eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Rhinovirus Infection

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: May 13, 2009

Introduction

Background

Rhinoviruses (RVs) are small (30 nm), nonenveloped viruses that contain a single-strand RNA genome within an icosahedral (20-sided) capsid. Rhinoviruses belong to the Picornaviridae family, which includes the genera Enterovirus (polioviruses, coxsackieviruses groups A and B, echoviruses, numbered enteroviruses, parechoviruses) and Hepatovirus (hepatitis A virus). Approximately 101 serotypes have been identified.

This article focuses on the common cold because it is most frequently associated with rhinovirus. Nasopharyngitis, croup, and pneumonia, which are uncommonly caused by RV, are also briefly discussed. Rhinovirus plays a significant role in the pathogenesis of otitis media and asthma exacerbations.1,2 Although incidence and prevalence are high, most cases are mild and self-limited.

Pathophysiology

Rhinovirus can be transmitted by aerosol or direct contact. The primary site of inoculation is the nasal mucosa, although the conjunctiva may be involved to a lesser extent. Rhinovirus attaches to respiratory epithelium and spreads locally. The major human rhinovirus receptor is intercellular adhesion molecule-1 (ICAM-1).3,4 The natural response of the human defense system to injury involves ICAM-1, which aids the binding between endothelial cells and leukocytes. Rhinovirus takes advantage of the ICAM-1 by using it as a receptor for attachment. In addition, rhinovirus uses ICAM-1 for subsequent viral uncoating during cell invasion. Some rhinovirus serotypes also up-regulate ICAM-1 expression on human epithelial cells to increase susceptibility to infection.

The optimal temperature for rhinovirus replication is 33-35°C. Rhinovirus does not efficiently replicate at body temperature. This may explain why rhinovirus replicates well in the nasal passages and upper tracheobronchial tree but less well in the lower respiratory tract. The incubation period is approximately 2-4 days.5 Viremia is uncommon.

Rhinovirus is shed in large amounts, with as many as 1 million infectious virions present per mL of nasal washings. Viral shedding can occur a few days before cold symptoms are recognized by the patient, peaks on days 2-7 of the illness, and may last as long as 3-4 weeks.

A local inflammatory response to the virus in the respiratory tract can lead to nasal discharge, nasal congestion, sneezing, and throat irritation. Damage to the nasal epithelium does not occur, and inflammation is mediated by the production of cytokines and other mediators.

Histamine concentrations in nasal secretions do not increase. By days 3-5 of the illness, nasal discharge can become mucopurulent from polymorphonuclear leukocytes that have migrated to the infection site in response to chemoattractants such as interleukin-8. Nasal mucociliary transport is markedly reduced during the illness and may be impaired for weeks. Both secretory immunoglobulin A and serum antibodies are involved in resolving the illness and protecting from reinfection.

Coronaviruses, reinfections with parainfluenza, and respiratory syncytial virus (RSV) are the most important of many other viruses that can cause common colds. Other viruses (eg, adenoviruses, influenza viruses) can also cause common colds but are more likely to cause acute nasopharyngitis and more severe respiratory infections.

Mycoplasma pneumoniae can occasionally present with common cold symptoms before developing into more extensive respiratory disease. Other pathogens include Coccidioides immitis, Histoplasma capsulatum, Bordetella pertussis, Chlamydia psittaci, and Coxiella burnetii.

Recent clinical studies indicate sinus involvement in common colds. Abnormalities on CT scan findings (eg, opacification, air-fluid levels, mucosal thickening) are present in adults with common colds that resolve over 1-2 weeks without antibiotic therapy.

Despite what is reported in folklore, no good clinical evidence suggests that colds are acquired by exposure to cold weather, getting wet, or becoming chilled.

Frequency

United States

Common colds are most frequent from September to April in temperate climates. Rhinovirus infections, which are present throughout the year, account for the initial increase in cold incidence during the fall and a second incidence peak at the end of the spring season. Colds that occur from October through March are caused by the successive appearance of numerous viruses, including parainfluenza, coronavirus, RSV, and influenza virus. Adenoviral infections occur at a constant rate throughout the season.

Seasonal variation of selected upper respiratory ...

Seasonal variation of selected upper respiratory tract infection pathogens. PIV is parainfluenza virus, RSV is respiratory syncytial virus, MPV is metapneumovirus, and Group A Strept is group A streptococcal disease.

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Seasonal variation of selected upper respiratory ...

Seasonal variation of selected upper respiratory tract infection pathogens. PIV is parainfluenza virus, RSV is respiratory syncytial virus, MPV is metapneumovirus, and Group A Strept is group A streptococcal disease.


Several studies demonstrate the incidence of the common cold to be highest in preschool and elementary school-aged children. An average of 3-8 colds per year is observed in this age group, with an even higher incidence in children who attend daycare and preschool. Because of the numerous viral agents involved and the many serotypes of several viruses (especially rhinovirus), younger children having new colds each month during the winter season is not unusual. Adults and adolescents typically have 2-4 colds per year.

International

A seasonal increase in incidence during the winter months is observed worldwide.

Mortality/Morbidity

The most common manifestation of rhinovirus, the common cold, is mild and self-limited. However, severe respiratory disease, including bronchiolitis, asthma exacerbations, and pneumonia, can occur, particularly in infants and young children.6

Race

Native Americans and Eskimos are more likely to develop the common cold and appear to have more frequent complications such as otitis media. These findings may be explained as much by environmental conditions (eg, poverty, overcrowding) as by ethnicity.

Age

Because antibodies to viral serotypes develop over time, the highest incidence is found in infants and young children. In addition, young children are more likely to have the frequent, close, personal contact necessary to transmit rhinovirus. Contrary to the experience of adults, children may also be more contagious due to having higher virus concentrations in secretions and longer duration of viral shedding.

Clinical

History

Rhinoviruses (RVs) cause or predispose to various upper respiratory infections (URIs) and lower respiratory infections (LRI), which are less common.

  • Common cold
    • Nose dryness or irritation is often the first symptom and is followed within hours by profuse watery rhinorrhea, nasal congestion, and sneezing.
    • A sore throat or throat irritation is common.
    • Malaise, headache, and cough are also common symptoms of the common cold.
    • Fever is absent or low grade. Infants and preschoolers are more likely to experience fevers, which are often 38-39°C.
    • Nasal secretions typically become thicker and colored after the first few days of illness.
    • Irritability or restlessness is common.
    • Nasal obstruction can interfere with sleep and feeding.
    • Post-tussive vomiting can occur.
    • Symptoms in adults and adolescents usually resolve by day 7; however, symptoms often last 10-14 days in younger children.
  • Acute otitis media
    • Viral URIs are common precipitating factors for acute otitis media (AOM). This is likely because they cause respiratory mucosal inflammation that leads to eustachian tube obstruction.
    • Respiratory viruses are found in either the middle ear fluid or nasopharynx in approximately 40% of patients with AOM.
    • As many as 24% of patients with AOM have rhinovirus present in nasopharyngeal secretions. Rhinovirus has also been obtained from middle ear fluid.
    • Patients whose symptoms are refractory to treatment with antibiotics are more likely to have positive viral cultures from the middle ear.
  • Sinusitis: Preceding rhinovirus infection can lead to bacterial superinfection.
  • Asthma exacerbations
    • Viral URI is a common trigger for asthma exacerbations in children of all ages.
    • In children younger than 5 years, rhinovirus and respiratory syncytial virus (RSV) are the most commonly implicated pathogens. Rhinovirus is the most commonly implicated pathogen in older children.
  • LRI: Rhinovirus may cause both pneumonia and bronchiolitis in infants.
  • Croup: Rhinovirus may cause laryngotracheobronchitis in infants.
  • Acute nasopharyngitis
    • Acute nasopharyngitis is most commonly caused by adenovirus, enteroviruses, influenza, and parainfluenza.
    • Rhinovirus is an uncommon cause of acute nasopharyngitis.
    • Common colds, by definition, do not have objective evidence of pharyngeal irritation.
  • Cystic fibrosis: Rhinovirus is the implicated virus in as many as 57% of respiratory exacerbations.
  • Transmission modes
    • Rhinovirus possesses various transmission modes and can infect a huge population at any given time.
    • Aerosol transmission is the most common transmission mode for respiratory tract infections (RTIs). Transmission occurs when small airborne particles are inhaled or large droplets are directly touched.
    • Direct hand contact with infected secretions or indirect contact with fomites is also important. Patients then infect themselves by touching their noses or conjunctivae.
    • Highly contagious behavior includes nose blowing, sneezing, and physically transferring infected secretions onto environmental surfaces or paper tissue.
    • Contrary to popular belief, behaviors such as kissing, talking, coughing, or even drooling do not contribute highly to the spread of disease.
    • Infection rates approximate 50% within the household and range from 0-50% within schools, which indicates that transmission requires long-term contact with infected individuals. Brief exposures to others in places such as movie theaters, shopping malls, friends' houses, or doctors' offices incur low risk of transmission.
    • The incubation period is approximately 2-4 days.
    • Because children carry the fewest antibodies, children who attend school are the most common reservoirs of rhinovirus infection.

Physical

Physical characteristics of the common cold include the following:

  • The common cold is usually afebrile, although temperatures of 38-39°C are possible in younger children.
  • Profuse nasal discharge can be clear and watery or mucopurulent. Purulent secretions are common after the first few days of illness and do not imply bacterial sinusitis unless secretions persist for more than 10-14 days.
  • Edema and erythema of nasal mucosae may be present.
  • Despite sore throat, the pharynx has a normal appearance, without any erythema, exudate, or ulceration.
  • Mildly enlarged nontender cervical lymph nodes are present.

Causes

Factors that increase infection risk and severity are as follows:

  • Smoking increases risk of respiratory infection by approximately 50%.
  • Very young or old individuals are at greater risk, possibly due to decreased immunity.
  • Exposure to infected contacts increases infection risk.
  • Touching the conjunctivae or nose with contaminated fingers and/or objects increases infection risk.
  • Crowding leads to increased transmission.
  • Men may have a slightly, probably insignificant, higher risk.
  • Breastfeeding has little effect on the incidence of the common cold.
  • Underlying chronic medical conditions, including anatomic, metabolic, genetic, or immunologic disorders (ie, tracheoesophageal fistula, congenital heart disease, cystic fibrosis, immunodeficiency) increase infection risk and severity.

More on Rhinovirus Infection

Overview: Rhinovirus Infection
Differential Diagnoses & Workup: Rhinovirus Infection
Treatment & Medication: Rhinovirus Infection
Follow-up: Rhinovirus Infection
Multimedia: Rhinovirus Infection
References
Further Reading
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References

  1. Busse WW, Gern JE, Dick EC. The role of respiratory viruses in asthma. Ciba Found Symp. 1997;206:208-13; discussion 213-9. [Medline].

  2. Friedlander SL, Busse WW. The role of rhinovirus in asthma exacerbations. J Allergy Clin Immunol. Aug 2005;116(2):267-73. [Medline].

  3. Bella J, Rossmann MG. Review: rhinoviruses and their ICAM receptors. J Struct Biol. Dec 1 1999;128(1):69-74. [Medline].

  4. Greve JM, Davis G, Meyer AM, et al. The major human rhinovirus receptor is ICAM-1. Cell. Mar 10 1989;56(5):839-47. [Medline].

  5. Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis. May 2009;9(5):291-300. [Medline].

  6. Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T. Rhinovirus associated with severe lower respiratory tract infections in children. Pediatr Infect Dis J. Apr 2009;28(4):337-9. [Medline].

  7. Doan QH, Kissoon N, Dobson S, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr. Jan 2009;154(1):91-5. [Medline].

  8. Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep. Jan 12 2007;56(1):1-4. [Medline]. [Full Text].

  9. AAP. Rhinovirus. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. 2006:566-7.

  10. Arden KE, McErlean P, Nissen MD, et al. Frequent detection of human rhinoviruses, paramyxoviruses, coronaviruses, and bocavirus during acute respiratory tract infections. J Med Virol. Sep 2006;78(9):1232-40. [Medline].

  11. Arruda E, Hayden FG. Update on therapy of influenza and rhinovirus infections. Adv Exp Med Biol. 1996;394:175-87. [Medline].

  12. Atmar RL, Dick EC, Byers RL. Rhinoviruses. In: Oski's Pediatrics, Principles and Practice. 3rd ed. 1999:1084-1086, 1217, 1276-1280.

  13. Bellei N, Carraro E, Perosa AH, et al. Influenza and rhinovirus infections among health-care workers. Respirology. Jan 2007;12(1):100-3. [Medline].

  14. Bermingham A, Henrickson K, Hayden F, et al. VII International Symposium on Respiratory Viral Infections. Antivir Ther. 2007;12(4 Pt B):671-93. [Medline].

  15. Calvo C, Garcia-Garcia ML, Blanco C, et al. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J. Oct 2007;26(10):904-8. [Medline].

  16. Cheuk DK, Tang IW, Chan KH, et al. Rhinovirus infection in hospitalized children in Hong Kong: a prospective study. Pediatr Infect Dis J. Nov 2007;26(11):995-1000. [Medline].

  17. Contoli M, Caramori G, Mallia P, et al. A human rhinovirus model of chronic obstructive pulmonary disease exacerbations. Contrib Microbiol. 2007;14:101-12. [Medline].

  18. Denny FW Jr. The clinical impact of human respiratory virus infections. Am J Respir Crit Care Med. Oct 1995;152(4 Pt 2):S4-12. [Medline].

  19. Dershewitz RA, Macknin ML. The common cold. In: Ambulatory Pediatric Care. 3rd ed. 1999:834-6.

  20. Freymuth F, Vabret A, Cuvillon-Nimal D, et al. Comparison of multiplex PCR assays and conventional techniques for the diagnostic of respiratory virus infections in children admitted to hospital with an acute respiratory illness. J Med Virol. Nov 2006;78(11):1498-504. [Medline].

  21. Gern JE, Brooks GD, Meyer P, et al. Bidirectional interactions between viral respiratory illnesses and cytokine responses in the first year of life. J Allergy Clin Immunol. Jan 2006;117(1):72-8. [Medline].

  22. Greenberg SB. Rhinovirus and coronavirus infections. Semin Respir Crit Care Med. Apr 2007;28(2):182-92. [Medline].

  23. Hamano-Hasegawa K, Morozumi M, Nakayama E, Chiba N, Murayama SY, Takayanagi R, et al. Comprehensive detection of causative pathogens using real-time PCR to diagnose pediatric community-acquired pneumonia. J Infect Chemother. Dec 2008;14(6):424-432. [Medline].

  24. Hayden FG. Respiratory viral threats. Curr Opin Infect Dis. Apr 2006;19(2):169-78. [Medline].

  25. Hershenson MB, Johnston SL. Rhinovirus infections: more than a common cold. Am J Respir Crit Care Med. Dec 15 2006;174(12):1284-5. [Medline].

  26. Heymann PW, Platts-Mills TA, Johnston SL. Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults. Pediatr Infect Dis J. Nov 2005;24(11 Suppl):S217-22, discussion S220-1. [Medline].

  27. Ison MG. Respiratory viral infections in transplant recipients. Antivir Ther. 2007;12(4 Pt B):627-38. [Medline].

  28. Jang YJ, Wang JH, Kim JS, Kwon HJ, Yeo NK, Lee BJ. Levocetirizine inhibits rhinovirus-induced ICAM-1 and cytokine expression and viral replication in airway epithelial cells. Antiviral Res. Dec 22 2008;[Medline].

  29. Kelly JT, Busse WW. Host immune responses to rhinovirus: mechanisms in asthma. J Allergy Clin Immunol. Oct 2008;122(4):671-82; quiz 683-4. [Medline].

  30. Khetsuriani N, Kazerouni NN, Erdman DD, et al. Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol. Feb 2007;119(2):314-21. [Medline].

  31. Kim SR, Ki CS, Lee NY. Rapid detection and identification of 12 respiratory viruses using a dual priming oligonucleotide system-based multiplex PCR assay. J Virol Methods. Dec 23 2008;[Medline].

  32. Kistler A, Avila PC, Rouskin S, et al. Pan-viral screening of respiratory tract infections in adults with and without asthma reveals unexpected human coronavirus and human rhinovirus diversity. J Infect Dis. Sep 15 2007;196(6):817-25. [Medline].

  33. Kistler AL, Webster DR, Rouskin S, et al. Genome-wide diversity and selective pressure in the human rhinovirus. Virol J. May 3 2007;4:40. [Medline].

  34. Lamson D, Renwick N, Kapoor V, et al. MassTag polymerase-chain-reaction detection of respiratory pathogens, including a new rhinovirus genotype, that caused influenza-like illness in New York State during 2004-2005. J Infect Dis. Nov 15 2006;194(10):1398-402. [Medline].

  35. Lee BE, Robinson JL, Khurana V, et al. Enhanced identification of viral and atypical bacterial pathogens in lower respiratory tract samples with nucleic acid amplification tests. J Med Virol. May 2006;78(5):702-10. [Medline].

  36. Lemanske RF, Jackson DJ, Gangnon RE, et al. Rhinovirus illnesses during infancy predict subsequent childhood wheezing. J Allergy Clin Immunol. Sep 2005;116(3):571-7. [Medline].

  37. Malmstrom K, Pitkaranta A, Carpen O, et al. Human rhinovirus in bronchial epithelium of infants with recurrent respiratory symptoms. J Allergy Clin Immunol. Sep 2006;118(3):591-6. [Medline].

  38. Manoha C, Espinosa S, Aho SL, et al. Epidemiological and clinical features of hMPV, RSV and RVs infections in young children. J Clin Virol. Mar 2007;38(3):221-6. [Medline].

  39. Miller EK, Edwards KM, Weinberg GA, Iwane MK, Griffin MR, Hall CB, et al. A novel group of rhinoviruses is associated with asthma hospitalizations. J Allergy Clin Immunol. Nov 20 2008;[Medline].

  40. Miller EK, Lu X, Erdman DD, et al. Rhinovirus-associated hospitalizations in young children. J Infect Dis. Mar 15 2007;195(6):773-81. [Medline].

  41. Monto AS. Viral respiratory infections in the community: epidemiology, agents, and interventions. Am J Med. Dec 29 1995;99(6B):24S-27S. [Medline].

  42. Pappas DE, Hendley JO, Hayden FG, et al. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J. Jan 2008;27(1):8-11. [Medline].

  43. Pelosi U, Porcu G, Chia L, Firinu D. Bronchiolitis today. J Chemother. Oct 2007;19 Suppl 2:5-7. [Medline].

  44. Peltola V, Waris M, Osterback R, et al. Rhinovirus Transmission within Families with Children: Incidence of Symptomatic and Asymptomatic Infections. J Infect Dis. Feb 1 2008;197(3):382-9. [Medline].

  45. Peltola V, Waris M, Osterback R, Susi P, Hyypiä T, Ruuskanen O. Clinical effects of rhinovirus infections. J Clin Virol. Dec 2008;43(4):411-4. [Medline].

  46. Piotrowska Z, Vázquez M, Shapiro ED, Weibel C, Ferguson D, Landry ML. Rhinoviruses Are a Major Cause of Wheezing and Hospitalization in Children Less Than 2 Years of Age. Pediatr Infect Dis J. Jan 2009;28(1):25-29. [Medline].

  47. Pitkäranta A, Hayden FG. Rhinoviruses: important respiratory pathogens. Ann Med. Dec 1998;30(6):529-37. [Medline].

  48. Quan PL, Palacios G, Jabado OJ, et al. Detection of respiratory viruses and subtype identification of influenza A viruses by GreeneChipResp oligonucleotide microarray. J Clin Microbiol. Aug 2007;45(8):2359-64. [Medline].

  49. Rankl C, Kienberger F, Wildling L, Wruss J, Gruber HJ, Blaas D, et al. Multiple receptors involved in human rhinovirus attachment to live cells. Proc Natl Acad Sci U S A. Nov 18 2008;105(46):17778-83. [Medline].

  50. Romero JR. Pleconaril: a novel antipicornaviral drug. Expert Opin Investig Drugs. Feb 2001;10(2):369-79. [Medline].

  51. Savolainen-Kopra C, Blomqvist S, Kilpi T, Roivainen M, Hovi T. Novel species of human rhinoviruses in acute otitis media. Pediatr Infect Dis J. Jan 2009;28(1):59-61. [Medline].

  52. Sears MR. Epidemiology of asthma exacerbations. J Allergy Clin Immunol. Oct 2008;122(4):662-8; quiz 669-70. [Medline].

  53. Singh AM, Busse WW. Human rhinovirus models in asthma. Contrib Microbiol. 2007;14:12-20. [Medline].

  54. Smith MB. Acute rhinitis and pharyngitis. In: Evidence-Based Pediatrics. 2000:83-90.

  55. Spiteri MA, Bianco A. The clinical and biological impact of viral respiratory infections on the human airway: focus on the rhinovirus. Monaldi Arch Chest Dis. Feb 1998;53(1):80-2. [Medline].

  56. Sung RY, Chan PK, Tsen T, Li AM, Lam WY, Yeung AC, et al. Identification of viral and atypical bacterial pathogens in children hospitalized with acute respiratory infections in Hong Kong by multiplex PCR assays. J Med Virol. Jan 2009;81(1):153-9. [Medline].

  57. Szefler SJ. Asthma exacerbations: putting a lid on the volcano. J Allergy Clin Immunol. Oct 2008;122(4):697-9. [Medline].

  58. Taketomo C. CHLA. In: Pediatric Dosing Handbook and Formulary. 12th ed. 1997-1998.

  59. Tapparel C, Junier T, Gerlach D, et al. New complete genome sequences of human rhinoviruses shed light on their phylogeny and genomic features. BMC Genomics. Jul 10 2007;8:224. [Medline].

  60. Terajima M, Yamaya M, Sekizawa K, et al. Rhinovirus infection of primary cultures of human tracheal epithelium: role of ICAM-1 and IL-1beta. Am J Physiol. Oct 1997;273(4 Pt 1):L749-59. [Medline]. [Full Text].

  61. Turner RB. New considerations in the treatment and prevention of rhinovirus infections. Pediatr Ann. Jan 2005;34(1):53-7. [Medline].

  62. Turner RB. Rhinovirus: more than just a common cold virus. J Infect Dis. Mar 15 2007;195(6):765-6. [Medline].

  63. Verboon-Maciolek MA, Krediet TG, Gerards LJ, et al. Clinical and epidemiologic characteristics of viral infections in a neonatal intensive care unit during a 12-year period. Pediatr Infect Dis J. Oct 2005;24(10):901-4. [Medline].

  64. Versteegh FG, Weverling GJ, Peeters MF, et al. Community-acquired pathogens associated with prolonged coughing in children: a prospective cohort study. Clin Microbiol Infect. Oct 2005;11(10):801-7. [Medline].

  65. Winther B, Hayden FG, Hendley JO. Picornavirus infections in children diagnosed by RT-PCR during longitudinal surveillance with weekly sampling: Association with symptomatic illness and effect of season. J Med Virol. May 2006;78(5):644-50. [Medline].

  66. Winther B, McCue K, Ashe K, et al. Environmental contamination with rhinovirus and transfer to fingers of healthy individuals by daily life activity. J Med Virol. Oct 2007;79(10):1606-10. [Medline].

  67. Wright PF, Deatly AM, Karron RA, et al. Comparison of results of detection of rhinovirus by PCR and viral culture in human nasal wash specimens from subjects with and without clinical symptoms of respiratory illness. J Clin Microbiol. Jul 2007;45(7):2126-9. [Medline].

  68. Yanney M, Vyas H. The treatment of bronchiolitis. Arch Dis Child. Sep 2008;93(9):793-8. [Medline].

  69. Zalm MM, van Ewijk BE, Wilbrink B, Uiterwaal CS, Wolfs TF, van der Ent CK. Respiratory Pathogens in Children with and without Respiratory Symptoms. J Pediatr. Sep 27 2008;[Medline].

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Keywords

rhinovirus infection, common cold, adenovirus, Bordetella pertussis, Chlamydia psittaci, Coccidioides immitis, coronaviruses, Coxiella burnetii, coxsackieviruses groups A and B, croup, echoviruses, enterovirus, hepatitis A virus, hepatovirus, Histoplasma capsulatum, intercellular adhesion molecule-1, ICAM-1, lower respiratory infection, LRI, Mycoplasma pneumoniae, nasal congestion, nasal discharge, nasopharyngitis, numbered enteroviruses, parainfluenza, parechoviruses, pneumonia, polioviruses, respiratory syncytial virus, RSV, rhinorrhea, RV infection, sneezing, throat irritation, upper respiratory infection, URI, viremia, parainfluenza, acute otitis media, AOM, treatment, diagnosis

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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