1c. A patient with persisting cough following viral upper respiratory tract infection.
Case history- A young lady presents with cough persisting for 13 days following recovery from a viral upper respiratory tract infection 20 days back.
What would you consider as differential diagnosis?
Acute bronchitis
Primary viral pneumonias
Post viral bronchial hyper reactivity
Precipitation of cough variant asthma
- Acute bronchitis– It often follows acute coryza. Initially dry cough, then chest tightness, wheeze and breathlessness develop. Sputum is initially scanty or mucoid then becomes mucopurulent, more copious, and often blood-stained. Acute bronchitis may be associated with a pyrexia of 38-39°C. On auscultation of chest, wide spread rhonchi and crepitation are found. Spontaneous recovery occurs over a few days
Treatment- Specific treatment rarely necessary in previously healthy individuals.
Amoxicillin 250 mg 8-hourly for 7 days
Cough may be eased by pholcodine 5-10 mg 6-8-hourly.
- Primary viral pneumonias– may cause pneumonia commonly complicated by secondary bacterial infection which is treated as bacterial pneumonia.
- Post viral bronchial hyperreactivity- Postviral bronchial hyperreactivity syndrome is a common complication of upper and lower respiratory tract viral infections. The respiratory symptoms closely resemble those of asthma (cough, wheeze and chest tightness), but they are present for only 3 weeks to 3 months following the acute viral infection.
Treatment- Bronchodilator such as beta 2 agonist inhaler (sulbutamol) and/or corticosteroid inhaler (beclomethasone) usually for 3 months.