Snapshot A 35-year-old gentleman presents to the urgent care center for a cough, runny nose, and sore throat of a week duration. Yesterday, his cough worsened, and he began coughing up yellow sputum. On physical exam, his lungs reveal rales in the right lower lobe. A chest radiograph demonstrates a right lower lobe infiltrate. He is started on antibiotics for pneumonia. (Coronavirus infection with bacterial superinfection) Introduction Clinical definition acute infection of upper respiratory system often caused by viral agents Prevention no vaccines available Epidemiology Incidence very common Demographics all ages Risk factors immunosuppression sick contacts smoking recent travel on airplane Etiology Pathogenesis depends on specific viral agent viral replication often occurs in tracheobronchial epithelium (except rhinovirus, which replicates in the nasopharynx epithelium) Rhinovirus (most common) Coronavirus (second most common) Influenza Respiratory syncytial virus Parainfluenza virus Adenovirus Presentation Symptoms rhinorrhea congestion cough sore throat malaise Physical exam low-grade fever hoarse voice lungs are usually clear to auscultation Imaging Chest radiography indication only if pneumonia is suspected (e.g., lung exam with rales or focal crackles/rhonchi) findings lobar consolidation Studies Making the diagnosis based on clinical presentation diagnosis of exclusion in patients with immunosuppression Differential Streptococcal pharyngitis distinguishing factor typically presents with erythematous pharynx, tonsillar exudates, petechiae, and tender lymphadenopathy tests positive on a rapid strep test Infectious mononucleosis distinguishing factor erythematous oropharyynx, tonsillar exudates, petechiae, posterior cervical lymphadenopathy, splenomegaly tests positive on monospot test Influenza distinguishing factor systemic symptoms usually predominate with high fever and general malaise Treatment Management approach mainstay of treatment is supportive care Conservative supportive care indication all patients modalities hydration analgesics steroid nasal spray may help with rhinorrhea Complications Bacterial superinfection Post-viral tussis self-resolves Prognosis Self-limited but may last for 2 weeks