Rhinovirus

Introduction

Also see common cold

Epidemiology

• rhinovirus most transmitted through direct contact or via aerosol particles
• the primary site of inoculation is the nasal mucosa,
  • conjunctiva may be involved to a lesser extent
• contagious behavior includes nose blowing, sneezing, & physically transferring infected secretions onto environmental surfaces or paper tissue
• kissing, talking, coughing do not contribute to rhinovirus transmission
• exposure to cold weather, getting wet, or becoming chilled do not cause rhinovirus infection
• large inoculum(s) to nasal mucosa are necessary for rhinovirus infection, thus transmission generally requires long-term contact with infected person(s)
• children who attend school are the most common reservoirs of rhinovirus
• viral shedding
  • can occur prior to symptoms
  • lasts, on average, 10-14 days
    • prolonged viral shredding is known to occur
  • may not be associated with respiratory symptoms
• adults average 2-3 colds/year

Pathology

• major group rhinovirus receptor: ICAM-1 (CD54)
• etiology of upper respiratory tract infection, viral pneumonia
• few cells are generally infected by rhinovirus, & infection involves only a small portion of the epithelium

Clinical manifestations

• symptoms develop 1-2 days inoculation, & oeak after 2-4 days
• nasal dryness or irritation may be the first symptom
• nasal congestion
• nasal secretions become thicker & colored after 2-3 days
• postnasal drip, pharnngitis
• sneezing
• sinusitis

Laboratory

• rhinovirus antigen
• rhinovirus RNA (test of choice)

Radiology

• CT of sinus
  • 85% abnormal
  • viral sinusitis indistinguishable from bacterial sinusitis

Complications

• otitis media
• sinusitis
• chronic bronchitis
• asthma exacerbation
• rhinovirus & enterovirus may be associated with severe clinical outcomes in hospitalized patients
  • fever, cough, dyspnea
  • risk is associated with comorbidities in children & older age in elderly
• rhinovirus is the most commonly detected pathogen in community-aquired pneumonia

Management

• rest, hydration
• antihistamine/decongestant combinations may improve symptoms
• zinc > 75 mg elemental zinc/day may benefit adults but not children

More general terms

• enterovirus

Additional terms

• common cold; acute nasopharyngitis; viral rhinosinusitis
• intercellular adhesion molecule 1; ICAM-1; major group rhinovirus receptor; CD54 (ICAM1)