Common Infections of the Upper Respiratory Tract

What’s Making Me Sick?

Many different pathogens can cause similar respiratory symptoms. Since it’s difficult to tell what’s causing an infection based on symptoms alone, your healthcare provider can run tests to determine what’s causing your illness and find the best way to treat it.

Illnesses like the common cold, influenza, COVID-19, strep throat, and others require different treatment approaches. Your healthcare provider will recommend treatment based on your individual diagnosis.

Disclaimer: Ultimate diagnosis and treatment are based on multiple factors (including your symptoms, severity of illness, and lab tests) and patients should listen to the guidance of their healthcare provider.

Finding the Right Treatment

Do I need antibiotics?

Antibiotics are not effective against viruses. They can only treat certain bacterial infections. Taking unnecessary antibiotics can cause unpleasant side effects and may even lead to antibiotic-resistant bacteria that are even more difficult to treat.

Treating viral infections	Treating bacterial infections
• Rest & fluids	• Rest & fluids
• Antivirals for influenza and COVID-19 for certain patient populations	• Antibiotics in certain cases
• Over-the-counter medication to treat symptoms, such as cough and runny nose	• Over-the-counter medication to treat symptoms, such as cough and runny nose

How long will I feel sick?

Patients with upper respiratory tract infections typically feel sick for one to two weeks; however, this can vary depending on the virus or bacteria causing the infection.^1,2

Pathogen-Specific Information

Viruses:

Adenovirus

Adenovirus. Adenovirus causes the common cold and pharyngitis (sore throat) in children and adults and can also sometimes cause conjunctivitis (pink eye) or gastroenteritis (diarrhea). It can cause more severe disease such as pneumonia in patients with a severely weakened immune system such as patients with cancer. Usually, no specific treatment is needed but patients with a weakened immune system are sometime treated with an intravenous antiviral medicine in the hospital.³

Coronavirus (seasonal)

Coronavirus (seasonal). These viruses are a frequent cause of the common cold in children and adults. They may also cause acute exacerbations of asthma and other chronic lung diseases such as COPD. They are not the same as SARS-CoV-2 (the cause of COVID-19) and generally only cause mild illnesses. They can also cause infection without any symptoms. There are no specific treatments available and no vaccine.^4,5

Coronavirus SARS-CoV-2

Coronavirus SARS-CoV-2. SARS-CoV-2 is a virus that has caused an ongoing pandemic of severe respiratory illness since 2019. Illness causes by SARS-CoV-2 is called COVID-19 (coronavirus associated infectious disease 2019). SARS-CoV-2 can cause a wide variety of illness in adults and children, including the common cold, pharyngitis (sore throat), and severe pneumonia. Some patients may be completely asymptomatic. Elderly patients and those with underlying health problems are at greater risk of developing severe disease. There are several effective vaccines available to help prevent COVID-19 and reduce the risk of severe diseases, and antivirals are also available for patients at high risk of developing severe diseases.^6-8

Human metapneumovirus

Human metapneumovirus. Human metapneumovirus causes the common cold and pharyngitis (sore throat) in children and adults but may also cause lower respiratory tract illness including pneumonia and bronchiolitis (lung infection) in children. There are no specific treatments available and there is no vaccine.⁹

Human rhinovirus/enterovirus

Human rhinovirus/enterovirus. Rhinoviruses are the most frequent cause of the common cold in children and adults. They may also cause acute exacerbations of asthma and other chronic lung diseases such as COPD. Rhinoviruses may also infect people and not cause any symptoms. They generally only cause mild illness and there is no specific treatment available. Enteroviruses are very similar and cause the common cold but may also cause infections in other organs of the body. Most illnesses caused by enteroviral infections are mild. There are no specific treatments available for either rhinovirus or enterovirus and there are no vaccines.^10-12

Influenza A and B virus

Influenza A and B virus. Influenza virus (the flu) causes many cases of respiratory illness every year. While the flu can cause mild symptoms, it more commonly causes moderate illness with fever, headache, muscle pains, and fatigue. It may also cause severe disease that requires care within the hospital. Antiviral medications are available and are recommend for certain patients, especially those at high risk of developing severe complications from influenza, such as pneumonia. Annual vaccines for the flu are available are recommended for anyone over the age of 6 months; however, for patients at high risk, including the elderly and those with underlying health problems, annual vaccination is particularly important.¹³

Parainfluenza virus

Parainfluenza virus. Parainfluenza viruses cause the common cold and pharyngitis (sore throat) in children and adults and can also cause croup (laryngotracheobronchitis) and bronchiolitis (airway infection) in young children. Patients with severely weakened immune systems may develop severe pneumonia. There are no specific treatments available and there is no vaccine.^14,15

Respiratory syncytial virus (RSV)

Respiratory syncytial virus (RSV). RSV causes epidemics of respiratory illness in winter usually just before and during influenza season. It causes the common cold and pharyngitis (sore throat) in children and adults and also frequently causes lower respiratory tract infection, including bronchiolitis and pneumonia (lung infections), in younger children. In addition, elderly patients with long-term health problems and those with weakened immune systems may develop a severe pneumonia. There is no specific treatment available for RSV and there is currently no vaccine although there are current efforts to develop one. There is, however, an antibody injection (Palivizumab) that is used to prevent infection in infants at risk of severe disease including those born prematurely.^16,17

Other

Other. There are other viruses that can affect the respiratory tract, but these are not listed here as they are more commonly associated with other illnesses. Examples include Epstein-Barr virus and cytomegalovirus (the causes of infectious mononucleosis, commonly called “mono”), varicella-zoster virus (the cause chickenpox and shingles), herpes simplex virus, and human immunodeficiency virus (HIV).^18-21

Bacteria

Bordetella pertussis and Bordetella parapertussis

Bordetella pertussis and Bordetella parapertussis. Bordetella pertussis causes the disease called whooping cough. Whooping cough, also known as pertussis, starts with common cold symptoms for around 1-2 weeks before progressing to severe coughing fits. Whooping cough generally affects young children, although teens and adults can be affected with a milder disease. Pertussis is treated with a course of antibiotics to help reduce the severity of illness and prevent spread to others. Pertussis vaccine is part of the standard vaccine schedule for children and is very effective at preventing disease, but immunity wears off over time. Bordetella parapertussis can also cause whooping cough but is less common and tends to cause less severe illness. It is treated with antibiotics in the same way as Bordetella pertussis. Although there is no vaccine for B. parapertussis, immunity from the B. pertussis vaccine may be protective.^22-24

Chlamydia pneumoniae

Chlamydia pneumoniae. Chlamydia pneumoniae is a bacterium that can cause a variety of respiratory illnesses, most commonly common cold symptoms and pharyngitis (sore throat). It can also sometimes cause conjunctivitis (pink eye) and pneumonia (lung infection). Unlike most viral infections, symptoms can last for several weeks. While no vaccine is available, Chlamydia pneumonia is treated with antibiotics.^25,26

Group A Streptococcus

Group A Streptococcus. Group A Streptococcus (also known as Streptococcus pyogenes) is a bacterium that may live the throat of children and adults without causing illness, but it can also cause disease. It is the most common cause of bacterial pharyngitis (“strep throat”) and tonsilitis, which especially affects school-aged children. People with illness caused by group A Streptococcus usually have a high fever and may also develop a characteristic rash (the illness is then called scarlet fever). Illness caused by group A Streptococcus is treated with antibiotics to reduce the severity of illness, reduce the risk of infecting others, and prevent complications which can be severe. There is no vaccine available for group A Streptococcus.²⁷

Mycoplasma pneumoniae

Mycoplasma pneumoniae. Mycoplasma pneumoniae is a bacterium that can cause a wide variety of respiratory illnesses and may also live in the throat without causing illness. Patients who become ill with Mycoplasma pneumoniae may have only common cold symptoms or otitis media (an ear infection), although some will develop pneumonia. Infection with Mycoplasma pneumoniae is sometimes accompanied by a rash that may involve the lips and mouth. Mycoplasma pneumoniae infections are treated with antibiotics and there is no vaccine available.^28,29

References

Cleveland Clinic. (2021, March 25). Upper Respiratory Infection. https://my.clevelandclinic.org/health/articles/4022-upper-respiratory-infection
National Health Service. (2021, April 28). Respiratory tract infections (RTIs). https://www.nhs.uk/conditions/respiratory-tract-infection/
Centers for Disease Control and Prevention (CDC). (2022, Nov 28). Adenovirus: A common cause of respiratory illness. https://www.cdc.gov/adenovirus/index.html
(2020, Feb 13). Common Human Coronaviruses. https://www.cdc.gov/coronavirus/general-information.html
American Lung Association (2023, May 4). Controlling Chronic Lung Diseases Amid COVID-19. https://www.lung.org/lung-health-diseases/lung-disease-lookup/covid-19/chronic-lung-diseases-and-covid
(2022, Oct 26). COVID-19: Symptoms of COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
(2023, April 13). COVID-19: Stay Up to Date with COVID-19 Vaccines Including Boosters. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html
(2023, Feb 10). COVID-19: COVID-19 Treatments and Medications. https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html
National Center for Immunization and Respiratory Diseases (NCIRD). (2023, Feb 10). Human Metapneumovirus (HMPV). https://www.cdc.gov/ncird/human-metapneumovirus.html
(2023, March 8). Rhinoviruses. https://www.cdc.gov/ncird/rhinoviruses-common-cold.html
(2020, Aug 8). Non-Polio Enterovirus: Symptoms. https://www.cdc.gov/non-polio-enterovirus/about/symptoms.html
(2020, Aug 8). Non-Polio Enterovirus: Prevention & Treatment. https://www.cdc.gov/non-polio-enterovirus/about/prevention-treatment.html
World Health Organization. (2023, Jan 12). Influenza (Seasonal). https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
(2022, Dec 22). Human Parainfluenza Viruses (HPIVs): Symptoms and Illnesses. https://www.cdc.gov/parainfluenza/symptoms.html
(2022, Dec 22). HPIVs: Prevention and Treatment. https://www.cdc.gov/parainfluenza/prevention-treatment.html
(2022, Nov). RSV in Infants and Young Children. https://www.cdc.gov/rsv/references.html#factsheet
(2022, Oct). Older Adults are at High Risk for Severe RSV Infection. https://www.cdc.gov/rsv/references.html#factsheet
(2020, Sept 28). Epstein-Barr Virus and Infectious Mononucleosis. https://www.cdc.gov/epstein-barr/index.html
(2020, Aug 18). Cytomegalovirus (CMV) and Congenital CMV Infection. https://www.cdc.gov/cmv/index.html
(2022, Oct 21). About Chickenpox. https://www.cdc.gov/chickenpox/about/index.html
(2022, June 30). About HIV. https://www.cdc.gov/hiv/basics/whatishiv.html
European Centre for Disease Prevention and Control. (2022, Feb 1). Disease factsheet about pertussis. https://www.ecdc.europa.eu/en/pertussis/facts
(2022, Aug 4). Pertussis (Whooping Cough): Diagnosis and Treatment. https://www.cdc.gov/pertussis/about/diagnosis-treatment.html
Liko, J., Robinson, S.G., & Cieslak, P. R.. (2017, June 15). Do Pertussis Vaccines Prevent Against Bordetella parapertussis? https://pubmed.ncbi.nlm.nih.gov/28369240/
(2021, Nov 15). Chlamydia pneumoniae Infection: Signs and Symptoms. https://www.cdc.gov/pneumonia/atypical/cpneumoniae/about/symptoms.html
(2021, Nov 15). Chlamydia pneumonia Infection: Diagnosis, Treatment, and Complications. https://www.cdc.gov/pneumonia/atypical/cpneumoniae/about/treatment.html
(2023, Jan 6). Group A Streptococcal (GAS) Disease. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html
Mount Sinai. (2021, July 31). Mycoplasma pneumonia. https://www.mountsinai.org/health-library/diseases-conditions/mycoplasma-pneumonia
(2022, Aug 24). Mycoplasma pneumoniae Infections: Treatment and Complications. https://www.cdc.gov/pneumonia/atypical/mycoplasma/about/treatment-complications.html