Respiratory Tract Infections ( common cold)

Acute Viral Rhinosinusitis (Common Cold)

Respiratory tract infection

Updated: 15/9/2021

A term used to describe infection of all the parts of the body that are involved in helping a person to breathe. Respiratory tract infection can be divided into: Upper respiratory tract infection  and Lower respiratory tract infection. Upper Respiratory Tract include the nose, sinuses, pharynx and trachea.

Common upper respiratory tract infections (URTIs) include: 

  • Common cold 
  • Sore throat – usually due to an infection of the pharynx (pharyngitis) 
  • Tonsillitis – infection of the tonsils 
  • Sinusitis – infection of the sinuses 
  • Laryngitis – infection of the larynx.

Coryza (common cold) is caused by a number of viruses: Rhinovirus, Adenovirus, coxsackievirus,  influenza virus, and parainfluenza. which are spread by droplets and by indirect transmission such as through freshly infected articles (handkerchiefs) 

Acute Viral Rhinosinusitis (Common Cold)

Because there are numerous serologic types of rhinoviruses, adenoviruses, and other viruses, patients remain susceptible to the common cold throughout life. These infections, while generally quite benign and self-limited, have been implicated in the development or exacerbation of more serious conditions, such as acute bacterial sinusitis and acute otitis media, asthma, cystic fibrosis, and bronchitis.

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Nasal congestion, decreased sense of smell, watery rhinorrhea, and sneezing, accompanied by general malaise, throat discomfort and, occasionally, headache are typical in viral infections.

Nasal examination usually shows erythematous, edematous mucosa and a watery discharge. The presence of purulent nasal discharge suggests bacterial rhinosinusitis.

Mode of Transmission of Common Cold

Droplet infection through talks, coughs, laughs, or sneezes discharges. Causative microorganisms is carried in droplets from infected person to another via respiratory tract. Airborne disease spread more easily when there is overcrowding

Major Signs and Symptoms of common cold 

  • Running nose and sneezing
  • Fever 
  • Malaise
  • Headache 
  • Running eye
  • Nasal congestion 
  • Sore throat
  • Cough 

Treatment of Common Cold

There are no effective antiviral therapies for either the prevention or treatment of most viral rhinitis despite a common misperception among patients that antibiotics are helpful. Prevention of influenza virus infection by boosting the immune system using the annually created vaccine may be the most effective management strategy.

Oseltamivir is the first neuramidase inhibitor approved for the treatment and prevention of influenza virus infection, but its use is generally limited to those patients considered high risk. These high-risk patients include young children, pregnant women, and adults older than 65 years of age. Oseltamivir is hard to use because it must be started within 48 hours for optimal effect. Other specific antiviral medications are available or in clinical trials but have not achieved significant use.

Zinc for the treatment of viral rhinitis has been controversial. Buffered hypertonic saline (3–5%) nasal irrigation has been shown to improve symptoms and reduce the need for nonsteroidal anti-inflammatory drugs (NSAIDs).

Other supportive measures, such as oral decongestants (pseudoephedrine, 30–60 mg every 4–6 hours or 120 mg twice daily), may provide some relief of rhinorrhea and nasal obstruction. Nasal sprays, such as oxymetazoline or phenylephrine, are rapidly effective but should not be used for more than a few days to prevent rebound congestion. Withdrawal of the drug after prolonged use leads to rhinitis medicamentosa, an almost addictive need for continuous usage.

Treatment of rhinitis medicamentosa requires mandatory cessation of the sprays, and this is often extremely frustrating for patients. Topical intranasal corticosteroids (eg, flunisolide, 2 sprays in each nostril twice daily), intranasal anticholinergic (ipratropium 0.06% nasal spray, 2–3 sprays every 8 hours as needed), or a short tapering course of oral prednisone may help during the withdrawal process.

Complications

Other than mild eustachian tube dysfunction or transient middle ear effusion, complications of viral rhinitis are unusual. Secondary acute bacterial rhinosinusitis is a wellaccepted complication of acute viral rhinitis and is suggested by persistence of symptoms beyond 10 days with purulent green or yellow nasal secretions and unilateral facial or tooth pain.

Prevention and Control of Common Cold and other URTIs

  • Prevent droplet infection from being inhaled by others
  • Improve ventilation for example building houses with adequate window to allow natural air flow
  • Avoid overcrowding e.g. building houses with enough space
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  • Isolation may be required for some conditions Cold and other URTIs
  • Health education about personal hygiene,  such as: To cover the mouth when coughing and sneezing
  • Use handkerchief or paper for disposal of nasal secretion and sputum
  • Avoid to spit on the ground or outside the house

Important links

References
https://www.mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/syc-20351605
https://www.cdc.gov/features/rhinoviruses/index.html
https://www.medicinenet.com/common_cold/article.htm
https://www.nhs.uk/conditions/common-cold/
https://www.webmd.com/cold-and-flu/default.htm
https://medlineplus.gov/commoncold.html
https://dphhs.mt.gov/Portals/85/dsd/documents/DDP/MedicalDirector/CommonCold101713.pdf
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)12162-9.pdf
https://www.aafp.org/afp/2011/1215/p1390.pdf
https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf
http://www.selfcareforum.org/wp-content/uploads/2013/03/20131030-SCF-Fact-Sheet-No-12-Common-Cold-v1-final.pdf

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