Hongni Jiang
Jieming Qu
Matthew E. Falagas
DESCRIPTION 
Acute upper respiratory tract viral infection
EPIDEMIOLOGY
Incidence
- The average adult reports 2–4 colds per year.
- The average children reports 6–10 colds per year.
Prevalence
An estimated number of about 1 billion colds annually in the US
RISK FACTORS
- Staying in the presence of an infected person in an enclosed area
- Hand contact with an infected person
- Winter season which leads to people clustering indoors
- Children with immature immune system
- Individuals with immunocompromised conditions
- Susceptibility increased by smoking and psychological stress
GENERAL PREVENTION
- Avoid hand-to-eye and hand-to-nose contact
- Wash hands frequently
PATHOPHYSIOLOGY
- A contagious, viral infectious disease of the upper respiratory system
- The virus is transmitted through virus-laden saliva, nasal secretions, or aerosol from infected persons
- Self-limiting
ETIOLOGY
- Rhinovirus (30–50%)
- Coronavirus (10–15%)
- Influenza (5–15%)
- Less common: Parainfluenza, respiratory syncytial virus, adenovirus, enterovirus, and metapneumovirus
COMMONLY ASSOCIATED CONDITIONS
[Outline]
HISTORY
PHYSICAL EXAM
- Fever is characteristically uncommon
- Signs of upper respiratory tract infection
DIAGNOSTIC TESTS & INTERPRETATION
Lab
Initial lab tests
No laboratory tests are required unless differential diagnosis is needed or complications are suspected
Follow Up & Special Considerations
Usually not required unless differential diagnosis is needed or complications are suspected
Imaging
Initial Approach
Not required unless differential diagnosis is needed or complications are suspected
Follow Up & Special Considerations
Not required unless differential diagnosis is needed or complications are suspected
Diagnostic Procedures/Other
- Usually not required:
- Virus isolation
- Direct detection of virus antigen
- Serology–virus neutralization tests
- Throat and/or sputum culture
- Influenza virus testing
- Culture of nasal discharge
DIFFERENTIAL DIAGNOSIS
- Infectious:
- Noninfectious:
[Outline]
MEDICATION
No antiviral agents with established merits
ADDITIONAL TREATMENT
General Measures
- Aspirin, acetaminophen, and ibuprofen to relieve aches and pains, as well as fever (4)
- Decongestants
- Nasal: Rebound effect with use greater than 3 days in adults
- Oral: Benefits questionable
- Ipratropium bromide nasal spray: Recommended for nasal congestion in children and adults
- Dextromethorphan: A treatment option for adults with cough
- Antihistamines: First-generation antihistamines to relieve symptoms in adults
Pediatric Considerations
- Aspirin is not recommended for children or teenagers for the risk of Reye's syndrome
- Codeine, dextromethorphan, and antihistamines: Not recommended for children
Issues for Referral
Severe symptoms
Additional Therapies
Echinacea (5), Vitamin C, and Zinc: Not recommended for active treatment
[Outline]
FOLLOW-UP RECOMMENDATIONS
A cough persisting longer than 3 weeks could be pneumonia or pertussis
Patient Monitoring
Usually not required
DIET
Plenty of fluids are recommended
PATIENT EDUCATION
- Emphasize that antibiotics are not required for common cold
- Advise against overuse of nasal drops or sprays because they may cause rebound congestion
- Minimize contact with people who have colds
- Wash hands and avoid sharing towels and drink lots of fluids
- Cover nose and mouth with an arm rather than hands when coughing or sneezing to avoid the spread of droplets
PROGNOSIS
The disease is generally mild and self-limiting
COMPLICATIONS
[Outline]
ICD9
460 Acute nasopharyngitis (common cold)