eMedicine Specialties > Infectious Diseases > Viral Infections

Rhinoviruses: Differential Diagnoses & Workup

Author: Michael Rajnik, MD, Assistant Professor, Department of Pediatrics, Acting Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences
Coauthor(s): Clinton Murray, MD, Program Director, Infectious Disease Fellowship, San Antonio Uniformed Services Health Education Consortium; Duane R Hospenthal, MD, PhD, Chief, Infectious Disease Service, Brooke Army Medical Center and Associate Professor, Department of Medicine, Uniformed Service University of Health Sciences
Contributor Information and Disclosures

Updated: Jun 30, 2008

Differential Diagnoses

Adenoviruses
Rhinitis, Allergic
Bronchitis
Sinusitis, Acute
Coxsackieviruses
Streptococcus Group A Infections
Infectious Mononucleosis
Upper Respiratory Infection
Influenza
Parainfluenza Virus

Other Problems to Be Considered

Coronavirus
Sphenoid sinusitis
Nonallergic rhinitis
Respiratory syncytial virus infection

Workup

Laboratory Studies

  • Because common-cold manifestations are so common, an aggressive workup is rarely necessary if findings from a thorough history and physical examination are consistent with a viral etiology and no complications are noted. Differentiation of one virus from another or one serotype of rhinovirus from another is difficult based on clinical presentation.
  • Shedding of virus peaks at 48 hours but can persist for up to 3 weeks. Virus can be cultured on M-HeLa and human embryonic lung cells with typical cytopathic effect observed after culture, at 33-35°C on roller drums, for 2-6 days. Culture occasionally takes up to 14 days. Because of the prolonged time to obtain positive culture findings, it has rarely been found useful in clinical settings.
  • Identity is confirmed by the acid sensitivity of the isolate. Specialized laboratories can identify serotypes by antibody neutralization, which requires a large battery of antisera.
  • Polymerase chain reaction (PCR) is currently available. This testing is faster and more sensitive than culture. Real-time PCR has been shown to be a rapid and effective way to detect rhinoviruses and has been proposed as the clinical method of detection. PCR has been found most useful in clinical settings in testing patients who are severely immunocompromised, such as patients who have undergone bone marrow transplant. PCR must be used carefully. One study has reported persistent positive results for 5-6 weeks following admission of children for illnesses determined to be secondary to rhinoviral infection. Furthermore, the use of nested PCR techniques has resulted in up to 20% of illnesses being attributed to more than one organism.19
  • The large number of serotypes restricts the use of immunocytochemical methods and serology testing.
  • Peripheral white blood cell counts may be elevated during the first 2-3 days of the infection, although use of common laboratory tests, such as complete blood count and erythrocyte sedimentation rate, are of virtually no benefit in managing rhinoviral infections.
  • Consider bacterial throat culture or rapid strep test to identify the presence of GAS if oropharyngeal examination suggests streptococcal infection.

Imaging Studies

  • Chest radiography is seldom needed and should be obtained only if another lower respiratory tract infection (eg, pneumonia) is suspected.
  • Sinus films or CT scanning of the sinuses may be used in cases of suspected sinusitis, although this imaging cannot differentiate viral processes from bacterial processes.

Procedures

  • Although respiratory tract aspirations, brushings, and biopsies have been used in research protocols to identify etiologies of infections, these tests are of limited value in individual patients.

More on Rhinoviruses

Overview: Rhinoviruses
Differential Diagnoses & Workup: Rhinoviruses
Treatment & Medication: Rhinoviruses
Follow-up: Rhinoviruses
References
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References

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Further Reading

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Keywords

rhinoviruses, rhinovirus infection, cold, common cold, respiratory virus, RV, acute respiratory tract infection, ARTI, upper respiratory tract infection, URTI, otitis media, sinusitis, chronic bronchitis, lower respiratory tract illness, rhinoviral infection, rhinorrhea

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Contributor Information and Disclosures

Author

Michael Rajnik, MD, Assistant Professor, Department of Pediatrics, Acting Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences
Michael Rajnik, MD is a member of the following medical societies: American Academy of Pediatrics, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Coauthor(s)

Clinton Murray, MD, Program Director, Infectious Disease Fellowship, San Antonio Uniformed Services Health Education Consortium
Clinton Murray, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Duane R Hospenthal, MD, PhD, Chief, Infectious Disease Service, Brooke Army Medical Center and Associate Professor, Department of Medicine, Uniformed Service University of Health Sciences
Duane R Hospenthal, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Society for Infectious Diseases, International Society of Travel Medicine, and Medical Mycology Society of the Americas
Disclosure: Merck Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Medical Editor

Gregory William Rutecki, MD, Associate Professor, Program Director, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University
Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gordon L Woods, MD, Consulting Staff, Department of Internal Medicine, University Medical Center
Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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