Acute viral nasopharyngitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Acute viral nasopharyngitis is a highly contagious viral infectious disease of the upper respiratory system primarily caused by rhinovirus and less commonly caused by picornaviruses or coronaviruses. Common symptoms are sore throat, runny nose, nasal congestion, sneezing, and cough sometimes accompanied by muscle aches, fatigue, malaise, headache, muscle weakness, or loss of appetite. Fever and extreme exhaustion are more common in influenza. The symptoms of a cold usually resolve after about one week, but can last up to 14 days. Symptoms may be more severe in infants and young children. Although the disease is generally mild and self-limiting, patients with the common cold often seek professional medical help, use over-the-counter drugs, and may miss school or work days. The annual cumulative societal cost of the common cold in the United States is billions of dollars. No vaccines are available. The primary method to prevent the infection is hand washing to minimize person-to-person transmission of the virus. There are no antiviral drugs approved to treat or cure the infection. Most available medications are palliative and treat symptoms only. Megadoses of vitamin C, preparations from echinacea, and zinc gluconate have been studied as treatments for the common cold, though none have been approved by the Food and Drug Administration or European Medicines Agency.
Historical Perspective
Common cold was first considered a distinct diagnosis by Benjamin Franklin in the 18th century.
Classification
There is no established classification system for acute viral nasopharyngitis.
Pathophysiology
Rhinovirus (the most common cause of the common cold) is usually transmitted via aerosols generated by coughing or sneezing. Following transmission, the virus invades the epithelial cells and causes the release of inflammatory cytokines, leading to various cold symptoms.
Causes
Acute viral nasopharyngitis is most commonly caused by an infection with rhinovirus. Other common causes include coronavirus, human parainfluenza viruses, and human respiratory syncytial virus (RSV).
Differentiating Acute Viral Nasopharyngitis from other Diseases
Acute viral nasopharyngitis should be differentiated from other diseases that cause runny nose, cough, and constitutional symptoms such as influenza, allergic rhinitis, and acute sinusitis.
Epidemiology and Demographics
Acute viral nasopharyngitis is the most common human infection worldwide and is responsible for about half of family physician visits.
Risk Factors
Common risk factors in the development of acute viral nasopharyngitis include contact with an infected patient and going to daycare centers.
Natural History, Complications, and Prognosis
If left untreated, common cold resolves completely within 7-10 days. Common complications of acute viral nasopharyngitis include sinusitis, otitis media, and exacerbation of reactive airway disease. Prognosis is generally excellent. 50% of patients recover completely within 7 days and 90% of patients recover within 15 days.
History and Symptoms
Symptoms of acute viral nasopharyngitis include runny nose, cough, and sore throat.
Physical Examination
Patients with acute viral nasopharyngitis usually appear ill. Physical examination of patients with acute viral nasopharyngitis is usually remarkable for runny nose, hyperemic nasal mucosa, and mild cervical lymphadenopathy.
Laboratory Findings
Laboratory findings consistent with the diagnosis of acute viral nasopharyngitis include positive viral culture, positive PCR, and leucocytosis in CBC.
Imaging Findings
There are no X-ray, CT, MRI, or ultrasound findings associated with acute viral nasopharyngitis.
Medical Therapy
The mainstay of therapy for acute viral nasopharyngitis is symptomatic treatment. The common cold is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins to produce specific antibodies that prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy immunocompetent individuals, on average, the common cold resolves in seven days.
Surgery
Surgical intervention is not recommended for the management of acute viral nasopharyngitis.
Prevention
Effective measures for the primary prevention of acute viral nasopharyngitis include avoiding close contact with patients and washing hands regularly.