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  • Snapshot
    • A 13-year-old girl presents to the urgent care center for 7 days of nasal congestion, runny nose, sore throat, and a nonproductive cough. She reports that she has had 1 or 2 subjective fevers. She denies any shortness of breath, chills, chest pain, or nausea. She has been taking over-the-counter Tylenol and Mucinex. As her younger sister was just born yesterday, she is worried. She is reassured that her illness will resolve on its own and to exercise extra precaution around the neonate.
  • Introduction
    • Classification
      • rhinovirus
        • a non-enveloped, linear, single-stranded, positive-sense RNA virus with an icosahedral capsid
        • a picornavirus
        • causes the “common cold”
        • does not cause viral meningitis or gastroenteritis
        • transmission via direct contact
    • Epidemiology
      • incidence
        • very common
      • demographics
        • all ages
      • risk factors
        • immunosuppression
        • sick contacts
        • smoking
        • recent travel on an airplane
    • Etiology
      • > 100 serologic types
    • Pathogenesis
      • attaches to the ICAM-1 receptor on the cell surface
      • RNA is translated into a large polypeptide that is cleaved by viral proteins
      • acid-labile and thus is not an enterovirus
      • vasodilation and increased vascular permeability causes rhinorrhea
      • replicates in nasopharynx epithelium
    • Prognosis
      • self-limited but may last for 2 weeks
  • Presentation
    • Symptoms
      • rhinorrhea
      • congestion
      • cough
      • sore throat
      • malaise
    • Physical exam
      • low-grade fever
      • hoarse voice
      • lungs are usually clear to auscultation
  • Imaging
    • Chest radiography
      • indication
        • only if pneumonia is suspected (e.g., lung exam with rales or focal crackles/rhonchi))
      • findings
        • lobar consolidation
  • Studies
    • Making the diagnosis
      • based on clinical presentation
      • diagnosis of exclusion in patients with immunosuppression
  • Differential
    • Streptococcal pharyngitis
      • distinguishing factor
        • typically presents with erythematous pharynx, tonsillar exudates, petechiae, and tender lymphadenopathy
        • tests positive on a rapid strep test
    • Influenza
      • distinguishing factor
        • systemic symptoms usually predominate with high fever and general malaise
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • hydration
          • anti-pyretics
          • analgesics
          • steroid nasal spray may help with rhinorrhea
  • Complications
    • Bacterial superinfection
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