eMedicine Specialties > Infectious Diseases > Viral Infections

Rhinoviruses: Follow-up

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

Follow-up

Further Inpatient Care

  • Inpatient care is rarely required.

Further Outpatient Care

  • Persons with rhinoviral infections are almost universally treated as outpatients.

Deterrence/Prevention

  • Hand-washing and avoidance of finger-to-eye and finger-to-nose contact are crucial to decreasing spread of infection. One study suggests that hand cleansers with salicylic acid and pyroglutamic acid prevent the transmission of rhinovirus as well as the number of patients who become clinically infected.38
  • The use of nasal tissues is encouraged because of possible aerosol spread of the virus.

Complications

  • Sinusitis: Viral infection of the sinus mucosa leads to alterations of sinus cavities, resulting in obstruction and entrapment of bacteria, such as Streptococcus pneumoniae and unencapsulated strains of Haemophilus influenzae, leading to bacterial sinusitis. The maxillary sinuses are involved most frequently.
  • Otitis media: Rhinoviruses have been suggested as both rare pathogens and as copathogens with bacteria in the etiology of otitis media. They have been recovered in middle ear fluid of people with otitis media and potentially allow secondary bacterial infection from obstruction secondary to mucosal changes in the eustachian tubes.
  • Precipitation of asthma: People with asthma develop more viral respiratory tract infections than people without asthma. Rhinoviral infection is also detected at the onset of symptoms; however, in a rhinovirus challenge model, exacerbations of wheezing was shown in a minority of adults, and only 20% had a 10% or greater decrease in forced expiratory volume in 1 second (FEV1).12 Additionally, recent data suggest that, in children at high risk for developing allergies and asthma, rhinoviral infection during infancy is the most significant risk factor for episodes of symptomatic wheezing.22 One recent study in Nashville noted that the hospitalization rate in all children younger than 5 years was 5 per 1000, but a history of asthma in this population increased the rate to 25.3 per 1000.49
  • Acute infectious episodes in patients with chronic bronchitis: Although rhinoviral invasion of the bronchial tree is unclear, alterations in ventilation and exacerbations of bronchitis have been described with rhinoviral infections.
  • Deep respiratory tract infections have been described in immunosuppressed patients, elderly persons, and infants and children with cystic fibrosis; however, determining the true impact of rhinovirus is difficult because it may be a marker of disease severity or an inciting event for other infectious processes.
  • Adults with chronic obstructive pulmonary disease may experience exacerbations attributed to rhinoviruses. One recent study noted that 20% of all exacerbations could be traced to concomitant rhinoviral infection. Bacterial colony counts and levels of proinflammatory cytokines were also more elevated when rhinoviruses were present.41

Prognosis

  • The prognosis is excellent.

Patient Education

  • Emphasize environmental measures to control infections, including hand-washing, avoiding finger-to-eye and finger-to-nose contact, and covering coughs and sneezes with disposable nasal tissues.
  • For excellent patient education resources, visit eMedicine's Cold and Flu Center. Also, see eMedicine's patient education article Colds.
 


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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