Differentiating acute viral nasopharyngitis from other diseases: Difference between revisions

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Revision as of 21:09, 28 July 2017

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]	Symptoms start with sore throat,Nasal congestion, and runny nose. Cough that may persist after resolution of the other symptoms. Fever is not common.	Nasal mucosa is congested and hyperemic. Pharynx is typically normal.	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 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”.	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.^[3]	Skin testing using intradermal skin prick tests to determine the specific allergens causing allergic rhinitis. Serum immune assays to determine IgE levels in the serum.
Acute sinusitis^[4]	Presents with symptoms similar to URTIs (sneezing, cough, and runny nose). Symptoms last for a longer time (about 10 days), with the peak between 4th and 6th days. Usually, acute sinusitis is not associated with fever.^[5]	Inspection may show erythema, and edema over the involved sinus. Palpation of sinuses shows tenderness. Transillumination of the sinuses may show opacity.	X-ray and CT may show air fluid level or bubbles in the affected sinuses. Culture of the nasal secretions is of limited use in acute sinusitis, as may be contaminated by nasal flora.
Infectious mononucleosis^[6]	Symptoms are like the symptoms of pharyngitis, which include: sore throat and difficult swallowing Fever Fatigue Lymphadenopathy, especially in the posterior cervical region.	Abdominal examination reveals splenomegaly. Maculopapular rash may be present.	Positive monospot test. Elevated liver enzymes.

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

↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
↑ 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.
↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
↑ 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.
↑ "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.
↑ 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.
↑ "National Institute of Allergy and Infectious Diseases (NIAID)- Flu (Influenza)".

[pmid12517470-1] Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.

[pmid20232579-2] 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.

[pmid11449200-3] Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.

[pmid9347786-4] 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.

[pmid7242607-5] "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.

[pmid4864269-6] 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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@@ Line 3: / Line 3: @@
 {{CMG}};{{AE}}{{AY}}
 ==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]].
+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.
@@ Line 17: / Line 17: @@
 | 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]]
+* Symptoms start with [[sore throat]],[[Nasal congestion]], and [[runny nose]].
-* [[Nasal congestion]] and [[runny nose]]
+* [[Cough]] that may persist after resolution of the other symptoms.
-* [[Cough]] that may persist after the resolution of the other symptoms
+* [[Fever]] is not common.
-* [[Fever]] is not common
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]]
+* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]].
-* [[Pharynx]] is typically normal
+* [[Pharynx]] is typically normal.
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Diagnosis is usually clinical and lab tests are rarely needed
+* Diagnosis is usually clinical; lab tests are rarely needed.
-* The virus can be [[Culture medium|cultured]] on human lung cells but results take time
+* The virus can be [[Culture medium|cultured]] on human lung cells, but it takes time.
-* [[PCR]] is rapid and accurate test but done only in [[immunocompromised]] patients when the [[virus]] strain needs to be known
+* [[PCR]] is rapid and accurate, but 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]].
+* 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”.
+* Symptoms may be related to a specific season of the year, hence the name “seasonal [[allergies]]”.
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[Rhinorrhea]] fluid is usually clear and watery.
+* [[Rhinorrhea]] discharge is usually clear and watery.
-* Examination of the nose reveals a crease below the [[nasal bridge]] from repeated pulling of the nose secondary to irritation.
+* 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>
+* [[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 prick skin tests to determine the specific [[allergens]] causing [[allergic rhinitis]].
+* 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]])
+* Presents with symptoms similar to [[URTI|URTIs]] ([[sneezing]], [[cough]], and [[runny nose]]).
-* Symptoms last for a longer time (about 10 days) with the peak of symptoms between 4th and 6th days.
+* Symptoms last for a longer time (about 10 days), with the peak between 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>
+* 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]]
+* Inspection may show [[erythema]], and [[edema]] over the involved [[sinus]].
-* Palpation of [[sinuses]] shows [[tenderness]] on palpation
+* Palpation of [[sinuses]] shows [[tenderness]].
 * [[Transillumination]] of the sinuses may show opacity.
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[X ray]] and [[CT]] may show air fluid level or bubbles in the affected sinus.
+* [[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 nasal secretions may be contaminated by [[Flora|nasal flora]].
+* [[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 of [[pharyngitis]]: [[sore throat]] and [[Dysphagia|difficult swallowing]]
+* Symptoms are like the symptoms of [[pharyngitis]], which include:
-* [[Fever]]
+** [[sore throat]] and [[Dysphagia|difficult swallowing]]
-* [[Fatigue]]
+** [[Fever]]
-* [[Lymphadenopathy]] especially in the posterior cervical region
+** [[Fatigue]]
+** [[Lymphadenopathy]], especially in the posterior cervical region.
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Abdominal examination reveals [[splenomegaly]]
+* Abdominal examination reveals [[splenomegaly]].
-* [[Maculopapular rash]] may be present
+* [[Maculopapular rash]] may be present.
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Positive monospot test
+* Positive monospot test.
-* Elevated [[liver enzymes]]
+* Elevated [[liver enzymes]].
 |}
@@ Line 74: / Line 74: @@
 ! style="background: #4479BA; color:#FFF;  width: 150px;" | Symptoms
 ! 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]]
@@ Line 85: / Line 85: @@
 |-
 | 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