RHINOPHARYNGITIS: SYMPTOMS, CAUSES, RISK FACTORS, PREVENTION - MEDICINE - 2024

The nasopharyngitis, nasopharyngitis or coryza is a viral disease of the upper respiratory tract. It is one of the most frequent causes of morbidity in children and adults, being the main reason for medical consultation in children.

In temperate countries, it is estimated that an adult can present between three to four episodes a year, while children can present between five and six. It is a disease that causes inflammation of the nasal and pharyngeal mucosa. It presents an increase in the production of mucus, fever, sore throat, general malaise, muscle aches, it may be accompanied by cough and hoarseness.

Generally, depending on the causative agent, the incubation period is short, from a few hours (15 to 16 hours) to 72 hours. The disease does not require treatment, only treatment for fever (antipyretics) and / or anti-inflammatories is indicated.

In some cases, in young children, saline nasal washes may be prescribed to relieve nasal obstruction.

Viruses are the causative agents of rhinopharyngitis. There are more than 200 viruses that have been linked to the common cold. Although the disease generally resolves on average after about five to seven days, complications can exist.

The most frequent complications are otitis media, sinusitis, bronchitis and pneumonia. Secondary bacterial infections can ensue.

Although rhinopharyngitis are acute viral processes, they can be caused by allergic problems and be recurrent or chronic.

Symptoms

After the incubation period, symptoms appear. The incubation period is very short, on average it is one to two days, but it can be as short as 10 to 15 hours or as long as 72 hours. These variations depend fundamentally on the causal agent and the host's health conditions.

The symptoms, according to some authors, can be divided into predominant symptoms, frequent symptoms and general symptoms, and that affect other organ systems.

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- Predominant symptoms: rhinorrhea or profuse nasal discharge, usually hyaline with nasal obstruction and frequent sneezing are the predominant initial symptoms.

- Frequent symptoms: sore throat or discomfort such as a sensation of irritation in the throat, cough, headache (headache), fever with variable intensity depending on the age of the patient. General malaise, temporary earache (otalgia) may appear.

- General symptoms and those affecting other organ systems: eye irritation with or without abundant tear secretion. Cervical lymphadenitis, that is, inflammation of the cervical lymph nodes. Chest pain, vomiting, diarrhea, abdominal pain, muscle pain (myalgia) and joint pain (arthralgia), irritability (in children), loss of appetite, refusal to eat.

In young children, especially infants, nasal obstruction can cause difficulties in sleeping and feeding. It can generate vomiting, with an increase in the frequency of bowel movements.

The smaller the infant, the more it depends on nasal breathing, so these obstructions can cause some respiratory distress.

In the course of rhinopharyngitis, which is self-limited, the fever can persist for up to five days, whereas the cough and rhinorrhea can persist for longer periods, up to 10 days. Nasal discharge, which is initially hyaline, after two to three days becomes thicker and whiter due to the presence of polymorphonuclear cells and bacteria.

Main causes of rhinopharyngitis

Rhinopharyngitis can be due to multiple causes, the most frequent being allergic and infectious.

Allergic rhinopharyngitis

Allergic rhinopharyngitis is a consequence of inflammation of the mucous membranes of the nose and pharynx, sometimes also compromising the paranasal sinuses (in which case it is called rhinosinusitis).

This inflammation is generated due to exposure to a given allergen, usually dust, mites, or pollen.

In each patient the allergen is different, so that what causes allergic rhinopharyngitis in one person will not necessarily do so in another. Likewise, there are patients who can be sensitive to multiple allergens, so there is the possibility that more than two elements in the environment trigger the symptoms.

Seasonal and perennial

When rhinopharyngitis occurs seasonally, especially in spring and as a result of exposure to certain types of pollen, it is called seasonal allergic rhinopharyngitis, also known as hay fever.

On the other hand, when this pattern is not present, it is often referred to as perennial rhinopharyngitis.

Infectious rhinopharyngitis

Almost all cases of infectious rhinopharyngitis are viral in origin. Usually the culprit is a rhinovirus, although there are many other viruses (adenovirus, coronavirus, parainfluenza) with the ability to infect the mucosa of the rhinopharynx, thus causing rhinopharyngitis.

Bacterial infection

In some cases, rhinopharyngitis may be due to a bacterial infection; the most common germs involved are Haemophilus influenzae and Streptococcus pyogenes.

When bacteria are involved, nasal compromise is much less, with symptoms focusing on the throat; For this reason, the term pharyngitis or pharyngotonsillitis is usually used, the latter when there is involvement of the tonsils.

High risk of contagion

In cases of infectious rhinopharyngitis it is usually possible to associate contact with a person with the disease. The contact should not be close, since the infectious agent can be transmitted up to 10 meters due to the micro-droplets of saliva (fluge) that are emitted by coughing or sneezing.

Viral rhinopharyngitis is highly contagious and usually occurs in outbreaks, particularly in cold months and in situations where there are high concentrations of people in relatively small spaces, such as schools, barracks, retirement homes, among others.

Risk factor's

Traditionally, it is theorized that rhinopharyngitis can be "caught" by exposure to a cold environment, rain, or common winter conditions. Hence the name of common cold or "cold" in English.

Many of the viruses that cause this disease are seasonal, and rhinopharyngitis is more common in cold, humid climates.

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The reason why the disease is seasonal is not fully elucidated. Some social factors may be involved.

When the climate is cold and humid, people stay longer in closed environments and being close to infected people favors contagion, such as school for children.

The role of low body temperature as a risk factor is controversial, but most of the evidence suggests that these low temperatures lead to an increase in susceptibility to infection.

A risk factor for this type of infectious pathology is related to a decrease in immune function. Decreased hours of sleep and malnutrition have been associated with an increased risk of infection from exposure to rhinovirus.

Breastfeeding reduces the risk of complications such as otitis and lower respiratory infections (lung) and it is recommended that, even if the infant is sick, it is not suspended.

Prevention

The only really useful measures to prevent the spread of rhinopharyngitis viruses are physical measures such as the correct use of hand washing technique and the use of masks. Disposable gloves, masks, and gowns should also be worn in the healthcare setting.

When a person is exposed to an infected patient, hand contact with eyes or nose should be avoided. Infected people must adequately remove nasal secretions and protect themselves when coughing or sneezing.

In these cases isolation or quarantine is not used, however, to avoid contagion, sick children should not attend school. Vaccination is not a really effective measure, since these viruses constantly mutate and are very numerous, so it is very difficult to obtain a vaccine that allows extensive protection against them.

Washing your hands regularly has apparently been effective in reducing the transmission of these viruses. Adding antibacterials or antivirals to normal hand washing is not clear to provide any additional benefit. Gel antiseptics have as their only advantage the convenience of a dry cleaning.

The use of vitamin C does not reduce the risk of contracting the disease, but it does reduce the duration of the disease. Zinc supplements, the use of which has become popular, it is not clear that they actually reduce the risk or affect the course of the disease.

References

1. Green, RJ (2006). Symptomatic treatment of upper respiratory tract symptoms in children. South African Family Practice, 48 (4), 38-42.
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3. Kardos, P., & Malek, FA (2017). Common Cold – an Umbrella Term for Acute Infections of Nose, Throat, Larynx and Bronchi. Pneumologie, 71 (04), 221-226.
4. Kopp, MV, Ankermann, T., & Härtel, C. (2011). Clinical potential for the use of probiotics in the management of respiratory conditions and cold-and influenza-like symptoms. Nutrition and Dietary Supplements, 3, 51.
5. Singh, M., Singh, M., Jaiswal, N., & Chauhan, A. (2017). Heated, humidified air for the common cold. Cochrane Database of Systematic Reviews, (8).
6. Tamayo Reus, CM (2015). Common cold and therapeutic violence in children population. MediSan, 19 (02), 229-241.