Differentiating acute viral nasopharyngitis from other diseases: Difference between revisions

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{{Acute viral nasopharyngitis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Acute_viral_nasopharyngitis_(common_cold)]]
{{CMG}};{{AE}}{{AY}}
{{CMG}}; {{AE}} {{AY}}
==Overview==
==Overview==
Acute viral nasopharyngitis should be differentiated from other diseases that cause [[runny nose]], [[cough]], and constitutional symptoms, such as [[influenza]], [[allergic rhinitis]], and [[acute sinusitis]].
==Differentiating acute viral nasopharyngitis from other diseases==
Acute viral nasopharyngitis should be differentiated from other diseases that cause [[runny nose]], [[cough]], and constitutional symptoms.


==Differentiating acute viral nasopharyngitis from other diseases==
{| style="border: 0px; font-size: 85%; margin: 7px; width:1000px;" align="center"
==Differentiating Flu and Common Cold==
 
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align=center
|+
|valign=top|
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | History
! style="background: #4479BA; color:#FFF;  width: 200px;" | Physical examination
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute viral nasopharyngitis<ref name="pmid12517470">{{cite journal |vauthors=Heikkinen T, Järvinen A |title=The common cold |journal=Lancet |volume=361 |issue=9351 |pages=51–9 |year=2003 |pmid=12517470 |doi=10.1016/S0140-6736(03)12162-9 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Symptoms start with [[sore throat]], [[nasal congestion]], and [[runny nose]].
* [[Cough]] that may persist after resolution of the other symptoms.
* [[Fever]] is not common.
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]].
* [[Pharynx]] is typically normal.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Diagnosis is usually clinical; lab tests are rarely needed.
* The virus can be [[Culture medium|cultured]] on human lung cells, but it takes time.
* [[PCR]] is rapid and accurate, but is done only when the infecting [[virus]] strain in [[immunocompromised]] patients needs to be known.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Allergic rhinitis]]<ref name="pmid20232579">{{cite journal |vauthors=Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J |title=Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective |journal=Asian Pac. J. Allergy Immunol. |volume=27 |issue=4 |pages=237–43 |year=2009 |pmid=20232579 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Characterized by repeated paroxysms of [[rhinorrhea]], [[sneezing]], and [[cough]].
* Symptoms may be related to a specific season of the year, hence the name “seasonal [[allergies]].”
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Rhinorrhea]] discharge is usually clear and watery.
* Examination of the nose reveals a crease below the [[nasal bridge]], formed from repeated pulling of the nose secondary to [[irritation]].
* [[Edema]] in the area below the eye, if associated [[conjunctivitis]] is present.<ref name="pmid11449200">{{cite journal |vauthors=Skoner DP |title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis |journal=J. Allergy Clin. Immunol. |volume=108 |issue=1 Suppl |pages=S2–8 |year=2001 |pmid=11449200 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Skin testing using intradermal skin prick tests to determine the specific [[allergens]] causing [[allergic rhinitis]].
* Serum immune assays to determine [[IgE|IgE levels]] in the [[serum]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Acute sinusitis]]<ref name="pmid9347786">{{cite journal |vauthors=Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ |title=A practical guide for the diagnosis and treatment of acute sinusitis |journal=CMAJ |volume=156 Suppl 6 |issue= |pages=S1–14 |year=1997 |pmid=9347786 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Presents with symptoms similar to [[URTI|URTIs]] ([[sneezing]], [[cough]], and [[runny nose]]).
* Symptoms last for a longer time (about 10 days), with a peak between the 4th and 6th days.
* Usually, [[acute sinusitis]] is not associated with [[fever]].<ref name="pmid7242607">{{cite journal |vauthors= |title=Acute maxillary sinusitis |journal=N. Engl. J. Med. |volume=305 |issue=4 |pages=226–7 |year=1981 |pmid=7242607 |doi=10.1056/NEJM198107233050419 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Inspection may show [[erythema]] and [[edema]] over the involved [[sinus]].
* Palpation of [[sinuses]] shows [[tenderness]].
* [[Transillumination]] of the [[sinuses]] may show opacity.
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[X ray|X-ray]] and [[CT]] may show air fluid level or bubbles in the affected [[sinuses]].
* [[Culture medium|Culture]] of the nasal secretions is of limited use in [[acute sinusitis]], as may be contaminated by [[Flora|nasal flora]].
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Infectious mononucleosis]]<ref name="pmid4864269">{{cite journal |vauthors=Niederman JC, McCollum RW, Henle G, Henle W |title=Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies |journal=JAMA |volume=203 |issue=3 |pages=205–9 |year=1968 |pmid=4864269 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* Symptoms are like the symptoms of [[pharyngitis]], which include:
** [[Sore throat]] and [[Dysphagia|difficulty swallowing]]
** [[Fever]]
** [[Fatigue]]
** [[Lymphadenopathy]] (especially in the posterior cervical region)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Abdominal examination reveals [[splenomegaly]].
* [[Maculopapular rash]] may be present.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Positive monospot test.
* Elevated [[liver enzymes]].
|}
 
===Differentiating Flu and Common Cold===
{| style="border: 0px; font-size: 85%; margin: 3px; width:500px;" align="center"
| valign="top" |
|+
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Symptoms
! style="background: #4479BA; color:#FFF;  width: 150px;" | Symptoms
! style="background: #4479BA; color:#FFF;  width: 200px;" | Flu  
! style="background: #4479BA; color:#FFF;  width: 200px;" | Flu  
! style="background: #4479BA; color:#FFF;  width: 200px;" | Common Cold
! style="background: #4479BA; color:#FFF;  width: 200px;" | Common cold
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Fever
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Fever]]
| style="padding: 5px 5px; background: #F5F5F5;" | High fever (100-102° F)
| style="padding: 5px 5px; background: #F5F5F5;" | High [[fever]] (100-102° F)
| style="padding: 5px 5px; background: #F5F5F5;" | Rare
| style="padding: 5px 5px; background: #F5F5F5;" | Rare
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Headache
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Headache]]
| style="padding: 5px 5px; background: #F5F5F5;" | Common
| style="padding: 5px 5px; background: #F5F5F5;" | Common
| style="padding: 5px 5px; background: #F5F5F5;" | Rare
| style="padding: 5px 5px; background: #F5F5F5;" | Rare
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Cough
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cough]]
| style="padding: 5px 5px; background: #F5F5F5;" | Common, moderate to severe
| style="padding: 5px 5px; background: #F5F5F5;" | Common,  
| style="padding: 5px 5px; background: #F5F5F5;" | Mild to moderate
moderate to severe
| style="padding: 5px 5px; background: #F5F5F5;" | Rare,
mild to moderate
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Body aches  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Body aches  
Line 29: Line 94:
| style="padding: 5px 5px; background: #F5F5F5;" | Slight
| style="padding: 5px 5px; background: #F5F5F5;" | Slight
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Fatigue
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Fatigue]]
| style="padding: 5px 5px; background: #F5F5F5;" | Usual, can last up to 2-3 weeks
| style="padding: 5px 5px; background: #F5F5F5;" | Usual, can last up to 2-3 weeks
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Nasal congestion  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Nasal congestion]]
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Common
| style="padding: 5px 5px; background: #F5F5F5;" | Common
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Sneezing  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Sneezing]]
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Common
| style="padding: 5px 5px; background: #F5F5F5;" | Common
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Sore throat
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Sore throat]]
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Sometimes
| style="padding: 5px 5px; background: #F5F5F5;" | Common
| style="padding: 5px 5px; background: #F5F5F5;" | Common
|-
|-
| style="padding: 0px 5px; background: #F5F5F5;" colspan=3| <small>Adapted from the National Institute of Allergy and Infectious Diseases (NIAID) <ref>{{cite web|url=http://www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/overview.aspx |title=National Institute of Allergy and Infectious Diseases (NIAID)- Flu (Influenza)}}</ref></small>
| colspan="3" style="padding: 0px 5px; background: #F5F5F5;" | <small>Adapted from the National Institute of Allergy and Infectious Diseases (NIAID) <ref>{{cite web|url=http://www.niaid.nih.gov/topics/Flu/understandingFlu/Pages/overview.aspx |title=National Institute of Allergy and Infectious Diseases (NIAID)- Flu (Influenza)}}</ref></small>
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Otolaryngology]]
[[Category:Pediatrics]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]

Latest revision as of 21:22, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Acute viral nasopharyngitis should be differentiated from other diseases that cause runny nose, cough, and constitutional symptoms, such as influenza, allergic rhinitis, and acute sinusitis.

Differentiating acute viral nasopharyngitis from other diseases

Acute viral nasopharyngitis should be differentiated from other diseases that cause runny nose, cough, and constitutional symptoms.

Disease History Physical examination Laboratory or radiological findings
Acute viral nasopharyngitis[1]
  • Diagnosis is usually clinical; lab tests are rarely needed.
  • The virus can be cultured on human lung cells, but it takes time.
  • PCR is rapid and accurate, but is done only when the infecting virus strain in immunocompromised patients needs to be known.
Allergic rhinitis[2]
  • Characterized by repeated paroxysms of rhinorrhea, sneezing, and cough.
  • Symptoms may be related to a specific season of the year, hence the name “seasonal allergies.”
Acute sinusitis[4]
Infectious mononucleosis[6]

Differentiating Flu and Common Cold
Symptoms Flu Common cold
Fever High fever (100-102° F) Rare
Headache Common Rare
Cough Common,

moderate to severe

Rare,

mild to moderate

Body aches Common, may be severe Slight
Fatigue Usual, can last up to 2-3 weeks Sometimes
Nasal congestion Sometimes Common
Sneezing Sometimes Common
Sore throat Sometimes Common
Adapted from the National Institute of Allergy and Infectious Diseases (NIAID) [7]

References

  1. ↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
  2. ↑ Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J (2009). "Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective". Asian Pac. J. Allergy Immunol. 27 (4): 237–43. PMID 20232579.
  3. ↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
  4. ↑ Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ (1997). "A practical guide for the diagnosis and treatment of acute sinusitis". CMAJ. 156 Suppl 6: S1–14. PMID 9347786.
  5. ↑ "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.
  6. ↑ Niederman JC, McCollum RW, Henle G, Henle W (1968). "Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies". JAMA. 203 (3): 205–9. PMID 4864269.
  7. ↑ "National Institute of Allergy and Infectious Diseases (NIAID)- Flu (Influenza)".
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