Details of the patient's history aid in differentiating a common cold from conditions that require targeted therapy, such

as group A streptococcal pharyngitis, bacterialsinusitis, and lower respiratory tract infections. The table below contrasts symptoms of URI with symptoms of allergy and seasonal influenza (adapted from the National Institute of Allergy and Infectious Diseases).[9, 12] Table. Symptoms of Allergies, URIs, and Influenza
Symptom Itchy, watery eyes Nasal discharge Nasal congestion Sneezing Sore throat Allergy common URI rare; conjunctivitis may occur with adenovirus common Influenza soreness behind eyes, sometimes conjunctivitis

common

common

common

common

sometimes

very common sometimes (postnasal drip) sometimes

very common very common

sometimes sometimes

Cough

common, mild to moderate, hacking cough rare rare in adults, possible in children sometimes sometimes

common, dry cough, can be severe

Headache Fever

uncommon never

common very common, 100-102F or higher (in young children), lasting 3-4 days; may have chills very common very common, can last for weeks, extreme exhaustion early in course very common, often severe 7 days, followed by additional days of cough and fatigue

Malaise Fatigue, weakness Myalgias Duration

sometimes sometimes

never weeks

slight 3-14 days

Viral nasopharyngitis
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. Foul breath: This occurs as resident flora process the products of the inflammatory process. Foul breath may also occurs with allergic rhinitis. Hyposmia: Also termed anosmia, it is secondary to nasal inflammation. Headache: This symptom is common with many types of URI. Sinus symptoms: These may include congestion or pressure and are common with viral URIs. 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. Fever: This is usually slight or absent, but temperatures can reach 39.4C (103F) 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 40C (104F). Gastrointestinal symptoms: Symptoms such as nausea, vomiting, and diarrhea may occur in persons with seasonal or H1N1 influenza, especially in children. Nausea and abdominal pain may be present in individuals with strep throat and viral syndromes. Severe myalgia: This is typical of influenza infection, especially in the setting of sudden-onset sore throat, fever, chills, nonproductive cough, and headache. Fatigue or malaise: Any type of URI can produce these symptoms. Extreme exhaustion is typical of influenza infection. Bacterial pharyngitis History alone is rarely a reliable differentiator between viral and bacterial pharyngitis. If symptoms persist beyond 10 days or progressively worsen after the first 5-7 days, a bacterial illness is suggested. Assessment for group A streptococci warrants special attention. A personal history of rheumatic fever(especially carditis or valvular disease) or a household contact with a history of rheumatic fever increases a person's risk. Fever increases the suspicion for infection with group A streptococci, as does the absence of cough, rhinorrhea, and conjunctivitis, because these are common in viral syndromes. Other factors include occurrence from November through May and a patient age of 5-15 years.

Pharyngeal symptoms: Sore or scratchy throat, odynophagia, or dysphagia are common. If the uvula or posterior pharynx is inflamed, the patient may have an uncomfortable feeling of a lump when swallowing. Nasal obstruction may cause mouth breathing, which may result in dry mouth, especially in the morning. Group A streptococcal infections often produce a sudden sore throat. Secretions: These may be thick or yellow; however, these features do not differentiate a bacterial infection from a viral one. Cough: It may be due to laryngeal involvement or upper airway cough syndrome related to nasal secretions (postnasal drip).

Foul breath: This symptom may occur because resident flora process the products of the inflammatory process. Foul breath may also occur with allergic rhinitis. Headache: While common with group A streptococci and mycoplasma infections, it also may reflect URI from other causes. Fatigue or malaise: These may occur with any URI. Extreme exhaustion is typical of influenza infection. Fever: While usually slight or absent, temperatures may reach 38.9C (102F) in infants and young children. Rash: A rash may be seen with group A streptococcal infections, particularly in children or adolescents younger than 18 years. Abdominal pain: This symptom may occur in streptococcal disease or with influenza and other viral conditions. History of recent orogenital contact: This is relevant in cases of gonococcal pharyngitis. However, most gonococcal infections of the pharynx are asymptomatic.[16] Acute viral or bacterial rhinosinusitis The presentation of rhinosinusitis is often similar to that of nasopharyngitis because many viral URIs directly involve the paranasal sinuses. Symptoms may have a biphasic pattern, wherein coldlike symptoms initially improve but then worsen. Acute bacterial rhinosinusitis is not common in patients whose symptoms have lasted fewer than 7 days. Unilateral and localizing symptoms raise the suspicion for sinus involvement.

Nasal discharge: This may be persistent and purulent, and sneezing may occur. Mucopurulent secretions are seen with both viral and bacteria infections. Secretions may be yellow or green; however, the color does not differentiate a bacterial sinus infection from a viral one, because thick, opaque, yellow secretions may be seen with uncomplicated viral nasopharyngitis. Rhinorrhea is typically minimal or does not respond to decongestants or antihistamines. Congestion and nasal stuffiness predominate in some individuals. Hyposmia or anosmia: This may occur secondary to nasal inflammation. Facial or dental pressure or pain: In older children and adults, symptoms tend to localize to the affected sinus. Frontal, facial, or retroorbital pain or pressure is common. Maxillary sinus inflammation may manifest as pain in the upper teeth on the affected side. Pain radiating to the ear may represent otitis media or a peritonsillar abscess. Oropharyngeal symptoms: Sore throat may result from irritation from nasal secretions dripping on the posterior pharynx. Nasal obstruction may cause mouth breathing, which may result in dry mouth, especially in the morning. Mouth breathing may especially be noted in children. Dry mouth may be prominent, especially after sleep. Halitosis: Foul breath may be noted because resident florae process the products of the inflammatory process. This symptom may also occur with allergic rhinitis. Cough: Upper airway cough syndrome related to nasal secretions (postnasal drip) may result in frequent throat clearing or cough. Rhinosinusitis-related cough is usually present throughout the day. The cough may also be most prominent on awakening, occurring in response to the presence of secretions that have gathered in the posterior pharynx overnight. Daytime cough that lasts more than 10-14 days suggests sinus disease, asthma, or other conditions. Nighttime-only cough is common in numerous disorders, and many forms of cough are most noticeable at night. Upper airway cough syndrome related to nasal secretions occasionally precipitates posttussive emesis. Clinically significant amounts of purulent sputum may suggest bronchitis or pneumonia. Fever: This is more likely to occur in children than adults with rhinosinusitis. Fever may occur concomitantly with purulent nasal secretions in persons with sinus disease. In those with viral URI, fever, if present, typically precedes the development of purulent nasal secretions.

Fatigue or malaise: These may be seen with any URI. Epiglottitis This condition is more often found in children aged 1-5 years who present with a sudden onset of symptoms:

Sore throat Drooling, odynophagia or dysphagia, difficulty or pain during swallowing, globus sensation of a lump in the throat Muffled dysphonia or loss of voice Dry cough or no cough, dyspnea Fever, fatigue or malaise (may be seen with any URI) Laryngotracheitis

Nasopharyngeal symptoms: Nasopharyngitis often precedes laryngitis and tracheitis by several days. Odynophagia or dysphagia may be reported. Swallowing may be difficult or painful. Patients may experience a globus sensation of a lump in the throat. Hoarseness or loss of voice: This is a key manifestation of laryngeal involvement. Dry cough: In adolescents and adults, laryngotracheal infection may manifest as severe dry cough following a typical URI prodrome. Mild hemoptysis may be present. Barking cough: Children with laryngotracheitis or croup may have the characteristic brassy, seal-like barking cough. Symptoms may be worse at night. Diphtheria also produces a barking cough. Whooping cough: The classic whoop sound[17] is an inspiratory gasping squeak that rises in pitch, typically interspersed between hacking coughs. The whoop is more common in children. Coughing often comes in paroxysms of a dozen coughs or more at a time and is often worst at night. The cough may persist for several weeks. Posttussive symptoms: Posttussive gagging or emesis may be present after paroxysms of whooping cough. Subconjunctival hemorrhage may result from severe cough. Rib pain, with pinpoint tenderness worsening with respiration, may result from rib fracture associated with severe cough. Dyspnea and increased work of breathing: Symptoms may be worse at night because of changes in airway mechanics while the patient is recumbent. Apnea may be a chief feature in infants with pertussis, or whooping cough. Apnea may also result from upper airway obstruction due to other causes. Other symptoms: Myalgias are characteristic in influenza infection, especially in the setting of hoarseness with sudden sore throat, fever, chills, nonproductive cough, and headache. Fever may be present, but it is not typical in persons with croup. Fatigue or malaise may occur with any URI.