Viral coryza, commonly known as the common cold, is an acute, self-limiting viral infection (7-10 days) of the upper respiratory tract. It is caused by several viruses, with Rhinoviruses being the most common etiological agent.

History and examination

  • History of exposure to others with common cold symptoms
  • Ask for burning micturition, vomiting, loss of appetite, shortness of breath, ear discharge, excessive crying, abnormal body movement to localize the cause of fever.
  • Risk factors: Crowded environments, daycare or school attendance, compromised immune system, lower immunity
SymptomsSigns
-Low grade fever (usually more during evening)
-Eye congestion
-Nasal congestion and runny nose
Sneezing
-Cough
-Sore throat
-Cold and bluish periphery		-Sick looking especially during fever
-Congested posterior pharyngeal wall or enlarged tonsil ( commonly present in 2-8 years of age)
-Nasal discharge and noisy breathing due to nasal blockage
-Cervical lymphadenopathy
-Conducted sound on auscultation due to nasal blockage
-No other significant systemic finding

Differential diagnosis (D/D) & Complication

D/D:

  • Influenza (higher fever, more severe symptoms, sudden onset)
  • Allergic rhinitis (itchy eyes and nose, clear nasal discharge, history of allergies)
  • Sinusitis (facial pain, persistent symptoms, thick yellow or green nasal discharge)
  • Measles (look for rash, watery eye)

Complications:

  • Otitis media (most common) excessive crying in children
  • Sinusitis
  • Lower respiratory tract infections (e.g., bronchitis or pneumonia)

Investigation

  • Usually, no investigations are required for viral coryza, as diagnosis is typically made based on clinical presentation
  • Send CBC, CRP, URME, Chest X-Ray if high grade fever persist more than 3 days

Admission criteria

  • Hospitalization is rarely needed for viral coryza, but may be necessary for severe complications or children with underlying health conditions

Management:

Symptomatic and supportive care

  • Adequate hydration
  • Nasal saline drops for nasal congestion
  • Acetaminophen or ibuprofen for fever and pain relief (avoid aspirin in children due to the risk of Reye’s syndrome)
  • Rest and maintaining a comfortable environment

Medical

  • Syp or Tab Paracetamol or Flexon (If fever is high grade and not subsided with Paracetamol)
  • Syp Levocetrizine or Fexofenadine ( To reduce the throat congestion and relieve cough)
  • NS Nasal drops
  • Antibiotic:
    • Give Azithromycin (Has both anti-viral and anti-inflammatory properties)Add Amoxicillin or Amoxcyclav (Diarrhea is common side effect) if sign of lower respiratory tract infection or tonsillitis is present.

Rx:

  1. Syp/Drop PCM PO TDS x 3 Days then SOS
  2. Syp LCTZ or Syp Fexofenadine for cough PO BD or HS x 5 days
  3. NS Nasal Drop 2 Drops Both Nose x 2hourly or 4 hourly x 2 days then SOS
  4. Syp Azithromycin PO OD x 5 Days / Syp Amoxicillin or Amoxyclav PO TDS x 7 Days (If needed)

Advices

  • Encourage hand hygiene to prevent the spread of infection
  • Educate about proper cough and sneeze etiquette
  • Ensure proper nutrition and hydration
  • Avoid exposure to cigarette smoke and other respiratory irritants

Referral

  • Referral to a pediatrician may be necessary for children with severe or persistent symptoms, complications, or underlying health conditions

Follow up

  • Schedule a follow-up appointment if symptoms worsen, persist beyond 10-14 days, or new complications arise.

References:

1. Heikkinen T, Järvinen A. The common cold. Lancet. 2003;361(9351):51-59.

2. Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007;75(4):515-520.

3. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153-159.