Can an upper respiratory tract infection cause vomiting?

Can Upper Respiratory Tract Infections Cause Vomiting?

Yes, upper respiratory tract infections can definitely cause vomiting, particularly in specific clinical contexts including pertussis (whooping cough), pediatric influenza, and certain viral infections with combined respiratory-gastrointestinal manifestations.

Pertussis as a Classic URTI Cause of Vomiting

The most characteristic URTI-associated vomiting occurs with pertussis (whooping cough), where posttussive vomiting is a hallmark diagnostic feature. 1

• When cough is accompanied by paroxysms of coughing, posttussive vomiting, and/or an inspiratory whooping sound, pertussis should be diagnosed unless another diagnosis is proven 1
• Posttussive vomiting has high specificity (77.7%) for pertussis, meaning when present, it strongly suggests the disease 2
• The vomiting occurs specifically after coughing paroxysms during the paroxysmal phase, which lasts 4-6 weeks 2
• This infection is highly contagious but responds to antibiotic coverage with an oral macrolide when administered early 1

Pediatric Influenza and URTIs

In children, vomiting is a common manifestation of influenza-related URTIs and should not be dismissed as merely gastrointestinal illness. 1

• Influenza is commonly characterized in children by otitis media, nausea, and vomiting in addition to respiratory symptoms 1
• Young children are less likely to report typical influenza symptoms and may present primarily with vomiting 1
• In infants, influenza can initially present with signs similar to bacterial sepsis, high fever, or febrile seizures 1

Pediatric Sinusitis

Acute bacterial sinusitis in children frequently presents with vomiting as a prominent symptom. 1

• Symptoms of acute bacterial sinusitis in children include increased irritability, prolonged cough, and vomiting that occurs in association with gagging on mucus 1
• This vomiting mechanism differs from pertussis—it results from gagging on postnasal drainage rather than post-coughing paroxysms 1

Viral Infections with Combined Symptoms

COVID-19 represents the predominant contemporary viral URTI that presents with both respiratory and gastrointestinal symptoms including vomiting. 3

• The prevalence of GI symptoms in COVID-19 patients ranges from 11-37%, with nausea/vomiting occurring in 3.7-25% of cases 3
• GI symptoms can precede respiratory symptoms by several days, making early recognition challenging 3
• The presence of GI symptoms (diarrhea or nausea/vomiting) increases the risk of testing positive for COVID-19 by 70% 3

Clinical Pitfalls to Avoid

Do not assume vomiting automatically indicates gastroenteritis when respiratory symptoms are present—consider pertussis, influenza, and COVID-19 in your differential. 1, 3

• Pertussis can be missed in vaccinated adolescents and adults because the illness may be milder with absent whoop, but posttussive vomiting may still occur 2
• In young children with URTI and vomiting, assess for dehydration and electrolyte abnormalities, as these patients may require aggressive hydration 3
• Patients are most infectious during the catarrhal stage of pertussis when symptoms are least specific and before the characteristic posttussive vomiting develops 2

When to Suspect Specific Etiologies

For pertussis: Look for cough lasting ≥2 weeks with paroxysms, vomiting specifically after coughing episodes, and possible inspiratory whoop 1, 2

For influenza in children: Consider when vomiting occurs with fever, cough, and during influenza season, especially if the child appears more systemically ill than typical gastroenteritis 1, 4

For COVID-19: Suspect when vomiting occurs with any respiratory symptoms during periods of community transmission, particularly if GI symptoms precede respiratory complaints 3