Symptoms and Management of Rhinovirus Infections
Rhinovirus infections primarily cause common cold symptoms including sneezing, rhinorrhea, nasal congestion, hyposmia/anosmia, facial pressure, postnasal drip, sore throat, cough, ear fullness, fever, and myalgia, with treatment being largely symptomatic as there is no generally recommended antiviral therapy. 1
Common Symptoms of Rhinovirus Infection
Rhinovirus infections typically present with a combination of upper respiratory symptoms that follow specific patterns of onset and resolution 2:
- Sneezing and nasal discharge (rhinorrhea) - initially clear and watery, may become cloudy due to white blood cells and desquamated epithelium 2
- Nasal congestion/obstruction 2
- Sore throat 2
- Cough - may persist for up to 10 days or longer 2
- Postnasal drip 2
- Facial pressure/pain 2
- Hyposmia/anosmia (reduced/absent sense of smell) 2
- Fever and myalgia - typically resolve within 5 days 2
- Ear fullness/pressure 2
The duration of symptoms follows characteristic patterns 2:
- Fever and myalgia typically resolve first
- Sneezing and sore throat resolve next (sore throat may persist up to 12 days in 60% of patients)
- Cough and rhinorrhea are the most persistent symptoms (cough may persist in 50% of patients at day 10)
- Nasal drainage may persist in 40% of patients at day 9
Pathophysiology
- Rhinoviruses are non-enveloped, single-stranded RNA viruses of the family Picornaviridae 1
- Unlike influenza and adenovirus which cause significant epithelial damage, rhinovirus and coronavirus typically do not cause discernible epithelial damage 3
- Symptoms are primarily caused by the host inflammatory response rather than direct viral damage 3:
- Rhinovirus triggers an inflammatory cascade with release of inflammatory mediators (e.g., IL-8) and proinflammatory cytokines 3
- This leads to upregulation of histamine, bradykinin, and various cytokines including interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-α, and leukotriene C4 2
- Viruses also suppress neutrophil, macrophage, and lymphocyte function, potentially increasing vulnerability to secondary bacterial infections 2
Distinguishing Features and Complications
- Contrary to popular belief, a change in color or characteristic of nasal discharge is not a specific sign of bacterial infection, as mucopurulent secretions can occur after a few days of viral infection due to neutrophil influx 2
- Rhinovirus infections can lead to complications including:
Management of Rhinovirus Infections
- Treatment is primarily symptomatic and supportive as there is no generally recommended antiviral therapy 1
- Most rhinovirus infections are self-limiting and resolve within 7-10 days without antibiotics 2
- Management options include:
Important Clinical Considerations
- Antibiotics are not effective for viral infections such as rhinovirus colds 2
- Bacterial superinfection occurs in less than 2% of cases 2
- Rhinovirus infections account for a significant proportion of inappropriate antibiotic use 2
- Children experience an average of 3-8 viral URIs per year, with symptoms potentially lasting longer in children attending daycare 2
- The mean duration of viral URI ranges between 6.6-8.9 days, but symptoms may last more than 15 days in approximately 7-13% of cases 2
- Consider bacterial superinfection if symptoms worsen after 5-7 days or persist beyond 10 days with severe unilateral pain, high fever, or "double sickening" (deterioration after initial improvement) 2