leads to typical symptoms: sore throat, nasal congestion, rhinorrhoea, cough, malaise, and fever.
• Secondary bacterial infection can occur (e.g. Group A Strep pharyngitis, bacterial sinusitis, otitis media).

⚠️ Common URTI Subtypes

• Common cold (acute viral rhinitis): Nasal congestion, sneezing, rhinorrhoea.
• Pharyngitis / Tonsillitis: Sore throat, painful swallowing ± exudates.
• Sinusitis: Facial pain, nasal blockage, purulent discharge.
• Laryngitis: Hoarse voice, dry cough.
• Otitis media: Ear pain, fever, irritability in children.

🩺 Clinical Features

• Nasal congestion, rhinorrhoea, sneezing 🤧
• Sore throat, dysphagia
• Cough (dry or productive)
• Fever, malaise, headache
• Hoarseness (laryngitis)
• Tender cervical lymph nodes (especially with bacterial pharyngitis)

🔎 Investigations

• Mostly clinical – tests are rarely needed in simple URTI.
• Throat swab / rapid strep test → if bacterial pharyngitis suspected (Centor score ≥3).
• Nasopharyngeal swabs (PCR) → in outbreaks or immunocompromised patients.
• Bloods (FBC, CRP) only if systemic infection suspected.
• Imaging (sinus X-ray/CT) only if recurrent or complicated sinusitis.

💊 Management

• Supportive care: Rest, fluids, paracetamol/ibuprofen, saline nasal sprays, throat lozenges.
• Antibiotics: Not indicated in viral URTIs. Consider only if bacterial cause strongly suspected (e.g. strep throat, bacterial sinusitis, otitis media with systemic illness).
• Symptomatic relief: Decongestants (short course only), antihistamines (if allergic component), honey (for cough in children >1 year).
• Hospital referral: If severe systemic illness, airway compromise, dehydration, or complications (e.g. peritonsillar abscess, mastoiditis, orbital cellulitis).

⚠️ Complications

• Sinusitis → orbital cellulitis, intracranial infection.
• Pharyngitis → peritonsillar abscess (quinsy), rheumatic fever, post-streptococcal GN.
• Otitis media → mastoiditis, hearing loss.
• Laryngitis → airway compromise (rare, usually in children).

📚 Key Teaching Pearls

• Most URTIs are viral and self-limiting — antibiotics usually unnecessary.
• Use Centor/McIsaac score to assess streptococcal pharyngitis risk.
• Always consider red flags: severe sore throat with trismus, stridor, unilateral swelling (think quinsy or epiglottitis).
• Public health importance: major driver of antibiotic overuse and resistance.

🌡️ Case 1 — Viral Pharyngitis

• Scenario: 21-year-old with sore throat, low-grade fever, mild cough, and coryzal symptoms.
• Context: Exam shows erythematous pharynx without tonsillar exudate.
• Teaching Point: 💡 Most pharyngitis is viral — supportive care (fluids, analgesia) is appropriate; antibiotics are not indicated.

🌡️ Case 2 — Acute Sinusitis

• Scenario: 37-year-old with 10 days of nasal congestion, purulent discharge, facial pressure worse on bending forward.
• Context: Febrile, tenderness over maxillary sinuses.
• Teaching Point: 💡 Usually post-viral; treat conservatively unless symptoms persist >10 days or severe, when antibiotics may be considered.

🌡️ Case 3 — Viral Laryngitis

• Scenario: 28-year-old teacher with hoarse voice and dry cough after recent cold.
• Context: Afebrile, laryngeal erythema on exam, no stridor.
• Teaching Point: 💡 Common and self-limiting; managed with voice rest, hydration, and reassurance. Antibiotics have no role.