Rhinoviruses Follow-up

  • Author: Michael Rajnik, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 15, 2011
 

Further Inpatient Care

  • Inpatient care is rarely required.
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Further Outpatient Care

  • Persons with rhinoviral infections are almost universally treated as outpatients.
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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.[18]
  • The use of nasal tissues is encouraged because of possible aerosol spread of the virus.
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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).[19] 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.[20] 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.[21]
  • 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.[22]
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Prognosis

  • The prognosis is excellent.
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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.
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Contributor Information and Disclosures
Author

Michael Rajnik, MD  Associate Professor, Department of Pediatrics, 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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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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