An Upper Respiratory Tract Dilemma

By Dr Floyd Gomes

Welcome, everybody. Thanks for tuning in. I’m Dr. Floyd Gomes and this is a very simple podcast to debunk your questions “is it a virus or bacteria? I’ve got a cough, I’ve got a fever. Is it a cold doctor? Do I need antibiotics or not?”

Well, when someone comes in, which they often do, thinking about this problem, the thing to understand is, it’s hard to say, with 100%, either, really. So you’re trying to work out the probabilities, like many things. The idea that someone has a virus is generally supported if you’ve got a runny nose, a cough, and a sore throat.  And all of these symptoms are in general, rather than on one side of your throat, or one side of your face hurting more, things like this.

A fever

The second part about that is is a fever. If someone has a high fever, that can be with a virus initially, but generally, that fades away. If after a week, and after they reasonably got better, then got worse and their fever started to spike again, you’d be a bit suspicious. What can happen there, is you start off with a virus, your body doesn’t quite get better. And you go on to get a secondary bacterial infection, or you get a little bit better, and then you go on to get a secondary bacterial infection. The fact is, that rather than getting better over a period of time, or after getting better, after a period of time, you get worse. And you have a fever, and you feel worse. It is an important question. Sometimes after a week, people will say, “Look, I’m still coughing, but I’m feeling really good.” Otherwise, “I’m eating and drinking and feeling good. But I’ve got this cough.” Well, that’s a bit different to someone who, after a period of time, is feeling worse. So a bit of a subjective thing. But “how do you feel, better or worse?” People will tell you.  If you’re feeling worse after a while, well you might be getting a secondary infection.

A sore throat

Thinking about a sore throat in particular, the evidence of having a bacterial infection, maybe tonsillitis or bacterial sore throat, that could include the fact that you don’t have a runny nose, you don’t have a cough, you just have a sore throat, and you’ve got perhaps one side of your throat that’s a lot more sore than the other. And in your neck, your glands are swollen and tender. You might find it really hard to eat. But that isolated sore throat particularly with a high fever, that’s suspicious of a bacterial infection. If you are able to look in the mirror and look down at your tonsils in your throat and you find yellow spots or white spots, and it’s very red, basically, if you’ve got pus, well that’s sounding more like a bacterial infection. It could also be something described as glandular fever, which is Epstein Barr Virus, which can also give you a bit of a white sort of layer on your tonsils and very big swollen neck but putting that aside, you’ve probably got a bacterial infection.

A cough

With regards to a cough, it’s a tough one. Have I got a chest infection or is it just a cough that lingers after a cold? It’s not so easy to decide. But once again, I think if someone’s feeling worse after a week or two, it’s a bit dubious. If they’ve persisted having fever, it’s a bit suss as well. And if they cough is productive, meaning, you’re coughing up a lot of phlegm, you’ve got to ask the question. “is it a bacterial infection?” If that phlegm is very colorful, green, yellow, thick, well, more likely to be bacterial.

Asthma

The only thing about that is sometimes people who have asthma do have a productive cough that has green phlegm in particular. And that’s because of the type of cells they tend to shed as part of asthma, called eosinophils. But basically, if you can have a cough that is primarily asthmatic, and have productive phlegm, usually, you’d also have wheeze with asthma, not always, but usually.

Virus or bacteria – summing it up

So coming back to this, a virus, which is your common cold not requiring antibiotics, you usually have a runny nose, or maybe a sore throat and a cough and the cough’s dry. You might still be coughing after a week, but you’re feeling better, you don’t have a fever. There’s no pus in your throat. But if you’ve got, after a week or so, a sore throat and you’ve got pus on your tonsils, and your neck is swollen, and coughing up a lot of phlegm and you’ve got a fever and generally feeling worse, well you might have a bacterial infection, particularly if you’ve only got a sore throat.

Sinusitis

Just one other thing, there’s sinusitis, which is what’s classically congestion in your face. What happens is you’ve got air spaces in your face in your skull, they usually drain through your nose. The reason for those air spaces, nobody really knows – if it’s to make your skull lighter or to help your voice resonate. Not sure. But the fact is that they can get blocked. And if they do, you can get that feeling of congestion in your face.  You get a headache, your eyes hurt, your cheeks might hurt.  It can be viral and just a mild thing.  Or, it can be more severe. That’s called sinusitis.  It’s a bacterial infection once again. And in this case, after a week or so, you’re very sore in the face. You have high fevers, and if you were to push on your face, indeed, probably pretty tender.  Might have thick phlegm that flows down the back of your throat or that you can blow out your nose. So that can happen after about a week to 10 days for some people so just keep an eye on that. Once again, early in the piece, could be viral, but could turn into something bacterial.

So those are the things guys. Is it a virus or bacteria? Bacteria – just a different type of infection really, that at the end of the day antibiotics could help with.  Keep those signs in mind and the symptoms in mind and if you’re needing anything, then you know what to do. Okay, thanks guys. Bye