The Common ColdRhinosinusitis

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INTRODUCTION• The common cold is a viral illness in which the Prominent nasal symptoms => rhinorrhea and

nasal obstruction; Mild or absent systemic symptoms = > headache,

myalgia, and fever.

Self-limited

Correct termed Rhino-sinusitis

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EtiologyMost common rhinovirus

Epidemiology

Reflecting the seasonal prevalence• Early fall until the late spring, (RHINOVIRUS ) .• Late fall and late spring (IV , PIV , RSV ).

•The incidence :• Young children have an average of 6-8 colds per year,

but 10-15% of children have at least 12 infections per year.

• The incidence of illness decreases with age, with 2 to 3 illnesses per year by adulthood.

• Mannose-binding lectin deficiency with impaired innate immunity may be associated with an increased incidence of colds in children.

Pathogenesis• Spread by small-particle aerosols, large-particle aerosols,

and direct contact.• Infections with rhinoviruses and adenoviruses (NOT BY

IV,PIV, RSV )result in the development of serotype-specific protective immunity. But Repeated infections due to a large number of distinct serotypes of each virus.

• Viral infection of the nasal epithelium can be associated with destruction of the epithelial lining, as with influenza viruses and adenoviruses, BUT no apparent histologic damage, as with rhinoviruses and RSV.

• acute inflammatory response appears to be responsible for S/S .

• Inflammation can obstruct the sinus ostium or eustachian tube and predispose to bacterial sinusitis or otitis media.

Clinical Manifestations• IP=> 1-3 days after viral

infection.• The 1st symptom noted is often

sore or scratchy throat, followed closely by nasal obstruction and rhinorrhea.

• The sore throat usually resolves quickly and, by the 2nd and 3rd day of illness, nasal symptoms predominate.

• Cough is associated with ∼30% of colds and usually begins after the onset of nasal symptoms.

• The usual cold persists for about 1 wk, although 10% last for 2 wk.

• The physical findings of the common cold are limited to the upper respiratory tract.

• Increased nasal secretion is usually obvious; a change in the color or consistency of the secretions is common during the course of the illness and does not indicate sinusitis or bacterial superinfection.

• Examination of the nasal cavity might reveal swollen, erythematous nasal turbinates, although this finding is nonspecific and of limited diagnostic value.

Etiology Key Points on History or Physical ExaminationIInfections Sinusitis Age (>2 yr), duration (>10 days), high fever,

unilateral headache, or facial tenderness, nasal discharge

   Pharyngitis (streptococcal) ) Exudate, petechiae, tender cervical lymph nodes, minimal congestion

Pneumonia (viral or bacterial) Respiratory signsAllergy Allergic rhinitis History of atopy, itchy and watery eyes, allergic

facies, nasal eosinophiliaStructural Foreign body Unilateral, foul-smelling   Anatomic (polyp, adenoids) Duration (>2 mo), often unilateraSystemic Disease Cystic fibrosis or immune Failure to thrive, duration (>2 mo), diarrhea,

pneumonia, and other infections

Laboratory Findings

ROUTINE LAB Routine laboratory

studies are not helpful for the diagnosis and management of the common cold.

A nasal smear for eosinophils may be useful if allergic rhinitis is suspected .

STUDY &SUSPECTED polymerase chain

reaction (PCR), culture, antigen detection, or serologic methods.

Bacterial cultures or antigen detection are useful only when group A streptococcus , Bordetella pertussis or nasal diphtheria is suspected.

Treatment

Symptomatic Treatment: Antiviral Treatment Ineffective Treatments

The management of the common cold consists primarily of symptomatic treatment

Symptomatic Treatment:

FEVER• Not indicated EXCEPT• COMPLICATION & H/O

FS

NASAL OBSTRUCTION• Either topical or oral

adrenergic agents can be used as nasal decongestants.

• Effective topical adrenergic agents such as xylometazoline, oxymetazoline, or phenylephrine are available as either intranasal drops or nasal sprays.

• > 2 YEARS .• Saline nose drops (wash,

irrigation) can improve nasal symptoms.

Symptomatic Treatment:

RHINORRHOEA• The first-generation

antihistamines reduce rhinorrhea by 25-30% BUT not second generation .

• The major adverse effect is sedation, but less bothersome in children than in adults .

• Ipratropium bromide, a topical anticholinergic , antihistamines NON sedative agent.

SORE THROAT• Treatment with mild

analgesics is occasionally indicated, particularly if there is associated myalgia or headache.

• The use of acetaminophen during rhinovirus infection has been associated with suppression of neutralizing antibody responses,

Symptomatic Treatment

COUGH• Cough suppression is

generally not necessary in patients with colds.

• Treatment with a first-generation antihistamine may be helpful.

• Sugar-containing cough drops or honey as a demulcent may be temporarily effective.

• cough that persists for days to weeks after the acute illness and might benefit from bronchodilator therapy .

• The combination of camphor, menthol, and eucalyptus oils may relieve nocturnal cough.

Ineffective Treatments• Vitamin C, guaifenesin, and inhalation of warm,

humidified air .• Zinc,• Echinacea

Antiviral & Antibacterial Treatment • Specific antiviral therapy has no role in the

treatment of the common cold.• Antibacterial therapy is of no benefit in the

treatment of the common cold.

Complications• OTITIS MEDIA ,• SINUSITIS ,• Exacerbation of asthma

Important consequence of the common cold• is the inappropriate use of antibiotics for these

illnesses and the associated contribution to the problem of increasing antibiotic resistance of pathogenic respiratory bacteria

Prevention

• Chemoprophylaxis or immunoprophylaxis is generally not available for the common cold

• Handwashing is commonly recommended for prevention of colds