R H I N I T I S

H. Helmi M. Lubis Dr, Sp.A(K)

H. Ridwan M. Daulay Dr, Sp.A(K)
Gabriel Panggabean Dr, Sp.A
Wisman Dr, Sp.A
Defenisi
Common cold Cold
Acute, highly infectious viral disease
Caracterized : nasal stuffines
sneezing
coryza
throat irritation
little / no fever
many times / yrs/ person
R H I N I T I S
Most common cause : Rhinoviruses
Common causes : Parainfluenza viruses
RSV
Coronaviruses
Occasional causes : Adenoviruses
Coxackieviruses
Influenza viruses
Reoviruses
Hervesviruses
Other organism : M. pneumonia H. capsulatum
C. immitis C. psittaci
C. burnetii
Etiology
R H I N I T I S
Usually : inhalation / self inoculation onto nasal
mucosa
Occasionally : onto conjunctival surface
Cells infected spread locally nasal secretion
, submucosal edema
Shedding of ciliated epithelial cells
Nasal mucociliary transpoprt
The number of neutrophils
Nasal discharge has a high protein, mucopurulent
Pathophysiology
R H I N I T I S
Greatest concentration in nasal secretion
Greatest amount : sneezing, nose blowing,
contaminated hands
Little : coughing, talking, saliva
Children : greater concentration of virus
longer period for shed virus
Virus shedding : 2 7 d 2 wks
Epithelium regenerated after 5
th
day
R H I N I T I S
Minimal symptoms : - nasal discharge
- nasal obstruction
- throat irritation

Onset of symptoms : Chilliness
Dryness & irritation in the nose
Scratchy throat
Nasal stuffiness or obstruction
Sneezing, watery nasal discharge
Throat irritation, eyes irritation
Coughing
General malaise, anorexia, low grade
fever
Clinical manifestation
R H I N I T I S
1 3 day : nasal secretion thicker &
purulent
Nasal obstruction mouth breathing
irritation of throat
Nasal discharge excoriation
Duration : 7 days
Irritable, interfere feeding & sleeping
Vomiting, diarrhea
R H I N I T I S
Acute otitis media
Tonsillitis
Sinusitis
LRTI
Complication
R H I N I T I S
Clinical feature & exposure hystory are
specific No investigation !!
Virus : Nasopharingeal culture
Recurrent cold allergic rhinitis
Persistent nasal symptom
adenoiditis/sinusitis


Investigation
R H I N I T I S
Usually resolve quickly no specific therapy
Feels miserable, fever, irritated throat analgesic /
antipyretic (acetaminophen/paracetamol)
Nasal obstruction isotonic saline nasaldrops
Nasal secretion suction / aspiration
Concentrated capsules of eucalyptus young children
contraindicated
Frequent intake of fluid help
Tobacco smoke aggravates avoided !!
OTC cold medication for children never established
RCT : antihistamin-decongestan placebo ; no difference

Hutton N, J Pediatr 1991(118):125-30
Management
R H I N I T I S
Decongestan : rebound obstruction
Antihistamines : aggravate the symptoms
- dry mouth
- nasal stuffiness
- agitation
Interferon : not recommended for children
Intranasal nedocromil sodium : beneficial effect
in rhinovirus infections in helthy volunteers
Zinc gluconate lozenges : ineffective
Goal : reducing the spread of nasal secretion
Preliminary studies : virucidal nasal paper tissue
spread of rhinovirus colds
Farr BM, Antimicrob Agents Chemother 1987(128):1162-72
R H I N I T I S