Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ URIs are among the leading causes of lost time from work or school. Distinguishing pts with primary viral URI from those with primary bacterial URI is difficult since the signs and symptoms are the same. URIs are often treated with antibiotics even though bacteria cause only 25% of cases. Inappropriate prescribing of antibiotics for URIs is a leading cause of antibiotic resistance in common community-acquired pathogens such as Streptococcus pneumoniae. +++ NONSPECIFIC URIs ++ Definition: Nonspecific URIs (the “common cold”) have no prominent localizing features. Etiology: A wide variety of viruses (e.g., rhinoviruses, coronaviruses, parainfluenza viruses, influenza viruses, adenoviruses) can cause nonspecific URIs. Clinical manifestations: an acute, mild, self-limited catarrhal syndrome, typically characterized by rhinorrhea, nasal congestion, cough, and sore throat Hoarseness, malaise, sneezing, and fever are more variable. The median duration of symptoms is ∼1 week (range, 2–10 days). Cough secondary to upper respiratory inflammation may last 2–3 weeks and does not necessarily indicate a need for antibiotics. Secondary bacterial infections complicate 0.5–2% of colds and are associated with a prolonged course and/or increased severity of illness, often with localization of signs and symptoms. Purulent nasal and throat secretions are poor predictors of bacterial infection. Treatment: Symptom-based treatment (e.g., with decongestants, NSAIDs) is typically all that is required. Antibiotics are not indicated. +++ SINUS INFECTIONS ++ Rhinosinusitis is an inflammatory condition most commonly involving the maxillary sinus; next, in order of frequency, are the ethmoid, frontal, and sphenoid sinuses. Sinusitis accounts for millions of visits to primary care physicians each year and is the fifth most common diagnosis for which antibiotics are prescribed. +++ ACUTE SINUSITIS ++ Definition: sinusitis of <4 weeks’ duration Etiology: Infectious and noninfectious causes lead to sinus ostial obstruction and retention of mucus. Infectious causes include viruses (e.g., rhinovirus, parainfluenza virus, influenza virus) and bacteria (e.g., S. pneumoniae, nontypable Haemophilus influenzae, and—in children—Moraxella catarrhalis). In immunocompromised pts, fungi (e.g., Rhizopus, Mucor, and occasionally Aspergillus) can be involved. Nosocomial cases are often polymicrobial and involve Staphylococcus aureus and gram-negative bacilli. Noninfectious causes include allergic rhinitis, barotrauma, and exposure to chemical irritants. Clinical manifestations: Common manifestations include nasal drainage and congestion, facial pain or pressure, and headache. Tooth pain and halitosis can be associated with bacterial sinusitis. Pain localizes to the involved sinus and is often worse when the pt bends over or is supine. Advanced frontal sinusitis can present as Pott’s puffy tumor: swelling and pitting edema over the frontal bone from a communicating subperiosteal abscess. Life-threatening complications include meningitis, epidural abscess, and brain abscess. Diagnosis: It is difficult to distinguish viral from bacterial sinusitis clinically, although viral cases greatly outnumber bacterial cases. Only 40–50% of pts with symptoms of >10 days’ duration, purulent nasal drainage, nasal obstruction, and facial pain have bacterial sinusitis. If fungal sinusitis is a consideration, ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth