Patient Handout: Common Wintertime Illnesses

The following was posted in my exam rooms today.  Feel free to copy/distribute it.

Upper Respiratory Infection

  • Symptoms:  Stuffy/runny nose, cough, sneezing, sore/scratchy throat, fever
  • Cause:  Viruses – Can happen any time of the year
  • Course: Lasts for 3-7 days
  • Treatment (Over 2 years of age)
    • Decongestants (Pseudoephedrine, phenylephrine)
    • Cough suppressants
    • Tylenol/Ibuprofen
    • Mucinex to loosen phlegm
    • Antibiotics do not help an upper respiratory infection.
  • Contagiousness: Viruses are transmitted through direct contact with someone who is carrying the virus.  Washing hands is the best way to prevent spread.

Sinus Infection

  • Symptoms:  Pressure/pain on the cheeks below the eyes and/or on the forehead immediately above the eyes upper teeth hurting, nasal congestion, fever and sore throat.
  • Cause:  Bacteria or Viruses – The sinuses are filled with mucous when a person gets an upper respiratory infection or has bad allergies, and the symptoms of sinusitis are not uncommon in this case.  If the fluid becomes infected with a bacteria, the fluid becomes thicker, and the pain can become more intense.
  • Course: If viral, will go away within a week.  If bacterial, will take longer.
  • Treatment
    • Decongestants (Pseudoephedrine, phenylephrine)
    • Antihistamines can thicken the phlegm, so can make things worse.
    • Over the counter nasal sprays (Afrin, etc) can help, but should never be used for more than 5 consecutive days.
    • Mucinex to loosen phlegm
    • Saline rinses of the nasal passages can loosen phlegm
    • Prescription nasal sprays like Flonase can help; they can also prevent sinus infections in people who are prone to it.
    • Antibiotic use is debatable (although it is standard practice).  Many studies show that the addition of antibiotics to the above treatments does not speed up improvement.  If an antibiotic is prescribed, we strongly prefer to wait until symptoms have been there for 1 week and the other treatments have been tried.  We do not give antibiotics “just to be on the safe side,” or “because it always turns into a sinus infection.”  This is the type of prescribing that has caused antibiotic resistance to occur.
  • Contagiousness:  The viruses that cause sinus infections have similar contagiousness to the upper respiratory infection.  The bacteria infection is not contagious.

Bronchitis

  • Symptoms:  Persistent loose cough
  • Cause:  Viruses are the most likely cause of bronchitis, not bacteria (as is widely thought).
  • Course: Viral bronchitis lasts for 3-7 days
  • Treatment
    • Humidifier
    • Cough suppressants
    • Mucinex to loosen phlegm
    • Antibiotics do not help viral bronchitis.  We strongly prefer to not treat bronchitis with an antibiotic until the symptoms have been there over a week.  We will use them sooner to people who have chronic lung problems or are particularly frail.  If it lasts over a week, the likelihood it is bacterial is much higher, so an antibiotic may help.
  • Contagiousness: The viruses and bacteria that cause bronchitis have similar contagiousness to upper respiratory infections, although some are more prone to become airborne (because of the coughing).

Influenza

  • Symptoms:  High fever, body aches, and headaches are the hallmark symptoms of flu.  The patient also can have cough, upper respiratory symptoms and mild intestinal tract symptoms.  The fever tends to run higher than with other infections (102-105 range).   People who have influenza look like they’ve been hit by a truck.
  • Cause:  Influenza virus – there are two types, A and B – A being more serious.  This occurs between December and April – usually in January through March, and it occurs in epidemics.
  • Course: Lasts for 5-7 days
  • Treatment
    • Ibuprofen/Tylenol for body aches and fever.
    • Symptomatic treatment of other symptoms (Medications like Thera-Flu can help).
    • Rest and lots of fluids.
    • There are anti-viral medications for influenza, but these are reserved for people with Influenza A who are at increased risk of complications (the very old or very young, and people with lung or heart problems).
  • Complications – Influenza is a very dangerous infection for people who are at risk (infants and elderly).  The major complication is pneumonia caused by the Staph bacteria.  If someone is diagnosed with influenza and develops the symptoms of pneumonia (productive cough and shortness of breath), they need to see the doctor immediately and are generally hospitalized.
  • Contagiousness – Flu is very contagious during epidemics.  Hand washing can help, but the best preventive measure is to get an influenza vaccine in the fall.  Even if the strain of influenza is not the one in the vaccine, people who get a flu shot are less likely to have a serious case.

10 thoughts on “Patient Handout: Common Wintertime Illnesses”

  1. I just wanted to say that this post might suddenly find itself translated to my language and hung in the waiting room of my wife’s practice. Great work, thanks for sharing!

  2. I just wanted to say that this post might suddenly find itself translated to my language and hung in the waiting room of my wife’s practice. Great work, thanks for sharing!

  3. Thoughts from a non-doctor, would antibiotics be appropriate if the URI has a bacterial etiology?
    And thoughts about Influenza:

    Historical Facts Believed To Be Associated With Influenza:

    The last influenza pandemic that occurred in the United States was nearly 100 years ago, and this deadly outbreak resulted in about 50 million deaths worldwide. The pandemic that occurred before this one happened about thirty years before the 1918 flu. Influenza epidemics typically occur about every 8 months or so. Influenza is caused by a virus, which is a parasite that needs a host to survive and reproduce.
    It was called the Spanish Flu because the first human case was identified there. The pandemic ended up killing more than those that died during WWI. Understandably there was panic among people worldwide, as influenza was not discovered until 1933, so the mystery was rather frightening of what was happening.
    Those who survived have allowed others to obtain antibodies from them to develop other antibodies for future viral outbreaks that may occur with this type of virus. This last influenza pandemic also allowed others to obtain this virus from those who died as a result to facilitate effective treatments and vaccines for viral outbreaks that may happen in the future as well.
    The virus responsible for the 1918 pandemic was an avian influenza. Nearly 700,000 people in the U.S. died as the result of the Spanish Flu- and those that did die was due often to a bacterial pneumonia that followed the viral invasion and damage. Ultimately, this pandemic killed nearly 3 percent of humans infected. Normally, an influenza strain may kill less than one percent of those infected. The Spanish Flu caused an unusually severe immune response in the human host which made it very deadly due to overkill of the cells of this host.
    The influenza viruses are categorized as A, B, and C. The Influenza A virus is the one that historically has caused pandemics that have developed-, such as the Spanish Flu Pandemic. The other influenza pandemics primarily have occurred in countries in Asia.
    With influenza, it is understood that the disease influenza is a disease caused by a RNA virus that can infect both mammals and birds. In fact, this particular virus can mutate to where it can be shared between the two life forms and multiply within each one of them. Unlike coryza, influenza expresses symptoms more severely, and usually lasts two weeks until one recovers who has the flu. Influenza, however, poses a danger to some with compromised immune systems, such as the chronically ill, so the recommendation is greater in such populations, along with women who may be pregnant during the flu season, residents of nursing homes or chronic care facilities. Health care personnel are encouraged to get the flu vaccine as well. Such populations allow influenza to progress to deadly pneumonia.
    Symptoms of influenza usually start to express themselves symptomatically about two days or so after being infected with the virus. Over 10 percent of the population is infected with this virus every year- resulting in about 200,000 hospitalizations and nearly 40,000 deaths. This season’s first influenza case was identified in Delaware in November of 2008, and it was a type B influenza strain.

    The flu vaccination is trivalent- meaning it contains three viral strains of suspected viruses for flu outbreaks during a particular winter season, as determined by the World Health Organization, as well as the Centers for Disease Control, and other organizations. Unfortunately, the influenza vaccine administered last flu season was largely ineffective due to unsuspected strains of the virus infecting others, although about 140 million injections of this vaccine were administered.
    After giving the vaccination dose to one, it takes about 10 days for that person to build up the immunity for the disease of influenza. The months of October to December are recommended to receive this vaccine. And the vaccine is about 50 percent effective in offering protection from influenza, according to others. Vaccines are a catalyst for antibody production in humans, which protect them against the virus. Influenza vaccines can be given by injection or nasally.
    Anti-virals, on the other hand, decrease greatly the ability for viruses to reproduce once established in a human.
    The Avian influenza that many have heard of is potentially the next flu pandemic- as humans have no immunity to what is called the H5N1 virus- on of about 1 strains of avian Influenza. For an Influenza pandemic to occur, which means a global disease existence, the virus must emerge from another species to humans without immunity, as well as the ability to make more humans ill than normal. Also, the virus must be highly contagious for a pandemic to occur. The H5N1 virus appears to replicate in the human GI tract and also has a longer incubation period in humans, one to two weeks, compared with other influenza strains. The H5N1 Avian influenza virus seems to have become progressively more pathogenic in the past decade, according to others.
    With the Avian Influenza existing with the H5N1 strain, millions of birds have been slaughtered due to the danger and unpredictability of this strain. The first human case infected with this strain occurred in China in 1997. The first human avian flu case outside of China was identified in 2003 in the Netherlands. The first recorded incidence of human-to-human transmission of the H5N1 virus was in Thailand in 2004. In 2006, it was discovered that the H5N1 had split into two separate strains. There have been outbreaks of Avian flu in about 15 countries in the world so far- with Indonesia being the worst. Migratory birds spread this influenza virus between continents.
    The pathogenic strength of the H5N1 strain varies due to constant re-assortment or switching of genetic material between the viruses- essentially creating a hybrid of what it was before this occurs. So far, about 300 people worldwide have been infected with this strain- and about half have died from the infection. Vaccinations are being developed and reformulated constantly at this time due to the pandemic threat of the H5N1 Influenza virus.
    Yet, the normal flu season that is now occurring was supplied with 150 million vaccines in the United States. However, some studies have shown that this vaccine is rather ineffective based on incidences of the acquisition of the influenza virus by others anyway.
    The influenza season peaks between the months of January and March. The vaccine for this influenza season is manufactured by 6 different companies. Yet the strains chosen are speculated influenza viruses, as this does not eliminate the chance of a new and dominant influenza viral strain that possibly could cause a pandemic. It takes manufacturers about 6 months to make and formulate the influenza vaccination. There is a vaccine for this illness that is produced every year according to which type of virus may be prevalent during a particular flu season. If influenza occurs in a human host, the results may be the patient acquiring pneumonia or meningitis.
    The presence of influenza can be widespread in certain states, yet not others. The vaccination is recommended to be administered to those who are at high risk, such as the chronically ill. Also, it is recommended that those under 18 years of age get the vaccine, as well as those people over the age of 50. Furthermore, those people who regularly take aspirin should receive the vaccine, as the influenza disease can become a catalyst for what is called Reye’s Syndrome. Pregnant women should receive the vaccine as well- as there are many other vaccines available to fortunately prevent other diseases, perhaps.
    http://www.cdc.gov/flu/weekly/
    Dan Abshear

  4. Thoughts from a non-doctor, would antibiotics be appropriate if the URI has a bacterial etiology?
    And thoughts about Influenza:

    Historical Facts Believed To Be Associated With Influenza:

    The last influenza pandemic that occurred in the United States was nearly 100 years ago, and this deadly outbreak resulted in about 50 million deaths worldwide. The pandemic that occurred before this one happened about thirty years before the 1918 flu. Influenza epidemics typically occur about every 8 months or so. Influenza is caused by a virus, which is a parasite that needs a host to survive and reproduce.
    It was called the Spanish Flu because the first human case was identified there. The pandemic ended up killing more than those that died during WWI. Understandably there was panic among people worldwide, as influenza was not discovered until 1933, so the mystery was rather frightening of what was happening.
    Those who survived have allowed others to obtain antibodies from them to develop other antibodies for future viral outbreaks that may occur with this type of virus. This last influenza pandemic also allowed others to obtain this virus from those who died as a result to facilitate effective treatments and vaccines for viral outbreaks that may happen in the future as well.
    The virus responsible for the 1918 pandemic was an avian influenza. Nearly 700,000 people in the U.S. died as the result of the Spanish Flu- and those that did die was due often to a bacterial pneumonia that followed the viral invasion and damage. Ultimately, this pandemic killed nearly 3 percent of humans infected. Normally, an influenza strain may kill less than one percent of those infected. The Spanish Flu caused an unusually severe immune response in the human host which made it very deadly due to overkill of the cells of this host.
    The influenza viruses are categorized as A, B, and C. The Influenza A virus is the one that historically has caused pandemics that have developed-, such as the Spanish Flu Pandemic. The other influenza pandemics primarily have occurred in countries in Asia.
    With influenza, it is understood that the disease influenza is a disease caused by a RNA virus that can infect both mammals and birds. In fact, this particular virus can mutate to where it can be shared between the two life forms and multiply within each one of them. Unlike coryza, influenza expresses symptoms more severely, and usually lasts two weeks until one recovers who has the flu. Influenza, however, poses a danger to some with compromised immune systems, such as the chronically ill, so the recommendation is greater in such populations, along with women who may be pregnant during the flu season, residents of nursing homes or chronic care facilities. Health care personnel are encouraged to get the flu vaccine as well. Such populations allow influenza to progress to deadly pneumonia.
    Symptoms of influenza usually start to express themselves symptomatically about two days or so after being infected with the virus. Over 10 percent of the population is infected with this virus every year- resulting in about 200,000 hospitalizations and nearly 40,000 deaths. This season’s first influenza case was identified in Delaware in November of 2008, and it was a type B influenza strain.

    The flu vaccination is trivalent- meaning it contains three viral strains of suspected viruses for flu outbreaks during a particular winter season, as determined by the World Health Organization, as well as the Centers for Disease Control, and other organizations. Unfortunately, the influenza vaccine administered last flu season was largely ineffective due to unsuspected strains of the virus infecting others, although about 140 million injections of this vaccine were administered.
    After giving the vaccination dose to one, it takes about 10 days for that person to build up the immunity for the disease of influenza. The months of October to December are recommended to receive this vaccine. And the vaccine is about 50 percent effective in offering protection from influenza, according to others. Vaccines are a catalyst for antibody production in humans, which protect them against the virus. Influenza vaccines can be given by injection or nasally.
    Anti-virals, on the other hand, decrease greatly the ability for viruses to reproduce once established in a human.
    The Avian influenza that many have heard of is potentially the next flu pandemic- as humans have no immunity to what is called the H5N1 virus- on of about 1 strains of avian Influenza. For an Influenza pandemic to occur, which means a global disease existence, the virus must emerge from another species to humans without immunity, as well as the ability to make more humans ill than normal. Also, the virus must be highly contagious for a pandemic to occur. The H5N1 virus appears to replicate in the human GI tract and also has a longer incubation period in humans, one to two weeks, compared with other influenza strains. The H5N1 Avian influenza virus seems to have become progressively more pathogenic in the past decade, according to others.
    With the Avian Influenza existing with the H5N1 strain, millions of birds have been slaughtered due to the danger and unpredictability of this strain. The first human case infected with this strain occurred in China in 1997. The first human avian flu case outside of China was identified in 2003 in the Netherlands. The first recorded incidence of human-to-human transmission of the H5N1 virus was in Thailand in 2004. In 2006, it was discovered that the H5N1 had split into two separate strains. There have been outbreaks of Avian flu in about 15 countries in the world so far- with Indonesia being the worst. Migratory birds spread this influenza virus between continents.
    The pathogenic strength of the H5N1 strain varies due to constant re-assortment or switching of genetic material between the viruses- essentially creating a hybrid of what it was before this occurs. So far, about 300 people worldwide have been infected with this strain- and about half have died from the infection. Vaccinations are being developed and reformulated constantly at this time due to the pandemic threat of the H5N1 Influenza virus.
    Yet, the normal flu season that is now occurring was supplied with 150 million vaccines in the United States. However, some studies have shown that this vaccine is rather ineffective based on incidences of the acquisition of the influenza virus by others anyway.
    The influenza season peaks between the months of January and March. The vaccine for this influenza season is manufactured by 6 different companies. Yet the strains chosen are speculated influenza viruses, as this does not eliminate the chance of a new and dominant influenza viral strain that possibly could cause a pandemic. It takes manufacturers about 6 months to make and formulate the influenza vaccination. There is a vaccine for this illness that is produced every year according to which type of virus may be prevalent during a particular flu season. If influenza occurs in a human host, the results may be the patient acquiring pneumonia or meningitis.
    The presence of influenza can be widespread in certain states, yet not others. The vaccination is recommended to be administered to those who are at high risk, such as the chronically ill. Also, it is recommended that those under 18 years of age get the vaccine, as well as those people over the age of 50. Furthermore, those people who regularly take aspirin should receive the vaccine, as the influenza disease can become a catalyst for what is called Reye’s Syndrome. Pregnant women should receive the vaccine as well- as there are many other vaccines available to fortunately prevent other diseases, perhaps.
    http://www.cdc.gov/flu/weekly/
    Dan Abshear

  5. Why evolution matters, part 1 « FYI: Science!

    […] influenza, or mono.  In addition, even infections which might be bacterial (like sinus infections) might not need antibiotics.  While I admit I do take my kids to the doctor probably more often than I need to, I know […]

  6. Among the decongestants, are pseudoephedrine and phenylephedrine still allowed? Also, do you think that mucinex actually does anything, or is it more placebo?

  7. Among the decongestants, are pseudoephedrine and phenylephedrine still allowed? Also, do you think that mucinex actually does anything, or is it more placebo?

  8. I hope your patients didn't notice, but...

    Mucous is an adjective. I think you mean mucus.

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