nasopharyngitis

nasopharyngitis
Nasopharingitis is also known as rhinopharingitis or common cold. The common cold is a viral infection of your upper respiratory tract — your nose and throat. A common cold is usually harmless, although it may not feel that way. If it's not a runny nose, sore throat and cough, it's the watery eyes, sneezing and congestion — or maybe all of the above. In fact, because any one of more than 200 viruses can cause a common cold, symptoms tend to vary greatly.
Most adults are likely to have a common cold two to four times a year. Children, especially preschoolers, may have a common cold as many as six to 10 times annually.
Most people recover from a common cold in about a week or two. If symptoms don't improve, see your doctor.

Symptoms
Symptoms of the common cold usually begin 2-3 days after inoculation. Viral URIs typically last 6.6 days in children aged 1-2 years in home care and 8.9 days for children older than 1 year in daycare. Cold symptoms in adults can last from 3-14 days, yet most people recover or have symptomatic improvement within a week. If symptoms last longer than 2 weeks, consider alternative diagnoses, such as allergy, sinusitis, or pneumonia.
• Nasal symptoms: Rhinorrhea, congestion or obstruction of nasal breathing, and sneezing are common early in the course. Clinically significant rhinorrhea is more characteristic of a viral infection rather than a bacterial infection. In viral URI, secretions often evolve from clear to opaque white to green to yellow within 2-3 days of symptom onset. Thus, color and opacity do not reliably distinguish viral from bacterial illness.
• Pharyngeal symptoms: These include sore or scratchy throat, odynophagia, or dysphagia. Sore throat is typically present in the first days of illness, although it lasts only a few days. If the uvula or posterior pharynx is inflamed, the patient may have an uncomfortable sensation of a lump when swallowing. Nasal obstruction may cause mouth breathing, which may result in a dry mouth, especially after sleep.
• Cough: This may represent laryngeal involvement, or it may result from upper airway cough syndrome related to nasal secretions (postnasal drip). Cough typically develops on the fourth or fifth day, subsequent to nasal and pharyngeal symptoms.
• Other symptoms
o Foul breath: This occurs as resident florae process the products of the inflammatory process. Foul breath also occurs with allergic rhinitis.
o Hyposmia: Also termed anosmia, it is secondary to nasal inflammation.
o Headache: This symptom is common with many types of URI.
o Sinus symptoms: These may include congestion or pressure and are common with viral URIs.
o Photophobia or conjunctivitis: These may be seen with adenoviral and other viral infections. Influenza may evoke pain behind the eyes, pain with eye movement, or conjunctivitis. Itchy, watery eyes are common in patients with allergic conditions.
o Fever: This is usually slight or absent, but temperatures can reach 39.4°C (103°F) in infants and young children. If present, fever typically lasts for only a few days. In influenza infection, fevers may result in temperatures as high as 40°C (104°F).
o Gastrointestinal symptoms: Symptoms such as nausea, vomiting, and diarrhea may occur in persons with influenza, especially in children. Nausea and abdominal pain may be present in individuals with strep throat and viral syndromes.
o Severe myalgia: This is typical of influenza infection, especially in the setting of sudden-onset sore throat, fever, chills, nonproductive cough, and headache.
o Fatigue or malaise: Any type of URI can produce these symptoms. Extreme exhaustion is typical of influenza infection.
The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won't have a high fever. You're also unlikely to experience significant fatigue from a common cold.

Diagnosis
Colds are diagnosed by observing a person's symptoms. There are no laboratory tests readily available to detect the cold virus. However, a doctor may do a throat culture or blood test to rule out a secondary infection.
Influenza is sometimes confused with a cold, but flu causes much more severe symptoms and generally a fever. Allergies to molds or pollens also can make the nose run. Allergies are usually more persistent than the common cold. An allergist can do tests to determine if the cold-like symptoms are being caused by an allergic reaction. Also, some people get a runny nose when they go outside in winter and breathe cold air. This type of runny nose is not a symptom of a cold.

Etiology
More than 200 viruses are known to cause the symptoms of the common cold.
• Rhinoviruses: These cause approximately 30-50% of colds in adults. They grow optimally at temperatures near 32.8°C (91°F), which is the temperature inside the human nares.
• Coronaviruses: While they are a significant cause of colds, exact case numbers are difficult to determine because, unlike rhinoviruses, coronaviruses are difficult to culture in the laboratory.
• Enteroviruses, including coxsackieviruses, echoviruses, and others: These are also leading causes of the common cold.
• Other viruses: Adenoviruses, orthomyxoviruses (including influenza A and B viruses), paramyxoviruses (eg, PIV), RSV, EBV, and hMPV account for many URIs. Varicella, rubella, and rubeola infections may manifest as a nasopharyngitis before other classic signs and symptoms develop. The remainder of URI pathogens are not identified but are presumed to be viral. This group represents greater than 30% of common colds in adults.
Risk factors
• Sex. The common cold occurs frequently in women, especially those aged 20-30 years. This frequency may represent increased exposure to small children, who represent a large reservoir for URIs. However, hormonal effects on the nasal mucosa may also play a role.
• Age. The incidence of the common cold varies by age. Rates are highest in children younger than 5 years. Children have approximately 3-8 viral respiratory illnesses per year. Adolescents and adults have approximately 2-4 colds a year, and people older than 60 years have fewer than 1 cold per year.
• Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You'll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses, have an allergic reaction that affects your nasal passages or have a weakened immune system. All of these factors increase your risk of a cold.
• Time of year. Both children and adults are more susceptible to colds in fall and winter. That's because children are in school, and most people are spending a lot of time indoors. In places where there is no winter season, colds are more frequent in the rainy season.

Treatment
As there is no medically proven and accepted medication directly targeting the causative agent, there is no cure for the common cold. Treatment is limited to symptomatic supportive options, maximizing the comfort of the patient, and limiting complications and harmful sequelae. The most reliable treatment is a combination of fluids and plenty of rest.
The common cold is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins producing specific antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average.
Palliative care
The National Institute of Allergy and Infectious Diseases suggests getting plenty of rest, drinking fluids to maintain hydration, gargling with warm salt water, using cough drops, throat sprays, or over-the-counter pain or cold medicines.[2] Saline nasal drops may help alleviate congestion.
The American Lung Association recommends avoiding coffee, tea or cola drinks that contain caffeine and avoiding alcoholic beverages. Both caffeine and alcohol cause dehydration.

Antivirals
There are no approved antiviral drugs for the common cold.
ViroPharma and Schering-Plough are developing an antiviral drug, pleconaril, that targets picornaviruses, the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in an oral form.[20][21] Schering-Plough is developing an intra-nasal formulation that may have fewer adverse effects.

Over-the-counter symptom medicines
There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.
• analgesics such as aspirin or paracetamol (acetaminophen), as well as localised versions targeting the throat (often delivered in lozenge form)
o Acetaminophen (Tylenol, Feverall, Tempra) Dose: Adult 325-650 mg PO q4-6h or 1000 mg tid/qid; not to exceed 4 g/d
• nasal decongestants such as pseudoephedrine or oxymetazoline which reduce the inflammation in the nasal passages by constricting local blood vessels
• Cough suppressants such as dextromethorphan which suppress the cough reflex.
o Guaifenesin and dextromethorphan (Benylin, Humibid, DM, Mytussin, Robitussin DM, Tuss DM) Adult dose: 5 mL PO q4h or 10 mL PO q6-8h; not to exceed 40 mL/24h
• first-generation anti-histamines such as brompheniramine, chlorpheniramine, diphenhydramine and clemastine (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation anti-histamines do not have a useful effect on colds.
o Diphenhydramine (Benadryl, Benylin). First-generation antihistamine with anticholinergic effects. Adult dose:25-50 mg PO q4-6h prn; not to exceed 400 mg/d

Lifestyle and home remedies
You may not be able to cure your common cold, but you can make yourself as comfortable as possible. These tips may help:
• Drink lots of fluids. Water, juice, tea and warm soup are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
• Try chicken soup. Generations of parents have spooned chicken soup into their sick children. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the movement of neutrophils — immune system cells that help the body's response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
• Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy from medications. This will give you a chance to rest as well as reduce the chances that you'll infect others. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
• Adjust your room's temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
• Soothe your throat. Gargling with warm salt water several times a day or drinking warm lemon water with honey may help soothe a sore throat and relieve a cough.
• Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops. You can buy these drops over-the-counter, and they're effective, safe and nonirritating, even for children. To use in babies, put several drops into one nostril, then immediately bulb suction that nostril. Repeat the process in the opposite nostril. Doing this before feeding your baby can improve your child's ability to nurse or take a bottle, and before bedtime it may improve sleep.

Alternative medicine
Alternative therapies probably won't cure your cold, but they may help make you more comfortable by easing your symptoms.
Echinacea. Whether taking preparations of the herb echinacea protects you from getting a cold or relieves cold symptoms continues to be debated. While no studies have shown that taking echinacea can prevent you from getting a cold, there is some evidence that it can modestly relieve cold symptoms or shorten the duration of a cold. Echinacea seems most effective when taken soon after cold symptoms are first experienced.
Vitamin C. There's no evidence that taking large doses of vitamin C reduces your risk of catching cold. However, there is some evidence that high doses of vitamin C — up to 6 grams a day — may have a small effect in reducing the duration of cold symptoms.
Zinc. There's evidence that zinc nasal sprays or lozenges taken at the beginning of a cold may help reduce symptoms. While some studies also suggest zinc nasal sprays can be helpful, many users experienced permanent loss of smell and therefore the use of these sprays is discouraged.

Further Outpatient Care
Symptomatic self-care
Nasal and sinus symptom relief
Several home care measures may help.
• Warm moist air: Nasal and paranasal sinus mucosae may become more irritated with dry air. The following strategies may maintain the moisture of membranes and loosen nasal secretions:
• Nasal saline: This may provide temporary relief of congestion by removing nasal crusts and dried secretions. A systematic review of nasal saline irrigation as an adjunct for chronic rhinosinusitis symptom management concluded that evidence shows symptom relief and that irrigation is well tolerated by most patients. Saline drops or sprays are commercially available. A homemade normal saline solution can be prepared by placing a fourth of a teaspoon of table salt in 8 oz. of water. A bulb syringe, dropper, clean pump spray bottle, or squeeze bottle can be used to instill the saline into each nostril while the person inhales and then expels the saline. Saline is safe to use as needed.
• Hydration: Drinking 8 or more 8-oz glasses of water, juice, or noncaffeinated beverages daily may help thin mucus secretions and replace fluid losses. Patients with congestive heart failure or renal or liver disease may need to moderate their fluid intake to avoid volume excess.
• Warm facial packs: These may provide comfort, relieve congestion, and promote drainage in cases of rhinosinusitis. A warm folded washcloth or hot-water bottle (filled with hot water from a tap) may be applied directly to the face and cheek for 5-10 minutes. Facial packs may be repeated 3-4 times a day as needed.
• Irritant avoidance: Patients should avoid nasal irritants, such as cigarette smoke and indoor and outdoor air pollutants.
Throat symptom relief
Warm saline gargles may reduce edema associated with a sore throat. Using lozenges, eating popsicles, or drinking cold and slushy beverages may soothe a sore throat. Avoid choking hazards in small children.
Cough relief
Reduce irritating stimuli (eg, cold, dry air; indoor or outdoor air pollutants) that may provoke coughing. An upright or semiupright posture, such as sleeping with the head and shoulders raised, may decrease cough related to pharyngeal secretions.
Sleep
Sleeping with the head and shoulders slightly elevated may promote sinus and nasal drainage. Many symptoms worsen at night because airway clearance mechanics are relatively ineffective in the prone position. In addition, distractions from the experience of symptoms are fewer than during the day. Under normal circumstances, the 2 nares alternate between being open or closed throughout the day. Cycles last approximately 45-90 minutes per nares. When the person is lying recumbent on one side, the nares closest to the pillow or surface tends to become congested while the higher nostril is decongested.

Prevention
No vaccine has been developed for the common cold, which can be caused by many different viruses. But you can take some common-sense precautions to slow the spread of cold viruses:
• Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Carry a bottle of alcohol-based hand rub containing at least 60 percent alcohol for times when soap and water aren't available. These gels kill most germs, and are safe for older children to use themselves.
• Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys after play.
• Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouth without using their hands.
• Don't share. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold.
• Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.
• Choose your child care center wisely. Look for a child care setting with good hygiene practices and clear policies about keeping sick children at home. The number of children in the center directly relates to the number of colds to which your child will be exposed.

Complications
• Acute ear infection (otitis media). Ear infection occurs when bacteria or viruses infiltrate the space behind the eardrum. It's a frequent complication of common colds in children. Typical signs and symptoms include earaches and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold. Children who are too young to verbalize their distress may simply cry or sleep restlessly. Ear pulling is not a reliable sign.
• Wheezing. A cold can trigger wheezing in children with asthma.
• Sinusitis. In adults or children, a common cold that doesn't resolve may lead to sinusitis — inflammation and infection of the sinuses.
• Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, bronchitis in adults and croup in children. These infections need to be treated by a doctor.
Prognosis
A common cold may last up to 14 days, with symptoms averaging 7-11 days in duration. Fever, sneezing, and sore throat typically resolve early, whereas cough and nasal discharge are among the symptoms that last longest.

Follow-up care
Patients withthis disease should follow-up with a physician if their symptoms do not improve, if their symptoms worsen within 72 hours, or if they have recurrences

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