Common Cold in Adults
A separate article on coronavirus infections is available Covid-19 and other Coronavirus Infections.
Essentials
- Acute nasal stuffiness and rhinitis, sore throat and cough are the most common symptoms.
- Viral infections should be differentiated from bacterial ones.
- Avoid unnecessary antimicrobial drugs Antibiotics for the Common Cold and Acute Purulent Rhinitis.
- Identify recurrent or chronic infections. Advise the patient to stop smoking.
Aetiology
- In more than half of the cases, the causative agent is some type of rhinovirus. of which over 100 serotypes are known.
- Other common viral aetiologies include coronavirus, RSV, influenza virus and parainfluenzavirus.
- Rarer aetiologies include, among others, adenovirus, enterovirus, metapneumovirus and EBV.
Symptoms
- Key symptoms are nasal stuffiness or runny nose and a cough.
- Other common symptoms include throat pain, headache, tiredness, muscle pain and slight rise in temperature.
- The peak of symptoms is typically around the 3rd or 4th day of the disease and symptoms alleviate within a week. Cough may persist for several weeks.
- History: earlier episodes of sinusitis or bronchitis, smoking, fever
- Pay attention to the general condition of the patient and identify complicated cases.
- Mouth and pharynx: peritonsillar swelling suggests an abscess Drainage of a Peritonsillar Abscess
- Neck
- Enlarged lymph nodes (adenovirus, mononucleosis, streptococci)
- Tender thyroid gland: subacute thyroiditis is an uncommon cause of a sore throat Subacute Thyroiditis.
- Maxillary sinuses: imaging studies of the maxillary sinuses are not recommended in short-lasting common cold which is often associated with accumulation of fluid in the sinuses.
- Ears: examined if the patient has ear symptoms
- Lungs: rales, wheezing, sputum; if the patient has wheezing or dyspnoea, measure the peak expiratory flow.
- Laboratory tests are generally not needed. They can be used for differential diagnosis between viral and bacterial infections or if there is a reason to search for a specific pathogen.
- Basic blood count with thrombocyte count. Lymphocytopenia is common in acute infections. Many viruses may reduce neutrophil production. Sometimes neutropenia may persist for several weeks after a viral infection that has already subsided. Bacterial infections typically cause neutrophilia and do not suppress the cell production in the bone marrow.
- The use of CRP assay to support treatment decisions reduces the prescription of antimicrobial drugs in lower respiratory tract infections and in sinusitis Crp Point-of-Care Testing in Maxillary Sinusitis and Lower Respiratory Tract Infection (Lrti).
- In suspected tonsillitis take a throat bacterial smear (preferably a streptococcal culture).
- In suspected mononucleosis take a rapid test or Epstein-Barr virus serology Mononucleosis.
- Influenza A and B can be tested with a rapid test from a nasopharyngeal sample. Use of the test is recommended only during the epidemic season and when a positive test leads to use of antiviral therapy (short duration of symptoms, primary diseases that warrant drug therapy) Influenza.
- Also other respiratory viruses can be diagnosed from a suction specimen of mucus (a specific test can identify RSV, influenza A/B, adenovirus, parainfluenza viruses, enterovirus, rhinovirus, metapneumovirus, coronavirus and bocavirus). Since specific treatments are not available, use of the test is warranted in special cases only.
References
- Llor C, Moragas A, Bayona C et al. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial. BMJ 2013;347():f5762. [PubMed]