Treatment Approach for Rhinovirus (RhV) and Enterovirus (EV) Infections
Rhinovirus and enterovirus infections are primarily managed with supportive care as there are no specific antiviral treatments approved for routine clinical use. 1
Diagnostic Considerations
- Reverse transcriptase PCR (RT-PCR) targeting the 5′non-coding region (5′NCR) is the recommended diagnostic method for enterovirus and rhinovirus infections due to its sensitivity, specificity, and short turnaround time 1
- Multiple samples should be collected for optimal detection: respiratory specimens (throat swabs, nasopharyngeal aspirates), stool samples, cerebrospinal fluid (CSF), and blood samples depending on clinical presentation 1
- Respiratory specimens are particularly important for detecting EV-D68, which is rarely found in CSF or stool samples 1
- Virus isolation should not be used for routine diagnosis but can be helpful for further characterization 1
- Serological methods such as ELISA and neutralization tests are not recommended for diagnosis of acute EV infection 1
Supportive Treatment for Uncomplicated Infections
- Adequate hydration to fluidify secretions 2
- Nasal saline irrigation to relieve congestion and facilitate clearance of secretions 2
- Antipyretics/analgesics (acetaminophen or NSAIDs) for fever and pain relief 2
- Rest to promote recovery 2
- Humidification of the environment to alleviate mucosal dryness 2
Pharmacological Management
- First-generation antihistamine/decongestant combinations containing sustained-release pseudoephedrine and brompheniramine may help reduce cough and other symptoms 2
- Newer generation non-sedating antihistamines are relatively ineffective for common cold symptoms 2
- Oral decongestants may provide symptomatic relief but consider contraindications like hypertension 2
- Topical nasal decongestants should be limited to short periods (3-5 days) to avoid rebound congestion 2
- Antibiotics are not recommended for uncomplicated rhinovirus or enterovirus infections as they are ineffective against viruses and contribute to antimicrobial resistance 2
Management of Severe Enterovirus Infections
- Severe enterovirus infections, particularly in neonates and immunocompromised patients, may require intensive supportive care 3, 4
- Intravenous immunoglobulin (IVIG) has been used in severe cases, particularly for neonatal enterovirus infections, though clinical efficacy has not been definitively proven 3, 4
- Mechanical ventilation and extracorporeal membrane oxygenation (ECMO) may be necessary in cases with severe respiratory compromise or myocarditis 3
- Blood component transfusion may be required in cases with coagulopathy 3
Special Considerations
- Neonates are at high risk for severe enterovirus infections with complications including hepatitis, myocarditis, meningoencephalitis, and coagulopathy 3, 4
- Immunocompromised patients may experience prolonged viral shedding and more severe disease 1, 5
- Avoid decongestants and antihistamines in children under 3 years due to potential adverse effects 2
- Monitor patients with underlying conditions like asthma closely, as rhinovirus is a common trigger for exacerbations 1, 6
Investigational Therapies
- Pleconaril is an investigational antiviral that inhibits viral attachment and uncoating, with activity against enteroviruses and rhinoviruses 7, 4
- Pocapavir has been used in some severe neonatal enterovirus cases, but more clinical evidence is needed regarding efficacy 3
- PI4KIIIβ inhibitors have shown promise in preclinical studies for broad-spectrum activity against enteroviruses 7