Rhinovirus (RV) Infection (Common Cold) Workup

Updated: Aug 18, 2023
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Approach Considerations

Clinical signs and symptoms of the common cold, by definition, are similar regardless of the infectious etiology. Accordingly, if findings from a thorough history and physical examination are consistent with a viral etiology and no complications are noted, an aggressive workup rarely is necessary. Differentiation of one virus from another or one rhinovirus (RV) serotype from another on the basis of clinical presentation is difficult.

In general, the white blood cell (WBC) count has little value in the diagnosis of the common cold, though in some cases, peripheral WBC counts may be elevated during the first 2-3 days of the infection. Other common laboratory tests, such as the complete blood count (CBC) and the erythrocyte sedimentation rate (ESR), are of virtually no benefit in managing rhinovirus infections.

Because of the prolonged time to obtain positive culture findings, culture of rhinovirus rarely has 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. However, with more than 100 different serotypes of rhinovirus alone, assisting the diagnosis by means of serologic methods is economically impractical.

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.

A 2009 study determined that rapid multiviral testing in the emergency department (ED) did not significantly affect treatment but could result in a reduction of antibiotic prescription in the community after discharge. [79] Rapid respiratory panel, which included a test for adenovirus, also shortened the duration of antibiotic use, length of hospital stay, and time in isolation in a similar study in 2015. [80]


Viral Testing

If a specific viral diagnosis is desired, the virus can be cultured from nasal secretions; nasal washings are more sensitive than throat specimens. 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. Direct antigen tests are routinely available for influenza virus and respiratory syncytial virus (RSV). Some centers offer direct antigen tests for parainfluenza and adenovirus.

Increasingly, microarray [81] and real-time polymerase chain reaction (PCR) assays are being used to detect rhinovirus in respiratory specimens. [82, 83, 84] PCR assay is faster and more sensitive than culture. Real-time PCR has been shown to be a rapid and effective way of detecting the virus and has been proposed as the clinical detection method of choice. In clinical settings, PCR testing has been most useful in evaluating patients who are severely immunocompromised, such as bone marrow transplant recipients.

The results of PCR testing must be interpreted carefully. [85] One study reported persistent positive results for 5-6 weeks after admission of children for illnesses determined to be secondary to rhinovirus infection; furthermore, the use of nested PCR techniques has resulted in as many as 20% of illnesses being attributed to more than 1 organism. [86]

Commercially available multiplex PCR assays cannot reliably differentiate rhinovirus from enterovirus, so results are reported as rhinovirus/enterovirus. In addition, detected rhinovirus may be related to a past infection rather than a current infection since prolonged viral shedding is known to occur. Among children younger than 1 year, viral shedding beyond 30 days is uncommon. [87]


Other Studies

Consider bacterial throat culture or rapid strep testing to identify the presence of group A streptococci if oropharyngeal examination suggests streptococcal infection.

Chest radiography is seldom needed and should be obtained only if another lower respiratory tract infection (eg, pneumonia) is suspected.

Sinus films or computed tomography (CT) scanning of the sinuses may be useful in cases of suspected sinusitis, though such imaging cannot differentiate viral processes from bacterial processes. More than 85% of patients with a common cold have sinus abnormalities on CT. A diagnosis of bacterial sinusitis is unlikely if the duration of symptoms is less than 10-14 days.