Why does rhinovirus infect the nose

Once the symptoms start, they usually last for 10 to 14 days, but sometimes the child will get better faster than that. When your child has a cold, make sure he or she gets enough rest and drinks extra fluid if he or she has a fever. If your child is uncomfortable, talk to his or her doctor about giving acetaminophen to lower the fever. Don't give over-the-counter cold and cough medicines without first checking with your doctor. Over-the-counter medicines do not kill the virus and, most of the time, will not help your child feel better.

If your baby is 3 months or younger and gets cold symptoms, talk with your child's doctor. Young children are more likely to get sicker from colds, including getting pneumonia or bronchiolitis. Older children usually don't need to be seen by a doctor when they have a cold. You can tell your child has a cold based on watching his or her symptoms.

In general, lab tests like blood tests or throat cultures are not needed to find out what kind of infection a child with cold symptoms has. Most rhinovirus infections are mild, and no medication is needed. Antibiotics do not work for the common cold and other infections caused by viruses. Make sure your child washes his or her hands often. This will decrease the chances he or she will get the virus. Coughs and Colds: Medicines or Home Remedies? You may be trying to access this site from a secured browser on the server.

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Evidence of symptomatic relief of cold in adults has been demonstrated with several drugs. A methacholine nasal spray can reduce the amount of nasal secretions, which often pour from the nose during the first few days of a cold Borum et al.

After 1 or 2 days, when nasal breathing becomes difficult due to the increased viscosity of the nasal secretions, a nasal decongestant spray such as oxymethazoline can relieve congestion. Topical nasal steroid sprays are not recommended for rhinovirus infection; the symptomatic benefit is limited and viral shedding is actually increased.

Oral antihistamines with anticholinergic and sedative effects first-generation antihistamines such as chlorpheniramine and brompheniramine and oral sympathomimetics such as pseudoephedrine hydrochloride and phenylephrine hydrochloride have been shown to be efficacious in adults for reducing nasal congestion, cough, and sneezing during colds.

Codeine and dextromethorphan are used to suppress cough, but have not been shown to be effective in controlled studies with patients with colds. Aspirin, naproxen, and ibuprofen are effective for reducing systemic aches, headache, and sore throat. In addition, naproxen has been shown to diminish cough and ibuprofen to reduce sneezing.

Oral steroids have not been shown to be beneficial for symptomatic relief in rhinovirus infection. Anti-inflammatory treatment of rhinovirus colds increases viral shedding. A reduction in the frequency of rhinovirus infections might be possible through interruption of transmission, since rhinoviruses must be acquired from another person. However, the alcohol gels commonly used as hand sanitizers to prevent colds were not shown to reduce rhinovirus infections in a controlled field trial Sandora et al.

In laboratory tests, alcohol may reduce titer but does not eradicate rhinovirus. Careful hand-washing will remove rhinovirus. Although a single rhinovirus infection is generally mild and self-limited, the frequency of colds produces morbidity that is a challenge to public health officials.

Colds occur at an estimated rate of one billion per year in the United States, with about 25 million patients seeking medical care for uncomplicated upper respiratory illness and 5 million for otitis media. Colds account for an estimated 22 million missed days of school and 20 million absences from work annually.

It is obvious that a better understanding of the pathogenesis of rhinovirus infections and more effective treatment modalities would have a strong impact on public health. Birgit Winther was born in Denmark. She received her medical degree from the University of Copenhagen in She was board certified in Otolaryngology in Denmark following residency at the Rigshospitalet and awarded the doctor of medical science degree from the University of Copenhagen for her thesis Effects on the Nasal Mucosa of Upper Respiratory Viruses Common Cold.

Following 18 months at the department of otolaryngology at Gentofte University Hospital in Denmark, she joined the faculty at the University of Virginia School of Medicine. Since , she has focused her attention on clinical research to develop antiviral and symptomatic treatment for colds and influenza.

Her publications include more than 60 articles in peer-reviewed journals about the pathogenesis of rhinovirus infections, common colds in children and adults, otitis media and sinusitis, and the human adenoid. She is married and lives with her husband and two teenage children in Keswick, Virginia. National Center for Biotechnology Information , U. International Encyclopedia of Public Health. Published online Aug Author information Copyright and License information Disclaimer.

All rights reserved. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. Abstract Rhinovirus is the major cause of common colds in humans.

Introduction The common cold has that name for a reason: It is the illness that most frequently affects humans around the world. Environment Rhinovirus is common throughout the world. Transmission Most rhinovirus infections are thought to occur when virus deposited onto the fingertips is introduced to the conjunctiva or nose self-inoculation from fomites , although small particle aerosol transmission is also a potential inoculation route.

Pathogenesis Rhinovirus has a propensity to affect young children disproportionately. Open in a separate window. Figure 1. Symptom Expression of a Rhinovirus Infection Although the majority of rhinovirus infections occur in children, our knowledge of the symptomatology is mainly acquired from adults.

Signs of Rhinovirus Infection Examination of the nasal cavity in adults with rhinovirus infection reveals an increase in nasal secretions but is otherwise unspecific, since abnormal erythema and swelling of the turbinates is seldom observed. Clinical Diagnosis Colds in adults are usually self-diagnosed, as everyone is familiar with the symptoms of a cold.

Clinical Implications Following introduction into the nose, rhinovirus can first be recovered from the adenoid area in the nasopharynx. Serious Complications of Rhinovirus Infections Fatal pneumonia caused by rhinovirus infection has been reported in immunocompromised patients. Treatment At the present time, there is no commercially available antiviral drug for treatment of rhinovirus infections. Nasal Sprays A methacholine nasal spray can reduce the amount of nasal secretions, which often pour from the nose during the first few days of a cold Borum et al.

Oral Combination Therapies Oral antihistamines with anticholinergic and sedative effects first-generation antihistamines such as chlorpheniramine and brompheniramine and oral sympathomimetics such as pseudoephedrine hydrochloride and phenylephrine hydrochloride have been shown to be efficacious in adults for reducing nasal congestion, cough, and sneezing during colds. Oral Anti-inflammatory Medications Aspirin, naproxen, and ibuprofen are effective for reducing systemic aches, headache, and sore throat.

Hand Sanitizers A reduction in the frequency of rhinovirus infections might be possible through interruption of transmission, since rhinoviruses must be acquired from another person. Socioeconomic Impact Although a single rhinovirus infection is generally mild and self-limited, the frequency of colds produces morbidity that is a challenge to public health officials.

Citations Borum P. Ipratropium nasal spray: A new treatment for rhinovirus in the common cold. American Review of Respiratory Diseases. Journal of Infectious Diseases. Editorial comments: The host response, not the virus, causes the symptoms of the common cold. Clinical Infectious Diseases. Otitis media. New England Journal of Medicine. Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatric Infectious Disease Journal.

Rhinoviral infection of epithelial cells also leads to production of numerous proinflammatory cytokines and chemokines, including interleukin IL -1, IL-6, and IL-8, which correlate with the severity of respiratory symptoms during infection. For example, expression of IL-1 in airway smooth muscle enhances contractile responses to bronchospastic agents and attenuates relaxation responses to bronchodilators.

The balance of T helper cell types 1 and 2 is likely to be an important factor in regulating the immune response to rhinovirus, inasmuch as weak T helper cell type 1 responses were associated with more severe respiratory symptoms and longer periods of viral shedding. Sinusitis is an inherent part of the common cold syndrome. The computed tomographic study involved patients who presented within 2 to 4 days of naturally acquiring a common cold.

Sinus abnormalities were most frequently detected in the maxillary and ethmoid sinuses, but some patients also had abnormalities in the sphenoid and frontal sinuses. Occlusion of the infundibulum was also commonly seen. In a magnetic resonance imaging study, ethmoid or antral sinus abnormalities were observed in 4 of 18 patients after experimental infection with rhinovirus Two additional subjects with technically unsatisfactory preinfection scans also developed sinus abnormalities during the acute infection.

In 3 of these subjects, sinus mucosal thickening was evident, whereas in the fourth subject an air-fluid level was present. Notably, rhinorrhea scores and nasal secretion weight were significantly higher among the subjects with sinus abnormalities than among those who had normal magnetic resonance imaging findings. Only a small proportion of cases of viral rhinosinusitis are complicated by bacterial infection 0.

However, the role of rhinovirus in sinusitis has not been clear, owing to the difficulty of isolating the pathogen. Although these observations show that rhinovirus is detectable in the sinus cavities of patients with acute sinusitis, it remains to be determined whether active viral replication occurs in the sinus mucosa. There is evidence that personal behaviors during a cold can be responsible for a viral sinusitis.

Gwaltney et al 28 reported that the intranasal pressure created by nose blowing, sneezing, and coughing is great enough to propel nasal secretions into the sinuses. Because rhinoviruses are present in nasal secretions, nose blowing may be an important factor in introducing rhinoviruses into the sinuses during colds.

Viruses are considered to play a role in the pathogenesis of AOM because the disease occurs concurrently with or just after a VRI. These events lead to an invasion of the middle ear by viruses and bacteria. Once the pathogens reach the middle ear, another inflammatory cascade is initiated, leading to middle ear fluid accumulation effusion , symptoms of AOM, and further opportunity for bacterial invasion.

Although AOM is less common in adults than in children, middle ear abnormalities are commonly seen during rhinoviral infections. Elkhatieb et al 33 described a total of 91 subjects who had symptoms of nasal obstruction and a documented rhinovirus cold. The changes were especially evident after 2 to 3 days of infection. These abnormalities usually resolved by 2 weeks; however, in 1 patient with a history of middle ear infections during childhood, a major abnormality in middle ear pressure persisted in 1 ear at 4 weeks.

Interestingly, middle ear pressure abnormalities were not clearly associated with complaints of earache or pressure or with the severity of the rhinoviral infection. Similarly, experimentally induced rhinovirus infection produced eustachian tube dysfunction and middle ear pressure abnormalities in adults that were detected within 2 days of infection and resolved within 2 weeks.

Finally, and perhaps most importantly, the presence of virus in middle ear fluid of patients with AOM predisposes them to antibiotic failure. Their study defined the pathogenesis, frequency, and severity of illness and the use of medical care services.

Acute respiratory illness occurred more frequently in the subjects with moderate to severe COPD 3. The subjects with COPD had more nonvirus-identified illnesses than virus-identified illnesses. No control subjects required emergency care or hospitalization.

Despite a similar rate of yearly occurrence of respiratory infections, there was a 2-fold increase in acute respiratory tract illness among the subjects with COPD compared with the control group. The cohort with moderate to severe COPD used significantly more medical resources, as reflected in the number of clinician visits, emergency center visits, and hospitalizations. Declines in pulmonary function were comparable in children with rhinovirus or other picornavirus infections as well as in those with nonpicornavirus infections.

These findings suggest that many respiratory viruses can adversely affect pulmonary function in cystic fibrosis. The impact of rhinovirus infections in the elderly was evaluated in a prospective community-based surveillance study conducted in England. The consequences of rhinovirus infection were significant. The median duration of illness was 16 days overall, but it was 19 days among those with lower respiratory tract illness.

One patient died of COPD that was exacerbated by the rhinovirus infection. Among high-risk patients with cancer, rhinovirus infections are often fatal. In 6 of the 7 fatal cases, rhinovirus had been isolated in bronchoalveolar lavage fluid or an endotracheal aspirate before death. Nevertheless, these studies show that rhinovirus infections cause considerable pulmonary morbidity and mortality in high-risk patients with cancer.

The specific diagnosis of rhinovirus infections has traditionally been made by virus isolation from appropriate patient specimens, using culture methods. Serologic testing is impractical, given the numerous rhinovirus serotypes. These assays use probes directed to conserved regions of the rhinoviral or enteroviral genome, and accordingly they are capable of identifying most serotypes.

Therefore, the diagnosis is usually made clinically, based on signs and symptoms. Rhinorrhea, nasal congestion, and sore or scratchy throat are very common symptoms. Arruda et al 5 found that sore throat, nasal congestion, and rhinorrhea were the first symptoms noticed. The most bothersome symptoms were runny nose, stuffy nose, sore throat, and malaise. Coughing, sneezing, hoarseness, facial pressure, ear fullness, and headache are also typical symptoms.

Less often, malaise, chills, and low-grade fever may occur. The use of over-the-counter symptomatic treatments can reduce symptoms in some patients. Antihistamines and nonsteroidal anti-inflammatory drugs may relieve some symptoms, but they do not shorten the duration of illness.

These other medications include zinc lozenges, echinacea, and high-dose vitamin C. Antiviral Agents. No antiviral drugs are currently approved for clinical use in picornaviral infections.

Intranasal interferon alfa therapy was shown to be protective in early prophylactic trials, but it was not pursued for clinical use because of its local adverse effects. In early studies, intravenously administered recombinant soluble ICAM-1 tremacamra appeared to reduce the severity of symptoms in patients with experimental rhinovirus colds. However, the compound has not been tested further. Human rhinovirus 3C protease inhibitors, such as AG, represent an alternative approach for rhinovirus infections because of their potent antiviral activity against rhinoviruses and enteroviruses.

The most common drug-related adverse events nausea and taste disturbance were mild. Capsid-function inhibitors bind to a hydrophobic pocket in VP4 at the site of viral attachment and uncoating, thereby inhibiting viral replication. Pleconaril was studied in an experimental challenge model using coxsackievirus A21 in normal adults.

Pleconaril mg or placebo was administered twice a day for 7 days to 33 subjects infected with a safety-tested strain of coxsackievirus A In 2 randomized, double-blind, placebo-controlled studies of patients with self-diagnosed colds for 24 hours or less, pleconaril mg twice a day was compared with placebo.

A significant reduction from baseline symptom scores was observed by day 2. Adverse events profiles were similar.