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