Research about nasal discharge differential diagnosis

Nasal discharge differential diagnosis

Introduction

Nasal discharge or in another words rhinorrhea. It is an excess nasal drainage that may be

transparent watery fluid, yellow or also green and don't be surprised when i say your nose

normally discharge about 1 to 1.5 liters a day but you don't feel anything because as i said

“NORMALLY” which means its drained to your mouth and you swallowed… yes it is normally

swallowed and digested i your stomach and don't feel creepy

Indeed you have suffered excess nasal discharge before when you last caught cold and you also

have seen people with allergy or even normal healthy people when they cry their nose leak. It is

simply the nose connected to the eyes by the nasolacrimal duct and tears get down into the nose

through it, which is normal and there is no pathology or shame when you cry

If you still amazed about that creepy yellow and green discharge you better wait as they are not

so dangerous. The real dangerous is when your nose bleed. Yes, that is “Epistaxis” RED nasal

discharge in another words bleeding might kill as the patient loses bood which may be severe

and cause hypovolemic shock with a rapid weak pulse and this patient really needs some help

Lets talk viscosity… i know its sounds creepy but its okay its science. When you last swallowed

your excess discharge “which is normal to swallow it” you might have felt it as if it was only a

salty water [watery] present in Allergy, cold, and also in CSF Rhinorrha. The discharge might

also be little viscid [mucous or purulent] and that purulent discharge present if there is a 2ry

bacterial infection on top of the common cold. Which simply means you got a viral plus a

bacteria infection on top and don't panic there is a treatment for that too. You might have had a

bleedy nose which may be as simple as a small tear in your nasal mucosa or as bad as a tumor in

nose. Bleedy nose for more that 10 min is risky and the patient should run to a doctor The

discharge might vary in color too. Yellow or green or light blue which indicate a bacterial infection of nose or paranasal sinus. And we will take about the diseases and even the normal

conditions that cause discharge as we go in the research.

Objectives

-A large number of questions related to diagnosis, evaluation and treatment of this condition

remain unanswered, so the aim of our study is to clarify all this

-differentiate among the symptoms of each disease

Overall, the most common causes of nasal discharge are:-

1- Common cold

2- Influenza

3- COVID-19

4- Acute sinusitis

5- Chronic sinusitis

6- Allergies

7- Nasal polyp

8- Granulomatosis with Polyangiitis

1.Common cold

Definition

The common cold is a viral infection of your nose and throat (rhinoviruses are the most common

cause) It's usually harmless, although it might not feel that way

Transmitted by

A cold virus enters your body through your mouth, eyes or nose. The virus can spread through

droplets in the air when someone who is sick coughs, sneezes or talks.

Symptoms of a common cold

Usually appear one to three days after exposure to a cold causing virus Runny or stuffy nose,

Sore throat, Cough, Congestion, Slight body aches or a mild headache, Sneezing, Low grade

fever And Generally feeling unwell.

Stages appear in clinic

Ischemic stage or dry stage: local discomfort in the nose and nasopharynx (burning, soreness) &

sneezing. Congestion stage or catarrhal stage marked by Slight fever headache malaise and a

watery nasal discharge and nasal obstruction due to mucosal swelling. Stage of secondary

bacterial infection: Nasal discharge become mucopurulent. Resolution stage: Symptoms usually

subside within a week.

Risk factors

These factors can increase your chances of getting a cold: Age. Infants and young children are at

greatest risk of colds. Weakened immune system. Time of year: common in Smoking: You’re

more likely to catch a cold and Exposure. If around crowds.

Complications

Inflammation and infection including strep throat, pneumonia, and croup or bronchiolitis in

children Spread to nasal vestibule &Otitis media &Asthma. A cold can trigger wheezing &

Pharyngitis and Sinusitis.

Prevention and treatment

There's no vaccine for the common cold but avoid predisposing factors: avoid contact with

patients. Most people recover from a common cold in a week or 10 days. Curative wash your hands, bed rest, Cover your cough, ample fluids, analgesics, antipyretics and Vít.C. Take care of

yourself. Eating well and getting exercise and enough sleep is good for your overall health. Nose

drops: shouldn’t be used more than one week to avoid rhinitis medicaments.

2.Influenza

Definition

Influenza is an acute viral respiratory infection that causes significant morbidity and mortality

worldwide. Three types of influenza cause disease in humans. Influenza A is the type most

responsible for causing pandemics because of its high susceptibility to antigenic variation.

Influenza is highly contagious.

Diagnosis

The hallmark of infection is abrupt onset of fever, cough, chills or sweats, myalgia, and malaise.

For most patients in the outpatient setting, the diagnosis is made clinically, and laboratory

confirmation is not necessary. Laboratory testing may be useful in hospitalized patients with

suspected influenza and in patients for whom a confirmed diagnosis.

Symptoms

Sore throat due to spread of infection and release of bradykinin. Cough it may persist for 3 weeks

and it mediated by Vegas nerve irritation. headache common symptoms in 60%of patients.

muscles aches and pain. Nasal congestion due to dilation of large veins of nasal epithelium.Malaise and mood changes. Fever is a common symptoms and sign about 38:39 8- Sneezing, like

sore throat, is a prominent early symptom associated with URTIs.

Complications

Inflammation and infection including strep throat, pneumonia, and croup or bronchiolitis in

children Spread to nasal vestibule &Otitis media &Asthma. A cold can trigger wheezing &

.Pharyngitis and Sinusitis.

Treatment

Rapid molecular assays are the preferred diagnostic tests because they can be done at the point of

care, are highly accurate, and have fast results. Treatment with one of four approved anti-

influenza drugs may be considered if the patient presents within 48 hours of symptom onset. The

benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom

onset. These drugs decrease the duration of illness by about 24 hours in otherwise healthy

patients and may decrease the risk of serious complications. No anti-influenza drug has been proven superior. Annual influenza vaccination is recommended for all people six months and

older who do not have contraindications.

3.COVID-19

Definition

Covid-19 is a disease caused by SARS-CoV-2 which is one of seven types of coronavirus,

including the ones that cause severe diseases like Middle East respiratory syndrome (MERS) and

sudden acute respiratory syndrome (SARS).

Symptoms and signs

Fever, Coughing, Shortness of breath, Trouble breathing, Fatigue, Chills, sometimes with

shaking, body aches, headache, sore throat, congestion runny nose, loss of smell or taste, nausea,

diarrhea, age and sex have been shown to affect the severity

Complications

Coagulopathy, mainly disseminated intravascular coagulation, venous thromboembolism,

elevated D-dimer and prolonged prothrombin time, laryngeal edema and laryngitis in critically ill

patients with COVID-19, necrotizing pneumonia due to superinfection caused by Panton-

Valentine leucocidin–secreting Staphylococcus aureus infection, massive pulmonary embolism

complicated by acute right-sided heart failure, sepsis, septic shock and multiple organ failure and

high risk of death with hyperglycemic patients and high dose corticosteroids, cardiovascular

complications, including acute pericarditis, left ventricular dysfunction, acute myocardial injury,

acute respiratory failure, approximately 5% of COVID-19 patients require admittance to an

intensive care unit because they develop severe disease complicated by acute respiratory distress

syndrome, ventilation-associated pneumonia in up to 30% of patients requiring intensive mechanical ventilation, elderly patients with chronic medical conditions are at an increased risk

of altered mental state and acute encephalopathy.

Investigations

generally we can do CT chest, Chest X-ray , CBC , Serum ferritin, C Reactive protein and D

dimer, for confirmation with Covid RT PCR should be done, cardiac biomarkers for cvs

complications.

Treatment

It’s especially important to get plenty of rest, drink fluids and eat healthy meals , get enough

sleep and get physical activity, conventional oxygen therapy if difficulty in breathing,

vitamins must be given asymptomatic or Presymptomatic Infection should be advised to isolate

themselves and monitor clinical symptoms, elderly patients and those with pre-existing

conditions should be monitored closely until clinical recovery is achieved, antipyretics and anti-

viral therapy must be given, antibiotics should be given if a second bacterial infection occurs,

anti-inflammatory drugs and immune modulators in severe cases.

Prevention

There are many steps you can take to reduce your risk of infection from the COVID-19 virus

and reduce the risk of spreading it to others. WHO and CDC recommend following these

precautions: Get vaccinated, avoid close contact (within about 6 feet, or 2 meters) with anyone

who is sick or has symptoms, keep at least 6 feet (2 meters) of distance between yourself and

others when you're in indoor public spaces if you're not fully vaccinated, avoid crowds and

indoor places that have poor airflow (ventilation), wash your hands often with soap and water for

at least 20 seconds. If you're not able to wash your hands, use an alcohol-based hand sanitizer

that contains at least 60% alcohol, wear a face mask in indoor public spaces if you're in an area

with a high number of people with COVID-19 in the hospital and new COVID-19 cases, whether

or not you're vaccinated, cover your mouth and nose with your elbow or a tissue when you cough

or sneeze. Throw away the used tissue. Wash your hands right away, avoid touching your eyes,

nose and mouth, clean and disinfect often-touched surfaces regularly, If you have a chronic

medical condition, you may have a higher risk of serious illness. Check with your health care

provider about other ways to protect yourself.

If you want to read the rest of the research, open the attached pdf of the research

And thank you