TAILIEUCHUNG - Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections

The enormous consumption of antibiotics for these illnesses has contributed to the rise in antibiotic resistance among common community-acquired pathogens such as Streptococcus pneumoniae—a trend that in itself has had an enormous influence on public health. Although most URIs are caused by viruses, distinguishing patients with primary viral infection from those with primary bacterial infection is difficult. Signs and symptoms of bacterial and viral URIs are, in fact, indistinguishable. Because routine, rapid testing is neither available nor practical for most syndromes, acute infections are diagnosed largely on clinical grounds. . | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections The enormous consumption of antibiotics for these illnesses has contributed to the rise in antibiotic resistance among common community-acquired pathogens such as Streptococcus pneumoniae a trend that in itself has had an enormous influence on public health. Although most URIs are caused by viruses distinguishing patients with primary viral infection from those with primary bacterial infection is difficult. Signs and symptoms of bacterial and viral URIs are in fact indistinguishable. Because routine rapid testing is neither available nor practical for most syndromes acute infections are diagnosed largely on clinical grounds. Thus the judicious use of antibiotics in this setting is challenging. Nonspecific Infections of the Upper Respiratory Tract Nonspecific URIs are a broadly defined group of disorders that collectively constitute the leading cause of ambulatory care visits in the United States. By definition nonspecific URIs have no prominent localizing features. They are identified by a variety of descriptive names including acute infective rhinitis acute rhinopharyngitis nasopharyngitis acute coryza and acute nasal catarrh as well as by the inclusive label common cold. Etiology The large assortment of URI classifications reflects the wide variety of causative infectious agents and the varied manifestations of common pathogens. Nearly all nonspecific URIs are caused by viruses spanning multiple virus families and many antigenic types. For instance there are at least 100 immunotypes of rhinovirus Chap. 179 the most common cause of URI 30-40 of cases other causes include influenza virus three immunotypes Chap. 180 as well as parainfluenza virus four immunotypes coronavirus at least three immunotypes and adenovirus 47 immunotypes Chap. 179 . Respiratory syncytial virus RSV also accounts for a small percentage of cases each year as do some viruses not typically associated with .

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