Acute Rhinitis
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Introduction
Acute viral rhinitis, or the common cold, is just that - the most common diagnosis made in a family doctor's office. With a peak in the winter months, adults tend to get 2-4 colds per year, while children get 6-10.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Acute rhinitis is predominantly caused by rhinoviruses, which are responsible for 30-35% of all colds. Other pathogens include:
- coronavirus
- adenovirus
- RSV
- influenza
- parainfluenza
- echovirus
- coxsackie virus
Risk factors for developing illness include psychological stress, excessive fatigue, allergic nasopharyngeal disorders, smoking, and contact with sick people.
Pathophysiology
Viral infection can lead to inflammation, mucosal swelling, and increased mucus production.
Signs and Symptoms
- history
- physical exam
History
Incubation is generally between 1-5 days.
Transmission can be via secretions on skin/objects, or by aerosol droplets.
Nasal congestion, with clear to mucopurulent secretions, sneezing, sore throat, conjunctivitis, and cough are all common.
Malaise, headache, myalgias, and mild fever can also occur.
Viral RTIs can be diagnosed by
- clinical syndrome
- time of year
- local prevalence rates
Physical Exam
The nasal/oropharyngeal mucosa can become boggy and erythematous. Anterhinoscopy reveals pale, congested nasal mucosa with clear drainage.
Patients are usually afebrile.
Lymph nodes can enlarge.
Chest exam is clear.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
RTIs can be diagnosed through the collection of various specimens, most commonly via naso-pharyngeal aspirates. Other methods include:
- sputum (good representation of lower airways)
- bronchio-alveolar lavage
- endotracheal aspirates
- sinus aspirates
- tympanocentesis
Sample collection can be followed by:
- virus culture
- antigen or antibody detection (not rhinovirus)
- molecular methods (ie PCR)
Diagnostic Imaging
Differential Diagnosis
Differential diagnosis includes allergic rhinitis, streptococcal pharyngitis, influenza, laryngitis, croup, sinusitis, and bacterial infections.
Treatments
Patient Education is very important, especially in regards to the lack of efficacy of antibiotics. Symptoms of viral infection typically subside within one week, though cough can persist for weeks. Secondary bacterial infection can occur within 3-10 days after cold onset.
Prevention includes frequent hand washing, avoidance of touching face, and use of surface disinfecant.
Treatment is supportive, with decongestants, analgesics, and antipyretics as needed.
Antibiotics are contraindicated in viral rhinosinusitis.
Symptomatic relief can come from rest, hydration, gargling salt water, and steam.
Analgesics and antipyretics can include acetaminophen and ASA (avoiding the latter in children due to Reye's syndrome)
Dextromethorphan or codiene can be used for cough suppression.
Decongestants, antihistamines may be useful.
Zinc losenges are controversial.
Patients with reactive airway disease or asthma will require increased usie of bronchidilators and inhaled steroids.
Consequences and Course
Resources and References
Topic Development
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