Common cold

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Common cold
Classification and external resources
File:Rhinovirus.PNG
Molecular surface of one variant of human rhinovirus.
ICD-10 J00.0
ICD-9 460
DiseasesDB 31088
MedlinePlus 000678
eMedicine aaem/118 med/2339
MeSH D003139

The common cold (viral upper respiratory tract infection (VURTI), acute viral rhinopharyngitis, acute coryza, or cold) is a contagious, viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses.[1] Common symptoms include a cough, sore throat, runny nose, and fever. There is no cure; however, symptoms usually resolve spontaneously in 7 to 10 days, with some symptoms possibly lasting for up to three weeks.[2]

The common cold is the most frequent infectious disease in humans[3] with on average two to four infections a year in individual adults and up to 6–12 in individual children. Collectively, colds, influenza, and other infections with similar symptoms are included in the diagnosis of influenza-like illness. They may also be termed upper respiratory tract infections (URTI). Influenza involves the lungs while the common cold does not.

Signs and symptoms

Symptoms are cough, sore throat, runny nose, and nasal congestion; sometimes this may be accompanied by conjunctivitis (pink eye), muscle aches, fatigue, headaches, shivering, and loss of appetite. Fever is often present thus creating a symptom picture which overlaps with influenza.[4] The symptoms of influenza however are usually more severe.[5] The common cold usually resolves spontaneously in 7 to 10 days, but some symptoms can last for up to three weeks.[2] In children the cough lasts for more than 10 days in 35–40% and continue for more than 25 days in 10%.[6]

Those suffering from colds often report a sensation of chilliness even though the cold is not generally accompanied by fever, and although chills are generally associated with fever, the sensation may not always be caused by actual fever.[4] In one study, 60% of those suffering from a sore throat and upper respiratory tract infection reported headaches[4], often due to nasal congestion.

Progression

The viral replication begins 8 to 12 hours after initial contact.[7] Symptoms usually begin 2 to 5 days after initial infection but occasionally occur in as little as 10 hours.[8] Symptoms peak 2–3 days after symptom onset, whereas influenza symptom onset is constant and immediate.[4] The symptoms usually resolve spontaneously in 7 to 10 days but some can last for up to three weeks.[2]

The first indication of an upper respiratory virus is often a sore or scratchy throat. Other common symptoms are runny nose, congestion, and sneezing.[9] These are sometimes accompanied by muscle aches, fatigue, malaise, headache, weakness, or loss of appetite.[10] Cough and fever generally indicate influenza rather than an upper respiratory virus with a positive predictive value of around 80%.[4] Symptoms may be more severe in infants and young children, and in these cases it may include fever and hives.[11] Upper respiratory viruses may also be more severe in smokers.[12]

Complications

The common cold can lead to symptoms of acute bronchitis, bronchiolitis, croup, pneumonia, sinusitis, otitis media, or strep throat. People with chronic lung diseases such as asthma and COPD are especially vulnerable. Colds may cause acute exacerbations of asthma, emphysema or chronic bronchitis.[7]

Cause

Viruses

The common cold is due to a viral infection of the upper respiratory tract. The most commonly implicated virus is a rhinovirus (30–50%), a type of picornavirus with 99 known serotypes.[4][13][14] Others include: coronavirus (10–15%), influenza (5–15%)[4], human parainfluenza viruses, human respiratory syncytial virus, adenoviruses, enteroviruses, and metapneumovirus.[9]

In total over 200 serologically different viral types cause colds.[4] Coronaviruses are particularly implicated in adult colds. Of over 30 coronaviruses, 3 or 4 cause infections in humans, but they are difficult to grow in the laboratory and their significance is thus less well-understood.[9] Due to the many different types of viruses and their tendency for continuous mutation, it is impossible to gain complete immunity to the common cold.

Risk factors

  • Spending time in an enclosed area with an infected person or in close contact with an infected person. Common colds are droplet-borne infections, which means that they are primarily transmitted through breathing in tiny particles that the infected person emits when he or she coughs, sneezes, or exhales.
  • The role of body cooling in causing the common cold is controversial.[15] It is the most commonly offered folk explanation for the disease, and it has received some experimental evidence. One study showed that exposure to the cold causes cold symptoms in about 10% of those exposed, and that the subjects experiencing this effect report far more colds overall than those who do not.[16] However, a variety of other studies do not show such an effect.[15]
  • Frequently touching eyes, nose, or mouth with contaminated fingers. This behavior somewhat increases the likelihood of transferring viruses from the surface of the hands, where they are harmless, into the upper respiratory tract, where they can infect the tissues.[7][9] Some studies show that very frequent hand washing and not touching any mucous membranes can somewhat reduce the likelihood of acquiring a cold among adults.[17]
  • A history of smoking extends the duration of illness by about three days.[18]
  • Getting fewer than seven hours of sleep per night has been associated with a risk three times higher of developing an infection when exposed to a rhinovirus, compared to those who sleep more than eight hours per night.[19]
  • Low blood vitamin D levels are associated with an increased risk of getting a common cold.[20] Whether this relation is causal has yet to be determined.[21]
  • Common colds are seasonal, occurring more frequently during winter outside of tropical zones. This is believed to be partly due to a change in behaviors such as increased time spent indoors, which puts infected people in close proximity to other people, rather than to exposure to cold temperatures.[9][22]
  • Low humidity increases viral transmission rates. One theory is that dry air causes evaporation of water, thus allowing small viral droplets to disperse farther and stay in the air longer.[23]

Pathophysiology

File:Illu conducting passages.svg
The common cold is a disease of the upper respiratory tract

The common cold virus is transmitted mainly from contact with the saliva or nasal secretions of an infected person, either directly, when a healthy person breathes in the virus-laden aerosol generated when an infected person coughs or sneezes, or by touching a contaminated surface and then touching the nose or eyes.[24]

Symptoms are not necessary for viral shedding or transmission, as a percentage of asymptomatic subjects exhibit viruses in nasal swabs.[25] It is generally not possible to identify the virus type through symptoms, although influenza can be distinguished by its sudden onset, fever, and cough.[4]

The major entry point for the virus is normally the nose, but can also be the eyes (in this case drainage into the nasopharynx would occur through the nasolacrimal duct). From there, it is transported to the back of the nose and the adenoid area. The virus then attaches to a receptor, ICAM-1, which is located on the surface of cells of the lining of the nasopharynx. The receptor fits into a docking port on the surface of the virus. Large amounts of virus receptor are present on cells of the adenoid. After attachment to the receptor, virus is taken into the cell, where it starts an infection.[7] Rhinovirus colds do not generally cause damage to the nasal epithelium. Macrophages trigger the production of cytokines, which in combination with mediators cause the symptoms. Cytokines cause the systemic effects. The mediator bradykinin plays a major role in causing the local symptoms such as sore throat and nasal irritation.[4]

The common cold is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins producing specific antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average.[7]

Prevention

The best prevention is staying away from people who are infected, because the overwhelming majority of infections are acquired by inhaling virus-laden air that an infected person has coughed, sneezed, or breathed out. Available clinical evidence also suggests that exposure to cold temperatures may compromise the immune system[15] (though this effect is controversial). Exposure to cold temperatures should thus be avoided during periods of low temperature, especially by vulnerable populations.[15]

Additionally, experts frequently recommend thorough and regular washing of the hands, especially in healthcare environments, as this reduces the likelihood of transmission through the less common route of direct contact.[26][27] In homes, schools, and workplaces, handwashing and alcohol-based hand sanitizers reduce the number of viruses on the skin significantly,[28] but because upper respiratory infections are primarily acquired through breathing, rather than physical contact, these are not especially effective preventive methods.[29] High levels of handwashing can result in a decrease of 20% or less in transmission of the common cold.[17] Alcohol-based hand sanitizers provide very little protection against upper respiratory infections, especially among children.[30][31] Because the common cold is caused by a virus instead of a bacterium, anti-bacterial soaps are no better than regular soap for removing the virus from skin or other surfaces.[26][32] Not touching the nose, eyes, or mouth with potentially contaminated fingers can also reduce transmission of the virus through direct contact.[7][9]

Efforts to develop a vaccine against the common cold have been unsuccessful. Common colds are produced by a large variety of rapidly mutating viruses; successful creation of a broadly effective vaccine is highly improbable.[33]

Management

File:Pneumonia strikes like a man eating shark.jpg
Poster encouraging citizens to "Consult your Physician" for treatment of the common cold

There are currently no medications or herbal remedies which have been conclusively demonstrated to shorten the duration of illness.[34] Treatment comprises symptomatic support usually via analgesics for fever, headache, sore muscles, and sore throat.

Conservative

Treatments that help alleviate symptoms include simple analgesics and antipyretics such as ibuprofen[35] and acetaminophen / paracetamol. Evidence does not show that cold medicines are any more effective than simple analgesics[36] and are not recommended for use in children due to no evidence supporting their effectiveness and the potential of harm.[37][38]

Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water, are reasonable conservative measures.[9] Evidence for encouraging the active intake of fluids in acute respiratory infections is lacking[39] as is the use of heated humidified air.[40] Saline nasal drops may help alleviate nasal congestion.[41]

Antibiotics and antivirals

Antibiotics are not effective against the viruses that cause the common cold[42] and due to their side effects cause overall harm.[42] There are no approved antiviral drugs for the common cold even though some preliminary research has shown benefit.[43]

Alternative treatments

Main article: Alternative treatments used for the common cold

Many alternative treatments are used to treat the common cold. However, there is insufficient scientific evidence to support the use of any alternative medicine treatments.[12][44] Honey may be an effective treatment of cough and improved sleep difficulty in children more than no treatment or dextromethorphan.[45] However honey should never be given to a child less than one because of the risk of infant botulism.[46]

Prognosis

The common cold is generally mild and self-limiting.[47]

Epidemiology

Upper respiratory tract infections are the most common infectious diseases among adults, who have two to four respiratory infections annually.[48] Children may have six to ten colds a year (and up to 12 colds a year for school children).[9][49] In the United States, the incidence of colds is higher in the fall (autumn) and winter, with most infections occurring between September and April. The seasonality may be due to the start of the school year, or due to people spending more time indoors (thus in closer proximity with each other) increasing the chance of transmission of the virus.[9]

History

File:Definition of a Cold by Benjamin Franklin Page 1.jpg
"Definition of a Cold." Benjamin Franklin's notes for a paper he intended to write on the common cold.

The name "common cold" came into use in the 16th century, due to the similarity between its symptoms and those of exposure to cold weather.[50] Norman Moore relates in his history of the Study of Medicine that James I continually suffered from nasal colds, which were then thought to be caused by polypi, sinus trouble, or autotoxaemia.[51]

In the 18th century, Benjamin Franklin considered the causes and prevention of the common cold. After several years of research he concluded: "People often catch cold from one another when shut up together in small close rooms, coaches, etc. and when sitting near and conversing so as to breathe in each other's transpiration." Although viruses had not yet been discovered, Franklin hypothesized that the common cold was passed between people through the air. He recommended exercise, bathing, and moderation in food and drink consumption to avoid the common cold.[52] Franklin's theory on the transmission of the cold was confirmed some 150 years later.[53]

Common Cold Unit

Main article: Common Cold Unit

In the United Kingdom, the Common Cold Unit was set up by the Medical Research Council in 1946. The unit worked with volunteers who were infected with various viruses.[54] The rhinovirus was discovered there.[55] In the late 1950s, researchers were able to grow one of these cold viruses in a tissue culture, as it would not grow in fertilized chicken eggs, the method used for many other viruses. In the 1970s, the CCU demonstrated that treatment with interferon during the incubation phase of rhinovirus infection protects somewhat against the disease,[56] but no practical treatment could be developed. The unit was closed in 1989, two years after it completed research of zinc gluconate lozenges in the prophylaxis and treatment of rhinovirus colds, the only successful treatment in the history of the unit.[57]

Social and cultural

Economics

File:The Cost Of The Common Cold & Influenza.jpg
A British poster from World War II describing the cost of the common cold[58]

In the United States, the common cold leads to 75 to 100 million physician visits annually at a conservative cost estimate of $7.7 billion per year. Americans spend $2.9 billion on over-the-counter drugs and another $400 million on prescription medicines for symptomatic relief.[48][59]

More than one-third of patients who saw a doctor received an antibiotic prescription, which has implications for antibiotic resistance from overuse of such drugs.[59]

An estimated 22 to 189 million school days are missed annually due to a cold. As a result, parents missed 126 million workdays to stay home to care for their children. When added to the 150 million workdays missed by employees suffering from a cold, the total economic impact of cold-related work loss exceeds $20 billion per year.[9][48][59] This accounts for 40% of time lost from work.[60]

Legal

Canada in 2009 restricted the use of over-the-counter cough and cold medication in children 6 years and under due to concerns regarding risks and unproven benefits.[38]

Cold weather

The traditional folk theory is that a cold can be "caught" by prolonged exposure to cold weather such as rain or winter conditions, which is where the disease got its name.[61] Common colds are seasonal, with more occurring during winter. The experimental evidence for this effect is uneven: many experiments have failed to produce evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection, implying that the seasonal variation is instead due to a change in behaviors such as increased time spent indoors at close proximity to others.[9][22] However, other experiments do find such an effect for both body chilling and cold air exposure, and a number of mechanisms by which lower temperatures could compromise the immune system have been suggested,[15] while other experiments have shown that exposure to cold temperatures may instead stimulate the immune system. [62] [63]

Research

Biota Holdings are developing a drug, currently known as BTA798, which targets rhinovirus. The drug has recently completed Phase IIa clinical trials.[64][65]

ViroPharma and Schering-Plough are developing an antiviral drug, pleconaril, that targets picornaviruses, the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in an oral form.[66][67] Schering-Plough is developing an intra-nasal formulation that may have fewer adverse effects.[68]

Researchers from University of Maryland, College Park and University of Wisconsin–Madison have mapped the genome for all known virus strains that cause the common cold.[68]

References

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External links

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Infectious diseases · Viral systemic diseases (A80–B34, 042–079)
Oncovirus
Immune disorders
Central
nervous system
Cardiovascular
Respiratory
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Common cold
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