Common Cold pp 47-75 | Cite as

Common respiratory infections diagnosed in general practice

  • Alex J. Elliot
  • Douglas M. Fleming
Part of the Birkhäuser Advances in Infectious Diseases book series (BAID)


Acute respiratory infections are one of the most common causes for presentation to a general practitioner. The range of symptoms associated with each infection can be wide ranging in both presentation and severity, depending on age of the patient, underlying co-morbidities and other confounding factors. In this chapter we describe the most common respiratory infections ranging from relatively mild infections such as the common cold, through to more serious presentations including pneumonia. Data are presented from a general practitioner morbidity surveillance system based in England and Wales. Each acute respiratory syndrome is described in respect of seasonality, secular trends and microbiological aetiology providing an insight into the complex nature of these acute respiratory episodes. The more serious endpoints of acute respiratory infections are hospitalisation and death. Many acute respiratory infections are mild in nature and generally self-limiting and therefore do not commonly require further medical interventions. However, despite major advances in the prevention and treatment of acute respiratory infections in recent years, hospitalisation and deaths continue to exert pressures on national health resources and provide an economic burden in countries across the world on an annual basis.


Respiratory Syncytial Virus Severe Acute Respiratory Syndrome Acute Otitis Medium Acute Respiratory Infection Respiratory Syncytial Virus Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fleming DM, Smith GE, Charlton JR, Charlton J, Nicoll A (2002) Impact of infections on primary care — Greater than expected. Commun Dis Public Health 5:7–12PubMedGoogle Scholar
  2. 2.
    Birmingham Research Unit of the Royal College of General Practitioners. Weekly Returns Service Annual Prevalence Report 2007. Available at: (accessed 27 February 2009)Google Scholar
  3. 3.
    Fleming DM (1999) Weekly Returns Service of the Royal College of General Practitioners. Commun Dis Public Health 2:96–100PubMedGoogle Scholar
  4. 4.
    McCormick A, Fleming D, Charlton J (1995) Morbidity statistics from general practice. Fourth national study 1991–1992, HMSO, LondonGoogle Scholar
  5. 5.
    Birmingham Research Unit of the Royal College of General Practitioners. Weekly Returns Service Annual Report 2006. Available at: http://www.rcgp. (accessed 27 February 2009)Google Scholar
  6. 6.
    Fleming DM, Ross AM, Cross KW, Kendall H (2003) The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing. Br J Gen Pract 53:778–783PubMedGoogle Scholar
  7. 7.
    Guo YJ, Jin FG, Wang P, Wang M, Zhu JM (1983) Isolation of influenza C virus from pigs and experimental infection of pigs with influenza C virus. J Gen Virol 64:177–182CrossRefPubMedGoogle Scholar
  8. 8.
    Osterhaus AD, Rimmelzwaan GF, Martina BE, Bestebroer TM, Fouchier RA (2000) Influenza B virus in seals. Science 288:1051–1053CrossRefPubMedGoogle Scholar
  9. 9.
    Nicholson KG (1998) Human Influenza. In: KG Nicholson, RG Webster, AJ Hay (eds): Textbook of Influenza. Blackwell Sciences, Oxford, 219–264Google Scholar
  10. 10.
    Webster RG, Bean WJ, Gorman OT, Chambers TM, Kawaoka Y (1992) Evolution and ecology of influenza A viruses. Microbiol Rev 56:152–179PubMedGoogle Scholar
  11. 11.
    Fouchier RA, Munster V, Wallensten A, Bestebroer TM, Herfst S, Smith D, Rimmelzwaan GF, Olsen B, Osterhaus AD (2005) Characterization of a novel influenza A virus hemagglutinin subtype (H16) obtained from black-headed gulls. J Virol 79:2814–2822CrossRefPubMedGoogle Scholar
  12. 12.
    Monto AS, Comanor L, Shay DK, Thompson WW (2006) Epidemiology of pandemic influenza: Use of surveillance and modeling for pandemic preparedness. J Infect Dis 194 (Suppl 2):S92–S97CrossRefPubMedGoogle Scholar
  13. 13.
    Zambon MC, Stockton JD, Clewley JP, Fleming DM (2001) Contribution of influenza and respiratory syncytial virus to community cases of influenza-like illness: An observational study. Lancet 358:1410–1416CrossRefPubMedGoogle Scholar
  14. 14.
    Mufson MA, Levine HD, Wasil RE, Mocega-Gonzalez HE, Krause HE (1973) Epidemiology of respiratory syncytial virus infection among infants and children in Chicago. Am J Epidemiol 98:88–95PubMedGoogle Scholar
  15. 15.
    Nicholson KG, McNally T, Silverman M, Simons P, Stockton JD, Zambon MC (2006) Rates of hospitalisation for influenza, respiratory syncytial virus and human metapneumovirus among infants and young children. Vaccine 24: 102–108CrossRefPubMedGoogle Scholar
  16. 16.
    Parrott RH, Kim HW, Arrobio JO, Hodes DS, Murphy BR, Brandt CD, Camargo E, Chanock RM (1973) Epidemiology of respiratory syncytial virus infection in Washington, D.C. II. Infection and disease with respect to age, immunologic status, race and sex. Am J Epidemiol 98:289–300PubMedGoogle Scholar
  17. 17.
    Walsh EE, Peterson DR, Falsey AR (2007) Is clinical recognition of respiratory syncytial virus infection in hospitalized elderly and high-risk adults possible? J Infect Dis 195:1046–1051CrossRefPubMedGoogle Scholar
  18. 18.
    Cane PA (2001) Molecular epidemiology of respiratory syncytial virus. Rev Med Virol 11:103–116CrossRefPubMedGoogle Scholar
  19. 19.
    Falsey AR, Walsh EE, Capellan J, Gravenstein S, Zambon M, Yau E, Gorse GJ, Edelman R, Hayden FG, McElhaney JE et al. (2008) Comparison of the safety and immunogenicity of 2 respiratory syncytial virus (RSV) vaccines — nonadjuvanted vaccine or vaccine adjuvanted with alum — given concomitantly with influenza vaccine to high-risk elderly individuals. J Infect Dis 198:1317–1326CrossRefPubMedGoogle Scholar
  20. 20.
    Kim HW, Canchola JG, Brandt CD, Pyles G, Chanock RM, Jensen K, Parrott RH (1969) Respiratory syncytial virus disease in infants despite prior administration of antigenic inactivated vaccine. Am J Epidemiol 89:422–434PubMedGoogle Scholar
  21. 21.
    Hall CB (2001) Respiratory syncytial virus and parainfluenza virus. N Engl J Med 344:1917–1928CrossRefPubMedGoogle Scholar
  22. 22.
    Jartti T, Lehtinen P, Vuorinen T, Osterback R, van den Hoogen B, Osterhaus AD, Ruuskanen O (2004) Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis 10:1095–1101PubMedGoogle Scholar
  23. 23.
    Fry AM, Curns AT, Harbour K, Hutwagner L, Holman RC, Anderson LJ (2006) Seasonal trends of human parainfluenza viral infections: United States, 1999–2004. Clin Infect Dis 43:1016–1022CrossRefPubMedGoogle Scholar
  24. 24.
    (2003) Severe acute respiratory syndrome (SARS). Wkly Epidemiol Rec 78:81–83Google Scholar
  25. 25.
    Drosten C, Gunther S, Preiser W, van der Werf S, Brodt HR, Becker S, Rabenau H, Panning M, Kolesnikova L, Fouchier RA et al. (2003) Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 348:1967–1976CrossRefPubMedGoogle Scholar
  26. 26.
    Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W et al. (2003) A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 348:1953–1966CrossRefPubMedGoogle Scholar
  27. 27.
    Message SD, Johnston SL (2002) Viruses in asthma. Br Med Bull 61:29–43CrossRefPubMedGoogle Scholar
  28. 28.
    Nicholson KG, Kent J, Ireland DC (1993) Respiratory viruses and exacerbations of asthma in adults. BMJ 307:982–986CrossRefPubMedGoogle Scholar
  29. 29.
    Hicks LA, Shepard CW, Britz PH, Erdman DD, Fischer M, Flannery BL, Peck AJ, Lu X, Thacker WL, Benson RF et al. (2006) Two outbreaks of severe respiratory disease in nursing homes associated with rhinovirus. J Am Geriatr Soc 54:284–289CrossRefPubMedGoogle Scholar
  30. 30.
    Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, Young SA, Chambers ST, Murdoch DR (2008) Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63:42–48CrossRefPubMedGoogle Scholar
  31. 31.
    Louie JK, Yagi S, Nelson FA, Kiang D, Glaser CA, Rosenberg J, Cahill CK, Schnurr DP (2005) Rhinovirus outbreak in a long term care facility for elderly persons associated with unusually high mortality. Clin Infect Dis 41:262–265CrossRefPubMedGoogle Scholar
  32. 32.
    van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA, Osterhaus AD (2001) A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 7:719–724CrossRefPubMedGoogle Scholar
  33. 33.
    Camps M, Ricart S, Dimova V, Rovira N, Munoz-Almagro C, Garcia JJ, Pons-Odena M, Marcos MA, Pumarola T (2008) Prevalence of human metapneumovirus among hospitalized children younger than 1 year in Catalonia, Spain. J Med Virol 80:1452–1460CrossRefPubMedGoogle Scholar
  34. 34.
    Stockton J, Stephenson I, Fleming D, Zambon M (2002) Human metapneumovirus as a cause of community-acquired respiratory illness. Emerg Infect Dis 8: 897–901PubMedGoogle Scholar
  35. 35.
    Johnstone J, Majumdar SR, Fox JD, Marrie TJ (2008) Viral infection in adults hospitalized with community-acquired pneumonia: Prevalence, pathogens, and presentation. Chest 134:1141–1148CrossRefPubMedGoogle Scholar
  36. 36.
    Walsh EE, Peterson DR, Falsey AR (2008) Human metapneumovirus infections in adults: Another piece of the puzzle. Arch Intern Med 168:2489–2496CrossRefPubMedGoogle Scholar
  37. 37.
    Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung-Lindell A, Andersson B (2005) Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci USA 102:12891–12896CrossRefPubMedGoogle Scholar
  38. 38.
    Ma X, Endo R, Ishiguro N, Ebihara T, Ishiko H, Ariga T, Kikuta H (2006) Detection of human bocavirus in Japanese children with lower respiratory tract infections. J Clin Microbiol 44:1132–1134CrossRefPubMedGoogle Scholar
  39. 39.
    Sloots TP, McErlean P, Speicher DJ, Arden KE, Nissen MD, Mackay IM (2006) Evidence of human coronavirus HKU1 and human bocavirus in Australian children. J Clin Virol 35:99–102CrossRefPubMedGoogle Scholar
  40. 40.
    Weissbrich B, Neske F, Schubert J, Tollmann F, Blath K, Blessing K, Kreth HW (2006) Frequent detection of bocavirus DNA in German children with respiratory tract infections. BMC Infect Dis 6:109CrossRefPubMedGoogle Scholar
  41. 41.
    Goddard NL, Cooke MC, Gupta RK, Nguyen-Van-Tam JS (2007) Timing of monoclonal antibody for seasonal RSV prophylaxis in the United Kingdom. Epidemiol Infect 135:159–162CrossRefPubMedGoogle Scholar
  42. 42.
    Fleming DM, Elliot AJ, Nguyen-van Tam JS, Watson JM, Wise R (2005) A Winter’s Tale: Coming to terms with winter respiratory illnesses. Health Protection Agency, LondonGoogle Scholar
  43. 43.
    Elliot AJ, Fleming DM (2008) Viral infections and acute otitis media in young children. Clin Infect Dis 47:146–147CrossRefPubMedGoogle Scholar
  44. 44.
    Fatahzadeh M, Schwartz RA (2007) Human herpes simplex labialis. Clin Exp Dermatol 32:625–630CrossRefPubMedGoogle Scholar
  45. 45.
    Gupta R, Warren T, Wald A (2007) Genital herpes. Lancet 370:2127–2137CrossRefPubMedGoogle Scholar
  46. 46.
    Fleming DM, Cross KW, Cobb WA, Chapman RS (2004) Gender difference in the incidence of shingles. Epidemiol Infect 132:1–5CrossRefPubMedGoogle Scholar
  47. 47.
    Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M (2008) Acyclovir for treating primary herpetic gingivostomatitis. Cochrane Database Syst Rev: CD006700Google Scholar
  48. 48.
    Amir J, Harel L, Smetana Z, Varsano I (1997) Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ 314:1800–1803PubMedGoogle Scholar
  49. 49.
    Spratley J, Silveira H, Alvarez I, Pais-Clemente M (2000) Acute mastoiditis in children: Review of the current status. Int J Pediatr Otorhinolaryngol 56:33–40CrossRefPubMedGoogle Scholar
  50. 50.
    Zenetti D, Nassif N (2006) Indications for surgery in acute mastoiditis and their complications in children. Int J Pediatr Otorhinolaryngol 70:1175–1182CrossRefGoogle Scholar
  51. 51.
    Gill JM, Fleischut P, Haas S, Pellini B, Crawford A, Nash DB (2006) Use of antibiotics for adult upper respiratory infections in outpatient settings: A national ambulatory network study. Fam Med 38:349–354.PubMedGoogle Scholar
  52. 52.
    Dykewicz MS (2003) 7. Rhinitis and sinusitis. J Allergy Clin Immunol 111:S520–S529CrossRefPubMedGoogle Scholar
  53. 53.
    Birmingham Research Unit of the Royal College of General Practitioners. Weekly Returns Service Annual Report 2007. Available at: (accessed 27 February 2009)Google Scholar
  54. 54.
    Denny FW, Murphy TF, Clyde WA Jr, Collier AM, Henderson FW (1983) Croup: An 11-year study in a pediatric practice. Pediatrics 71:871–876PubMedGoogle Scholar
  55. 55.
    Bjornson CL, Johnson DW (2008) Croup. Lancet 371:329–339CrossRefPubMedGoogle Scholar
  56. 56.
    Stroud RH, Friedman NR (2001) An update on inflammatory disorders of the pediatric airway: Epiglottitis, croup, and tracheitis. Am J Otolaryngol 22: 268–275CrossRefPubMedGoogle Scholar
  57. 57.
    Guldfred LA, Lyhne D, Becker BC (2008) Acute epiglottitis: Epidemiology, clinical presentation, management and outcome. J Laryngol Otol 1222:818–823Google Scholar
  58. 58.
    McIntyre P (2004) Vaccines for other neonatal infectio9ns: vaccination strategies for the prevention of neonatal pertussis. Expert Rev Vaccines 3:375–378CrossRefPubMedGoogle Scholar
  59. 59.
    Miller E, Fleming DM, Ashworth LA, Mabbett DA, Vurdien JE, Elliott TS (2000) Serological evidence of pertussis in patients presenting with cough in general practice in Birmingham. Commun Dis Public Health 3:132–134PubMedGoogle Scholar
  60. 60.
    Montella S, De Stefano S, Sperli F, Barbarano F, Santamaria F (2007) Increased risk of chronic suppurative lung disease after measles or pertussis in nonvaccinated children. Vaccine 25:402–403CrossRefPubMedGoogle Scholar
  61. 61.
    Gershon AA (2005) Measles virus (Rubeola). In: GL Mandell, JE Bennett, R Dolin (eds): Principles and Practice of Infectious Diseases. Elsevier, Philadelphia, 2031–2038Google Scholar
  62. 62.
    Fleming DM (1994) Facts for audit and facts from an audit of throat swabs. Audit Trends 2:137–141Google Scholar
  63. 63.
    Martin JM, Green M (2006) Group A streptococcus. Semin Pediatr Infect Dis 17:140–148CrossRefPubMedGoogle Scholar
  64. 64.
    Dunn N, Lane D, Everitt H, Little P (2007) Use of antibiotics for sore throat and incidence of quinsy. Br J Gen Pract 57:45–49PubMedGoogle Scholar
  65. 65.
    Morris MC, Edmunds WJ (2002) The changing epidemiology of infectious mononucleosis? J Infect 45:107–109CrossRefPubMedGoogle Scholar
  66. 66.
    di Camugliano GN (1933) The chronicles of a Florentine family, 1200–1470, J. Cape, LondonGoogle Scholar
  67. 67.
    Smith W, Andrewes CH, Laidlaw PP (1933) A virus obtained from influenza patients. Lancet ii:66–68CrossRefGoogle Scholar
  68. 68.
    Elliot AJ, Fleming DM (2006) Surveillance of influenza-like illness in England and Wales during 1966–2006. Euro Surveill 11:249–250PubMedGoogle Scholar
  69. 69.
    Kilbourne ED (2006) Influenza pandemics of the 20th century. Emerg Infect Dis 12:9–14PubMedGoogle Scholar
  70. 70.
    Elliot AJ, Cross KW, Fleming DM (2007) Acute respiratory infections and winter pressures on hospital admissions in England and Wales 1990–2005. J Public Health (Oxf) 30:91–98Google Scholar
  71. 71.
    Fleming D, Harcourf S, Smith G (2003) Influenza and adult hospital admissions for respiratory conditions in England 1989–2001. Commun Dis Public Health 6: 231–237PubMedGoogle Scholar
  72. 72.
    Bhat N, Wright JG, Broder KR, Murray EL, Greenberg ME, Glover MJ, Likos AM, Posey DL, Klimov A, Lindstrom SE et al. (2005) Influenza-associated deaths among children in the United States, 2003–2004. N Engl J Med 353: 2559–2567CrossRefPubMedGoogle Scholar
  73. 73.
    Health Protection Agency (2003) Influenza in the United Kingdom. CDR Weekly 13:6Google Scholar
  74. 74.
    Chapman RS, Smith GE, Warburton F, Mayon-White RT, Fleming DM (2002) Impact of NHS Direct on general practice consultations during the winter of 1999–2000: Analysis of routinely collected data. BMJ 325:1397–1398CrossRefPubMedGoogle Scholar
  75. 75.
    Fleming DM, Elliot AJ (2006) Changing disease incidence: The consulting room perspective. Br J Gen Pract 56:820–824PubMedGoogle Scholar
  76. 76.
    Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K (2003) Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 289:179–186CrossRefPubMedGoogle Scholar
  77. 77.
    Health Protection agency. Seasonal Influenza. Available at: (accessed 27 February 2009)Google Scholar
  78. 78.
    Fleming DM, Pannell RS, Cross KW (2005) Mortality in children from influenza and respiratory syncytial virus. J Epidemiol Community Health 59:586–590CrossRefPubMedGoogle Scholar
  79. 79.
    Elliot AJ, Paget WJ, Donker G, Falcao JM, Falcao I, Fleming DM (2008) Are children the main transmitters of influenza-like illness in the community; an analysis of data from European sentinel networks: The third European Influenza Conference. European Scientific Working Group on Influenza, Vilamoura, PortugalGoogle Scholar
  80. 80.
    Fleming DM, Elliot AJ, Cross KW (2007) Morbidity profiles of patients consulting during influenza and respiratory syncytial virus active periods. Epidemiol Infect 135:1099–1108PubMedGoogle Scholar
  81. 81.
    Mangtani P, Hajat S, Kovats S, Wilkinson P, Armstrong B (2006) The association of respiratory syncytial virus infection and influenza with emergency admissions for respiratory disease in London:an analysis of routine surveillance data. Clin Infect Dis 42:640–646CrossRefPubMedGoogle Scholar
  82. 82.
    Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K (2004) Influenza-associated hospitalizations in the United States. JAMA 292:1333–1340CrossRefPubMedGoogle Scholar
  83. 83.
    Hospital Episode Statistics Online. Hospital Episode Statistics: Primary diagnosis 3 character—2006/07. Available at: (accessed 27 February 2009)Google Scholar
  84. 84.
    Fleming DM (2000) The contribution of influenza to combined acute respiratory infections, hospital admissions, and deaths in winter. Commun Dis Public Health 3:32–38PubMedGoogle Scholar
  85. 85.
    Fleming DM, Cross KW, Pannell RS (2005) Influenza and its relationship to circulatory disorders. Epidemiol Infect 133:255–262CrossRefPubMedGoogle Scholar
  86. 86.
    National Statistics Online. Population estimates for UK, England and Wales, Scotland and Northern Ireland. Available at: (accessed 27 February 2009)Google Scholar
  87. 87.
    Elliot AJ, Cross KW, Smith GE, Fleming DM (2007) Do children drive the spread of influenza-like illness in the community? Presented at: Options for the Control of Influenza VI. mediTech Media Conferencing, Inc., Toronto, Canada, Abstract P1311Google Scholar

Copyright information

© Birkhäuser Verlag Basel/Switzerland 2009

Authors and Affiliations

  • Alex J. Elliot
    • 1
    • 2
  • Douglas M. Fleming
    • 1
  1. 1.Royal College of General Practitioners Research and Surveillance CentreHarborne, BirminghamUK
  2. 2.Real-Time Syndromic Surveillance TeamHealth Protection AgencyBirminghamUK

Personalised recommendations