What is the primary approach to managing rhinovirus or enterovirus (EV) infections?

Management of Rhinovirus and Enterovirus Infections

The primary approach to managing rhinovirus and enterovirus infections is supportive care, as there are currently no approved antiviral medications for these infections, which are typically self-limiting. 1

Clinical Presentation and Epidemiology

• Rhinoviruses are the most common cause of upper respiratory infections (30-80% of common colds) 1
• Enteroviruses can cause a wider range of clinical manifestations, from mild respiratory symptoms to severe neurological infections 2
• Both viruses belong to the Enterovirus genus of the Picornaviridae family 2, 1
• Most infections are self-limiting, but can occasionally cause severe disease, especially in immunocompromised patients 2, 3

Diagnostic Approach

Sample Collection

• For respiratory symptoms: Collect respiratory specimens (nasal/throat swabs, nasopharyngeal aspirates) 2
• For neurological symptoms: Collect cerebrospinal fluid (CSF), blood, respiratory and stool samples 2
• Important: For suspected EV-D68 infections with neurological symptoms, respiratory specimens are crucial as this virus is rarely detected in CSF or stool 2

Laboratory Testing

• Reverse transcriptase PCR (RT-PCR) targeting the 5′non-coding region is the recommended diagnostic method due to its:
  • High sensitivity and specificity
  • Short turnaround time 2
• Virus isolation should not be used for routine diagnosis 2
• Serological methods are not recommended for diagnosis of acute infections 2

Treatment Algorithm

1. Supportive Care (First-line management)

• Symptom management:

  • Acetaminophen or ibuprofen for fever and pain 1
  • Adequate hydration
  • Rest

• For respiratory symptoms:

  • Nasal saline irrigation (safe and effective for symptom relief) 1
  • Short-term use of topical decongestants (no more than 3-5 days to avoid rebound congestion) 1
  • Oral decongestants if no contraindications exist 1
  • First-generation antihistamine/decongestant combinations for cough, throat clearing, and postnasal drip 1
  • Honey for adults with distressing cough 1
  • Ipratropium bromide (inhaled) for cough suppression 1

2. Special Considerations

• Immunocompromised patients:

  • Require closer monitoring as they may develop more severe disease 1
  • May experience persistent infections (documented persistence up to 455 days) 3
  • More aggressive management and follow-up recommended 1

• Patients with severe presentations:

  • Evaluate for complications such as bacterial sinusitis or pneumonia 1
  • Consider hospitalization for respiratory support if needed 4
  • Children with rhinovirus/enterovirus infections may have more severe clinical course than those with RSV or influenza infections 4

3. What NOT to Do

• Avoid antibiotics unless bacterial superinfection is suspected 1

  • Signs of bacterial infection include:
    • Symptoms persisting >10 days without improvement
    • Severe symptoms or worsening after initial improvement
    • Development of bacterial sinusitis 1

• Avoid systemic corticosteroids in patients with acute post-viral rhinosinusitis due to lack of evidence and potential adverse effects 1

Prevention Strategies

• Hand hygiene is the most effective way to prevent transmission 1
• Mask use and social distancing during outbreaks 1
• Annual influenza vaccination for high-risk patients to prevent co-infections 1

Follow-up Recommendations

Return for medical evaluation if:

• Fever >38°C persists for more than 48 hours
• Breathing difficulty develops
• Symptoms worsen instead of improving 1
• Symptoms persist ≥10 days beyond onset of URI 1

Important Clinical Considerations

• Acute exacerbation of chronic rhinosinusitis (AECRS) can be triggered by rhinovirus infections 2
• Persistent infections occur mainly in immunosuppressed patients 3
• Some enterovirus types (EV-A71, EV-D68) can cause severe outbreaks with significant morbidity and mortality 2
• Currently, no antiviral drug is approved for the treatment of rhinovirus or enterovirus infections, despite ongoing research 5, 6

By following this management approach, most patients with rhinovirus and enterovirus infections will recover without complications, while those at risk for severe disease can be identified and monitored appropriately.