History and exam
Key diagnostic factors
Onset is rapid over the course of 1 to 2 days.
Clear or purulent rhinitis may be present. Colored secretions are often a sign of oxidation and do not necessarily indicate any complications to a viral illness bacterial superinfection.
A characteristic feature.
A characteristic feature.
A characteristic feature.
Clear sputum initially, may become purulent, may be nonproductive.
More likely in children; greater than 100.4°F (>38°C) suggestive of alternative cause in adults.
Common feature on examination of oropharynx.
Common feature on examination of nares.
Common feature on examination of nares/oropharynx.
Pulse should be <100 bpm and blood pressure normal for the patient's age. Pulse and BP should be checked in any patient who appears moderately sick, to rule out septic shock from a bacterial cause (e.g., meningococcal septicemia).
Other diagnostic factors
Sick but not extremely tired; persistent fatigability may suggest alternative cause.
A constitutional symptom, suggestive of viremia.
May be suggestive of streptococcal infection if tonsillar exudates are present.
Risk factors
Bedroom sharing is associated with higher rates of antibody conversion to common rhinoviruses than sleeping in a room alone.[8]Monto AS. Occurrence of respiratory virus: time, place and person. Pediatr Infect Dis J. 2004 Jan;23(suppl 1):S58-64.
http://www.ncbi.nlm.nih.gov/pubmed/14730271?tool=bestpractice.com
Children have more episodes than adults.[3]Fry J, Sandler G. Common diseases. Their nature, prevalence and care. Dordrecht, The Netherlands: Kluwer Academic; 1993.[4]Tupasi TE, de Leon LE, Lupisan S, et al. Patterns of acute respiratory tract infection in children: a longitudinal study in a depressed community in Metro Manila. Rev Infect Dis. 1990 Nov-Dec;12(suppl 8):S940-9.
http://www.ncbi.nlm.nih.gov/pubmed/2270416?tool=bestpractice.com
[5]Cruz JR, Pareja G, de Fernandez A, et al. Epidemiology of acute respiratory tract infections among Guatemalan ambulatory preschool children. Rev Infect Dis. 1990 Nov-Dec;12(suppl 8):S1029-34.
http://www.ncbi.nlm.nih.gov/pubmed/2270400?tool=bestpractice.com
[6]Kvaerner KJ, Nafstad P, Jaakkola JJ. Upper respiratory morbidity in preschool children: a cross-sectional study. Arch Otolaryngol Head Neck Surg. 2000 Oct;126(10):1201-6.
http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/405408
http://www.ncbi.nlm.nih.gov/pubmed/11031406?tool=bestpractice.com
Respiratory infections are more common in winter than in other seasons.[8]Monto AS. Occurrence of respiratory virus: time, place and person. Pediatr Infect Dis J. 2004 Jan;23(suppl 1):S58-64.
http://www.ncbi.nlm.nih.gov/pubmed/14730271?tool=bestpractice.com
According to one study analyzing data from the US, children in daycare centers were 4.5 times more likely to be hospitalized than those in other settings and developed more upper respiratory tract infections.[12]Bell DM, Gleiber DW, Mercer AA, et al. Illness associated with child day care: a study of incidence and cost. Am J Public Health. 1989 Apr;79(4):479-84.
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.79.4.479
http://www.ncbi.nlm.nih.gov/pubmed/2929808?tool=bestpractice.com
Smokers are at greater risk of developing the condition than nonsmokers.[13]Cohen S, Tyrrell DA, Russell MA, et al. Smoking, alcohol consumption, and susceptibility to the common cold. Am J Public Health. 1993 Sep;83(9):1277-83.
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.83.9.1277
http://www.ncbi.nlm.nih.gov/pubmed/8363004?tool=bestpractice.com