THE COMMON COLD
DR.LINDA OMBITO
LECTURE OUTLINE
• Definition
• Epidemiology
• Pathophysiology
• Clinical Features
• Diagnosis
• Complications
• Differentials
• Management
THE COMMON COLD
• Acute, self-limiting viral infection of the upper
respiratory tract, involving, to variable
degrees, sneezing, nasal congestion and
discharge (rhinorrhea), sore throat, cough,
low-grade fever, headache, and malaise.
• It can be caused by members of several
families of viruses; the most common are the
more than 100 serotypes of rhinoviruses.
• Frequently referred to as infectious rhinitis
but may also include self-limited involvement
of the sinus mucosa and is more correctly
termed rhinosinusitis.
Virology, Epidemiologic and clinical features
Epidemiology
• Subsequent immunity
• Rhinoviruses, adenoviruses, influenza viruses, and enteroviruses produce
lasting immunity, but immunity does little to prevent subsequent colds
because there are so many serotypes.
• RSV, parainfluenza viruses, and coronaviruses do not produce lasting
immunity. Reinfection may occur, but subsequent infection with the
same agent is generally milder and of shorter duration.
Epidemiology
Transmission
Viruses that cause colds are spread by
three mechanisms:
Hand contact – Self-inoculation of
one's own conjunctivae or nasal
mucosa after touching a person or
object contaminated with cold virus
Inhalation of small particle droplets
(droplet nuclei or aerosols) that
become airborne from sneezing or
coughing.
Deposition of large particle droplets
that are expelled during sneezing and
land on nasal or conjunctival mucosa
(typically requires close contact with
an infected person).
Epidemiology
Transmission
Young children are more often
responsible than adults for
transfer of infection within the
home
The risk of person-to-person
transfer is dependent upon the
amount of time people spend
together, the proximity of their
contact with one another, and the
amount of virus shed by the
infected patient.
Epidemiology
Period of infectivity
• Rhinovirus shedding peaks on the third day after inoculation; this coincides
with a peak in symptoms.
• Low levels of viral shedding may persist for up to two weeks.
Incubation period
• The incubation period (time between contact with infectious material until
the onset of symptoms) for most common cold viruses is 24 to 72 hours.
Pathophysiology
• Symptoms of the common cold are largely due to the innate immune
response to infection rather than to direct viral damage to the respiratory
tract.
• After deposition on nasal or conjunctival mucosa, cold viruses attach to
receptors on epithelial cells in the nasopharynx and enter the cells.
• During rhinovirus infection, viral replication occurs in only a small number
of nasal epithelial cells. The infected cells release cytokines, including
interleukin (IL)-8, which attracts polymorphonuclear cells (PMNs).
• Large numbers of PMNs (100-fold increase) accumulate in the nasal
secretions and mucociliary clearance is slowed.
Pathophysiology
• Symptoms usually appear one to two days after viral inoculation, coinciding
with the influx of PMNs in the nasal submucosa and epithelium.
• The severity of symptoms correlates with mucosal IL-8 concentrations. A
change in the character of the nasal discharge from clear to yellow/white or
green correlates with the increase in PMNs but NOT with an increase in
positive bacterial cultures.
• The colored discharge may signify the presence of PMNs (yellow or white)
or of PMN enzymatic activity (green color).
• Rhinovirus infection increases vascular permeability in the nasal
submucosa, releasing albumin and kinins (bradykinin), which may then
contribute to the symptoms of the common cold.
Clinical Features
Frequency and duration
• Children younger than six years have an average of six to eight colds per year,
with a typical symptom duration of 14 days.
• Young children in daycare appear to have more colds than children cared for
at home. However, when they enter primary school, children who attended
daycare are less vulnerable to colds than those who did not.
• Older children and adults have an average of two to four colds per year, with
a typical symptom duration of five to seven days. The duration of symptoms
is increased among cigarette smokers.
Clinical Features
Symptom profile
Varies from patient to patient, in part due to
age and in part due to the causative virus.
However, the wide range and overlapping
manifestations of the various cold-causing
viruses make it impossible to determine the
specific causative virus without laboratory
testing.
Infants
fever
Nasal discharge
fussiness
difficulty feeding
decreased appetite
difficulty sleeping.
Clinical Features
Symptom Profile
Preschool and school-age
children
Nasal congestion, nasal
discharge, and cough are the
predominant symptoms.
Sore throat (typically an early
manifestation),
Hoarseness
Headache,
Irritability,
difficulty sleeping,
decreased appetite,
anterior cervical adenopathy
Clinical Features
• Fever may be the predominant manifestation of the common cold
during the early phase of infection in young children. It is uncommon in
older children and adults.
• Middle ear abnormalities — Middle ear abnormalities are common
during the course of an uncomplicated cold and may predispose to the
development of acute otitis media.
Diagnosis
• The diagnosis of the common cold is made clinically, based upon history
and examination findings, including exposure to someone with a cold,
nasal congestion, nasal discharge, sore throat, fever (in young children),
anterior cervical adenopathy, and erythema of nasal mucosa and
oropharynx.
• Laboratory tests are not helpful in making the diagnosis.
Diagnosis
Clinical features that may indicate a diagnosis other than an uncomplicated cold
include:
• Persistent fever, high-fever (>39°C),
• Ill-appearance,
• Absence of nasal symptoms
• Oral mucosal lesions (eg, the posterior vesicles of herpangina)
• Wheezing
• Focal findings on lung examination (eg, dullness to percussion, reduced air
entry,crackles, bronchial breathing)
• Hemoptysis
• Acute onset of cough or difficulty breathing (may suggest inhaled foreign body)
• Features of a chronic respiratory disorder (eg, poor weight gain, finger clubbing,
over-inflated chest, chest deformity, atopy) .
Complications
• Acute otitis media
• Asthma exacerbation
• Sinusitis
• Lower respiratory tract infection
• Epistaxis,
• Conjunctivitis
• Pharyngitis
Differential Diagnosis
• Allergic Seasonal or vasomotor rhinitis; Rhinitis medicamentosa
• Acute bacterial Sinusitis
• Nasal Foreign Body
• Structural abnormalities of the nose
• Inhaled foreign body
• Influenza
• Pertussis
• Covid 19
• Bronchitis
• Bacterial Pharyngitis
Common Cold Management
CAREGIVER EDUCATION is the mainstay of management
• Expected course of illness — In infants and young children, the symptoms of
the common cold usually peak on day 2 to 3 of illness and then gradually
improve over 10 to 14 days.
• Indications for re-evaluation — Re-evaluation may be warranted if the
symptoms worsen (eg, difficulty breathing or swallowing, high fever) or
exceed the expected duration).
Common Cold Management
Supportive care
We generally recommend one or a combination of the following interventions as
first-line therapy for children with the common cold.
• Ingestion of warm fluids
• Topical saline
• Humidified air
• Over-the-counter medications
Children <6 years – Except for antipyretics/analgesics, OTC medications for the
common cold should be avoided in children <6 years of age.
6 to 12 years – Except for antipyretics/analgesics, we suggest not using OTC
medications for the common cold in children 6 to 12 years of age.
Adolescents ≥12 years – OTC decongestants may provide symptomatic relief of
nasal symptoms in adolescents ≥12 years.
Prevention
• Hygiene — The best methods for preventing transmission of the
common cold are frequent handwashing and avoiding touching one's
mouth, nose, and eyes.
• Disinfectants — Decontamination of environmental surfaces with
virucidal disinfectants such as phenol/alcohol (eg, Lysol) may help
decrease the rate of transmission of cold-inducing viruses.
• Immunizations — There is not an immunization to prevent the
common cold. However, there are immunizations to prevent some of
the viruses that can cause clinical syndromes similar to common cold.
The END
