What is the most common upper respiratory virus?

Rhinovirus is the Most Common Upper Respiratory Virus

Rhinovirus is the most common upper respiratory virus, accounting for 30-80% of all common cold cases. 1

Epidemiology and Prevalence

• Rhinoviruses are the predominant cause of the common cold syndrome, with over 100 different serotypes identified 1
• The prevalence hierarchy of upper respiratory viruses:
  1. Rhinovirus (30-80% of colds)
  2. Human coronavirus (approximately 15% of colds)
  3. Respiratory syncytial virus (10-15% of colds)
  4. Adenovirus (approximately 5% of colds) 1

Rhinovirus Characteristics

• Rhinoviruses are non-enveloped, single-stranded RNA viruses belonging to the Picornaviridae family 2
• They primarily infect the upper respiratory tract by attaching to ICAM-1 receptors on epithelial cells in the posterior nasopharynx 1
• Unlike some respiratory viruses (influenza, adenovirus), rhinoviruses do not cause major epithelial damage but trigger significant inflammatory responses 1

Clinical Presentation

• Rhinovirus infections typically present with:
  • Nasal congestion
  • Rhinorrhea (nasal discharge)
  • Sneezing
  • Sore throat
  • Cough 1, 3
• Symptoms typically peak by days 3-6 and resolve within 7-10 days 3
• Fever is more common in children than adults 4

Complications and Special Considerations

• While primarily causing upper respiratory infections, rhinoviruses can also:
  • Exacerbate asthma and chronic obstructive pulmonary disease 5
  • Cause lower respiratory tract infections including bronchiolitis and pneumonia, especially in vulnerable populations 2, 5
  • Lead to secondary bacterial infections such as sinusitis and otitis media 1

Transmission and Prevention

• Rhinovirus spreads through:

  1. Airborne droplets (aerosols)
  2. Direct contact with infected secretions
  3. Contact with contaminated objects (fomites) 1

• Prevention strategies:

  • Hand hygiene (most effective prevention method)
  • Mask use during outbreaks
  • Social distancing when appropriate 3

Diagnostic Considerations

• Diagnosis is typically clinical based on symptoms
• When testing is needed, nucleic acid amplification tests (NAATs) are most commonly used in commercial respiratory panels 1
• Respiratory secretions or nasopharyngeal swabs placed in viral transport medium are the specimens of choice 1

Management Approach

• Treatment is primarily supportive as rhinovirus infections are self-limiting 3, 2
• Symptomatic relief options:
  • First-generation antihistamine/decongestant combinations for cough, throat clearing, and postnasal drip
  • Nasal saline irrigation
  • Analgesics/antipyretics for pain and fever
  • Short-term use of topical decongestants (≤5 days)
  • Honey for cough in adults 3

Important Caveats

• Antibiotics are not effective against rhinovirus and should be reserved for suspected bacterial complications 3
• Nasal discharge color alone does not indicate bacterial infection 3
• Currently, no specific antiviral therapy is routinely recommended for rhinovirus infections 2
• Special attention should be given to high-risk populations (elderly, very young children, immunocompromised) who may develop more severe disease 3, 5