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HelenaLiira
JukkapekkaJousimaa

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.

Differential diagnosis

Investigations Sinus Ultrasound and Radiography in the Diagnosis of Sinusitis

  • 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.

Prevention and treatment Delayed Antibiotics for Respiratory Infections, Garlic for the Common Cold, Intranasal Corticosteroids for the Common Cold

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]

Evidence Summaries