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==
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! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute viral nasopharyngitis
| 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>
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* 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
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* Nasal mucosa is congested and hyperemic
* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]].
* Pharynx is typically normal
* [[Pharynx]] is typically normal.
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* Diagnosis is usually clinical and lab tests are rarely needed
* Diagnosis is usually clinical; lab tests are rarely needed.
* The virus can be 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 is done only when the infecting [[virus]] strain in [[immunocompromised]] patients needs to be known.
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Allergic rhinitis
| 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>
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* 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]].”
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* 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.
* [[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>
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* Skin testing using intradermal prick skin tests to determine the specific allergens causing allergic rhinits.
* 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.
* Serum immune assays to determine [[IgE|IgE levels]] in the [[serum]].
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute sinusitis
| 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>
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* Presents with symptoms similar to 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 a peak between the 4th and 6th days.
* Usually, acute sinusitis is not associated with fever
* 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>
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* 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 to palpation
* Palpation of [[sinuses]] shows [[tenderness]].
* Transillumination of the sinuses may show opacity.
* [[Transillumination]] of the [[sinuses]] may show opacity.
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* 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 of the nasal secretions is of limited use in acute sinusitis as nasal secretions may be contaminated by nasal flora.
* [[Culture medium|Culture]] of the nasal secretions is of limited use in [[acute sinusitis]], as may be contaminated by [[Flora|nasal flora]].
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Infectious mononucleosis  
| 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>
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* Symptoms of pharyngitis: sore throat and difficult swallowing
* Symptoms are like the symptoms of [[pharyngitis]], which include:
* Fever
** [[Sore throat]] and [[Dysphagia|difficulty swallowing]]
* Fatigue
** [[Fever]]
* Lymphadenopathy especially in the posterior cervical region
** [[Fatigue]]
** [[Lymphadenopathy]] (especially in the posterior cervical region)
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* Abdominal examination reveals splenomegaly
* Abdominal examination reveals [[splenomegaly]].
* Maculopapular rash may be present
* [[Maculopapular rash]] may be present.
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* Positive monospot test
* Positive monospot test.
* Elevated liver enzymes
* Elevated [[liver enzymes]].
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! 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
|-
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| 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  
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| style="padding: 5px 5px; background: #F5F5F5;" | Slight
| style="padding: 5px 5px; background: #F5F5F5;" | Slight
|-
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| 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
|-
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| 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
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==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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