Common cold

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Common cold
Classification and external resources

Molecular surface of one variant of human rhinovirus.

ICD-10 J00.0
ICD-9 460
DiseasesDB 31088
MedlinePlus 000678
eMedicine aaem/118 med/2339
MeSH D003139

The common cold (viral upper respiratory tract infection (VURI), acute viral
rhinopharyngitis, acute coryza, or cold) is a contagious, viral infectious disease of the upper
respiratory system, caused primarily by rhinoviruses and coronaviruses.[1] Common symptoms
include a sore throat, runny nose, and fever. There is no cure; however, symptoms usually
resolve spontaneously in 7 to 10 days, with some symptoms possibly lasting for up to three
weeks.[2]

The common cold is the most frequent infectious disease in humans[3] with on average two to
four infections a year in individual adults and up to 6 - 12 in individual children. Collectively,
colds, influenza, and other infections with similar symptoms are included in the diagnosis of
influenza-like illness. They may also be termed upper respiratory tract infections (URTI).
Influenza involves the lungs while the common cold does not.
Contents
[hide]

 1 Signs and symptoms

o 1.1 Progression
o 1.2 Complications
 2 Cause
o 2.1 Viruses
o 2.2 Risk factors
 3 Pathophysiology
 4 Prevention
 5 Management
o 5.1 Conservative
o 5.2 Antibiotics and antivirals
o 5.3 Alternative treatments
 6 Prognosis
 7 Epidemiology
 8 History
o 8.1 Common Cold Unit
 9 Social and cultural
o 9.1 Economics
o 9.2 Legal
o 9.3 Cold weather
 10 Research
 11 References
 12 External links

[edit] Signs and symptoms

Symptoms are cough, sore throat, runny nose, and nasal congestion; sometimes this may be
accompanied by conjunctivitis (pink eye), muscle aches, fatigue, headaches, shivering, and loss
of appetite. Fever is often present thus creating a symptom picture which overlaps with
influenza.[4] The symptoms of influenza however are usually more severe.[5] The common cold
usually resolves spontaneously in 7 to 10 days, but some symptoms can last for up to three
weeks.[2] In children the cough lasts for more than 10 days in 35-40% and continue for more than
25 days in 10%.[6]

Those suffering from colds often report a sensation of chilliness even though the cold is not
generally accompanied by fever, and although chills are generally associated with fever, the
sensation may not always be caused by actual fever.[4] In one study, 60% of those suffering from
a sore throat and upper respiratory tract infection reported headaches[4], often due to nasal
congestion.
[edit] Progression

The viral replication begins 8 to 12 hours after initial contact.[7] Symptoms usually begin 2 to 5
days after initial infection but occasionally occur in as little as 10 hours.[8] Symptoms peak 2–3
days after symptom onset, whereas influenza symptom onset is constant and immediate.[4] The
symptoms usually resolve spontaneously in 7 to 10 days but some can last for up to three weeks.
[2]

The first indication of an upper respiratory virus is often a sore or scratchy throat. Other common
symptoms are runny nose, congestion, and sneezing.[9] These are sometimes accompanied by
muscle aches, fatigue, malaise, headache, weakness, or loss of appetite.[10] Cough and fever
generally indicate influenza rather than an upper respiratory virus with a positive predictive
value of around 80%.[4] Symptoms may be more severe in infants and young children, and in
these cases it may include fever and hives.[11] Upper respiratory viruses may also be more severe
in smokers.[12]

[edit] Complications

The common cold can lead to symptoms of acute bronchitis, bronchiolitis, croup, pneumonia,
sinusitis, otitis media, or strep throat. People with chronic lung diseases such as asthma and
COPD are especially vulnerable. Colds may cause acute exacerbations of asthma, emphysema or
chronic bronchitis.[7]

[edit] Cause
[edit] Viruses

The common cold is due to a viral infection of the upper respiratory tract. The most commonly
implicated virus is a rhinovirus (30-50%), a type of picornavirus with 99 known serotypes.[4][13][14]
Others include: coronavirus (10-15%), influenza (5-15%)[4], human parainfluenza viruses, human
respiratory syncytial virus, adenoviruses, enteroviruses, and metapneumovirus.[9]

In total over 200 serologically different viral types cause colds.[4] Coronaviruses are particularly
implicated in adult colds. Of over 30 coronaviruses, 3 or 4 cause infections in humans, but they
are difficult to grow in the laboratory and their significance is thus less well-understood.[9] Due to
the many different types of viruses and their tendency for continuous mutation, it is impossible to
gain complete immunity to the common cold.

[edit] Risk factors

 Spending time in an enclosed area with an infected person or in close contact with an
infected person. Common colds are droplet-borne infections, which means that they are
primarily transmitted through breathing in tiny particles that the infected person emits
when he or she coughs, sneezes, or exhales.
  The role of body cooling in causing the common cold is controversial.[15] It is the most
commonly offered folk explanation for the disease, and it has received some
experimental evidence. One study showed that exposure to the cold causes cold
symptoms in about 10% of those exposed, and that the subjects experiencing this effect
report far more colds overall than those who do not.[16] However, a variety of other
studies do not show such an effect.[15]
 Frequently touching eyes, nose, or mouth with contaminated fingers. This behavior
somewhat increases the likelihood of transferring viruses from the surface of the hands,
where they are harmless, into the upper respiratory tract, where they can infect the
tissues.[7][9] Some studies show that very frequent hand washing and not touching any
mucous membranes can somewhat reduce the likelihood of acquiring a cold among
adults.[17]
 A history of smoking extends the duration of illness by about three days.[18]
 Getting fewer than seven hours of sleep per night has been associated with a risk three
times higher of developing an infection when exposed to a rhinovirus, compared to those
who sleep more than eight hours per night.[19]
 Low blood vitamin D levels are associated with an increased the risk of getting a
common cold.[20] Whether this relation is causal has yet to be determined.[21]
 Common colds are seasonal, occurring more frequently during winter outside of tropical
zones. This is believed to be partly due to a change in behaviors such as increased time
spent indoors, which puts infected people in close proximity to other people, rather than
to exposure to cold temperatures.[9][22]
 Low humidity increases viral transmission rates. One theory is that dry air causes
evaporation of water, thus allowing small viral droplets to disperse farther and stay in the
air longer.[23]

[edit] Pathophysiology

The common cold is a disease of the upper respiratory tract

The common cold virus is transmitted mainly from contact with the saliva or nasal secretions of
an infected person, either directly, when a healthy person breathes in the virus-laden aerosol
generated when an infected person coughs or sneezes, or by touching a contaminated surface and
then touching the nose or eyes.[24]

Symptoms are not necessary for viral shedding or transmission, as a percentage of asymptomatic
subjects exhibit viruses in nasal swabs.[25] It is generally not possible to identify the virus type
through symptoms, although influenza can be distinguished by its sudden onset, fever, and
cough.[4]

The major entry point for the virus is normally the nose, but can also be the eyes (in this case
drainage into the nasopharynx would occur through the nasolacrimal duct). From there, it is
transported to the back of the nose and the adenoid area. The virus then attaches to a receptor,
ICAM-1, which is located on the surface of cells of the lining of the nasopharynx. The receptor
fits into a docking port on the surface of the virus. Large amounts of virus receptor are present on
cells of the adenoid. After attachment to the receptor, virus is taken into the cell, where it starts
an infection.[7] Rhinovirus colds do not generally cause damage to the nasal epithelium.
Macrophages trigger the production of cytokines, which in combination with mediators cause the
symptoms. Cytokines cause the systemic effects. The mediator bradykinin plays a major role in
causing the local symptoms such as sore throat and nasal irritation.[4]

The common cold is self-limiting, and the host's immune system effectively deals with the
infection. Within a few days, the body's humoral immune response begins producing specific
antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-
mediated immune response, leukocytes destroy the virus through phagocytosis and destroy
infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the
common cold resolves in seven days on average.[7]

[edit] Prevention
The best prevention is staying away from people who are infected, because the overwhelming
majority of infections are acquired by inhaling virus-laden air that an infected person has
coughed, sneezed, or breathed out. Available clinical evidence also suggests that exposure to
cold temperatures may compromise the immune system[15](though this effect is controversial).
Exposure to cold temperatures should thus be avoided during periods of low temperature,
especially by vulnerable populations.[15]

Additionally, experts frequently recommend thorough and regular washing of the hands,
especially in healthcare environments, as this reduces the likelihood of transmission through the
less common route of direct contact.[26][27] In homes, schools, and workplaces, handwashing and
alcohol-based hand sanitizers reduce the number of viruses on the skin significantly,[28] but
because upper respiratory infections are primarily acquired through breathing, rather than
physical contact, these are not especially effective preventive methods.[29] High levels of
handwashing can result in a decrease of 20% or less in transmission of the common cold.[17]
Alcohol-based hand sanitizers provide very little protection against upper respiratory infections,
especially among children.[30][31] Because the common cold is caused by a virus instead of a
bacterium, anti-bacterial soaps are no better than regular soap for removing the virus from skin
or other surfaces.[26][32] Not touching the nose, eyes, or mouth with potentially contaminated
fingers can also reduce transmission of the virus through direct contact.[7][9]

Efforts to develop a vaccine against the common cold have been unsuccessful. Common colds
are produced by large variety of rapidly mutating viruses; successful creation of a broadly
effective vaccine is highly improbable.[33]

[edit] Management

Poster encouraging citizens to "Consult your Physician" for treatment of the common cold

There are currently no medications or herbal remedies which have been conclusively
demonstrated to shorten the duration of illness.[34] Treatment comprises symptomatic support
usually via analgesics for fever, headache, sore muscles, and sore throat.

[edit] Conservative

Treatments that help alleviate symptoms include simple analgesics and antipyretics such as
ibuprofen[35] and acetaminophen / paracetamol. Evidence does not show that cold medicines are
any more effective than simple analgesics[36] and are not recommended for use in children due to
no evidence supporting their effectiveness and the potential of harm.[37][38]

Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water,
are reasonable conservative measures.[9] Evidence for encouraging the active intake of fluids in
acute respiratory infections is lacking[39] as is the use of heated humidified air.[40] Saline nasal
drops may help alleviate nasal congestion.[41]
[edit] Antibiotics and antivirals

Antibiotics are not effective against the viruses that cause the common cold[42] and due to their
side effects cause overall harm.[42] There are no approved antiviral drugs for the common cold
even though some preliminary research has shown benefit.[43]

[edit] Alternative treatments

Main article: Alternative treatments used for the common cold

Many alternative treatments are used to treat the common cold. However, there is insufficient
scientific evidence to support the use of any alternative medicine treatments.[12][44] Honey may be
an effective treatment of cough and improved sleep difficulty in children more than no treatment
or dextromethorphan.[45]

[edit] Prognosis
The common cold is generally mild and self-limiting.[46]

[edit] Epidemiology
Upper respiratory tract infections are the most common infectious diseases among adults, who
have two to four respiratory infections annually.[47] Children may have six to ten colds a year
(and up to 12 colds a year for school children).[9][48] In the United States, the incidence of colds is
higher in the fall (autumn) and winter, with most infections occurring between September and
April. The seasonality may be due to the start of the school year, or due to people spending more
time indoors (thus in closer proximity with each other) increasing the chance of transmission of
the virus.[9]

[edit] History
"Definition of a Cold." Benjamin Franklin's notes for a paper he intended to write on the
common cold.

The name "common cold" came into use in the 16th century, due to the similarity between its
symptoms and those of exposure to cold weather.[49] Norman Moore relates in his history of the
Study of Medicine that James I continually suffered from nasal colds, which were then thought
to be caused by polypi, sinus trouble, or autotoxaemia.[50]

In the 18th century, Benjamin Franklin considered the causes and prevention of the common
cold. After several years of research he concluded: "People often catch cold from one another
when shut up together in small close rooms, coaches, etc. and when sitting near and conversing
so as to breathe in each other's transpiration." Although viruses had not yet been discovered,
Franklin hypothesized that the common cold was passed between people through the air. He
recommended exercise, bathing, and moderation in food and drink consumption to avoid the
common cold.[51] Franklin's theory on the transmission of the cold was confirmed some 150 years
later.[52]

[edit] Common Cold Unit

Main article: Common Cold Unit

In the United Kingdom, the Common Cold Unit was set up by the Medical Research Council in
1946. The unit worked with volunteers who were infected with various viruses.[53] The rhinovirus
was discovered there.[54] In the late 1950s, researchers were able to grow one of these cold
viruses in a tissue culture, as it would not grow in fertilized chicken eggs, the method used for
many other viruses. In the 1970s, the CCU demonstrated that treatment with interferon during
the incubation phase of rhinovirus infection protects somewhat against the disease,[55] but no
practical treatment could be developed. The unit was closed in 1989, two years after it completed
research of zinc gluconate lozenges in the prophylaxis and treatment of rhinovirus colds, the only
successful treatment in the history of the unit.[56]