COMMON COLD

Common Cold
Common Cold (pilek,
selesma) adalah suatu
infeksi virus pada
selaput hidung,sinus
dan saluran pernafasan

Common Cold Syndrome includes

rhinitis, tonsilitis, pharyngitis, laryngitis

(including croup), pharyngo-laryngitis
etc.
Sometimes Influenza (the flu) and
sinusitis are characterized as a
common cold syndrome.

Subjective symptoms are variously related

with the region of upper respiratory tracts
:such as
snivel,
nasal obstruction,
sneezing,
sore throat (pain, thirst feeling and hoarseness),
cough,
sputum,
headache,
fever,
general malaise (laziness),
muscle pains,
arthralgia (joints pain)

Digestive troubles such as nausea, vomiting, diarrhea and

abdominal pain are often recognized with various subjective
symptoms mentioned above.

In influenza infection (flu),

these subjective symptoms
are seen acutely and
strongly.

Comparison of Influenza
and the Common Cold

Features

Influenza

Common
cold

Onset

Abrupt

More gradual

Fever

Common

Uncommon

Myalgia

Severe, common

Uncommon

Arthralgia

Severe, common

Uncommon

Anorexia

Common

Uncommon

Headache

Severe, common

Mild,
uncommon

Cough (dry)

Common, severe

Mild to
moderate

Malaise

Severe

Mild

Fatigue,
weakness

More common
than with the
common cold;
lasts 2 to 3 weeks

Very mild,
short lasting

Chest discomfort Common, severe

Mild to
moderate

Stuffy nose

Occasional

Common

Sneezing

Occasional

Common

Sore throat

Occasional

Common

The common cold

may be caused
by more than
.different viruses 100

Medications can help

relieve cold symptoms, but

only time
can cure a cold.

Although many people are

convinced that a cold results
from:
1. exposure to cold weather
2. from getting chilled or
overheated
3. fatigue, or sleep deprivation.
these conditions have little or
no effect on the development or
severity of a cold.

On the other hand, research suggests

:that
psychological stress
allergic disorders affecting
the nasal passages or
throat
menstrual cycles

may have an impact on

a person's susceptibility
to colds.

Viruses Associated with

Respiratory Infections
Syndrome

Commonly Associated Viruses

Less Commonly Associated Viruses

Corza

Rhinoviruses, Coronaviruses

Influenza and parainfluenza viruses,

enteroviruses, adenoviruses

Influenza

Influenza viruses

Parainfluenza viruses, adenoviruses

Croup

Parainfluenza viruses

Influenza virus, RSV, adenoviruses

Bronchiolitis

RSV

Influenza and parainfluenza viruses,

adenoviruses

Bronchopneumonia

Influenza virus, RSV, Adenoviruses Parainfluenza viruses, measles, VZV, CMV

Common cold
Acute respiratory infections,
predominantly rhinovirus
infections, are estimated to cause
30-50% of time lost from work
by adults and 60-80% of time
lost from school by children.

Common cold
UP TO 6 COMMON
COLDS/YEAR IN ADULTS
AND 8 COMMON
COLDS/YEAR IN
CHILDRENS ACCEPTABLE.

Common Cold Viruses

Common colds account for one-third to

one-half of all acute respiratory
infections in humans.

Rhinoviruses are responsible for 30-50%

of common colds, coronaviruses 10-30%.
adenoviruses, enteroviruses,
RSV, influenza, and parainfluenza viruses,
The rest are due to

which may cause symptoms indistinguishable to those of

rhinoviruses and coronaviruses.

RISK FACTOR FOR MORE

SEVER COMMON COLD

LOW NEUTRALIZING Ab
CHRONIC LUNG DISEASE
EXTREMES AGE
ASTHMA
ALLERGY
Ig E
CYTOKINE PRODUCTION
I F N -gamma
I L-5

Physical examination

Red nose with dripping nasal discharge may be

present.
Nasal mucous membranes have a glistening,
glassy appearance without obvious erythema and
edema.
Yellow or green nasal discharge does not
indicate bacterial infection because a large number
of white blood cells migrate to the site of viral
infection.
Auscultation of the chest may reveal rhonchi

Physical examination
If marked:
1. erythema, edema, exudates, or small vesicles
are observed in the oropharynx
2. conjunctivitis
3. polyps in the nasal mucosa

occur, consider other etiologies, including:

adenovirus, herpes simplex virus,

mononucleosis, diphtheria, Coxsackie A
virus, or group A streptococcus (GAS).

TREATMENT

TREATMENT

TREATMENT

Rhinovirus infections are

predominately mild and selflimited:
thus, treatment is generally focused on symptomatic relief and
prevention of person-to-person spread and complications.

The mainstays of therapy include:

rest,
hydration,
antihistamines,
nasal decongestants.

TREATMENT

Antibacterial agents are

not effective unless
bacterial superinfection
occurs.

TREATMENT

Development of effective antiviral medications

has been hampered by the short course of these
infections.
Because peak symptom severity occurs at 24-36
hours after inoculation, only a narrow window of
time exists in which antivirals could positively
impact upon this infection.
In addition, the cause of the common cold is not
always rhinovirus.
Therefore, rapid and accurate diagnostic tests
would be needed if a specific antiviral therapy
were developed.

TREATMENT
Because of the large number of
rhinovirus immunotypes and the
inaccessibility of the conserved region
of the viral capsid (the most likely
effective site for targeting a vaccine),

no rhinovirus vaccine is on the

horizon.

TREATMENT

Because infection is spread by:

hand-to-hand contact,
autoinoculation,
possibly, aerosol particles,
emphasize appropriate hand
washing, avoidance of finger-to-eyes
or finger-to-nose contact, and use of
nasal tissue.

TREATMENT
One study suggests that hand
cleansers with salicylic acid

and pyroglutamic acid

prevent the transmission of
rhinovirus as well as the number of
patients who become clinically
infected.

TREATMENT

Heated, humidified air

has been used for decades for the
alleviation of symptoms due to
rhinovirus infections but has never
been shown to improve objective
outcome measures

TREATMENT

Pleconaril inhibits approximately

92% of rhinovirus serotypes.

Susceptibility to pleconaril is dependent

on the viral capsid surface protein VP1.
400 mg PO tid for 5 days, initiated within
24 hours of symptom onset, resulted in a
decrease in the duration of symptoms by 1
day.

TREATMENT

intranasal interferon-alpha2b + ipratropium +

oral naproxen
started within 24 hours of rhinovirus inoculation
resulted in a decrease in viral shedding, geometric
mean virus titers, and symptoms in the treatment
group.

TREATMENT

Recombinant interferon-alpha2b
applied topically to the nose at 5 million U or
more a day prevented experimental
infections.
Unfortunately, the effect of this agent on
symptomatic illness was limited.

TREATMENT
A recombinant soluble ICAM-1

administered intranasally after rhinovirus

challenge was analyzed in a randomized, doubleblinded study.
Neither strategy affected the incidence of
infection,
but combining results from both treatment groups
found :
23% decrease in clinical colds,
45% decrease in total symptom score,
56% decrease in total nasal secretion weight.

TREATMENT
ruprintrivir, a 3C protease inhibitor
delivered as a nasal spray was well tolerated and
resulted in decreased positive viral culture results
and improved symptom scores but did not decrease
the frequency of colds.
These drugs act by interfering with the cleaving
of a single large polyprotein that produces
individual structures and enzymatic proteins of
the virus.

TREATMENT

Dietary supplements have been

touted as possible therapeutic or

preventive measures.
large doses of vitamin C have been used for

prevention and treatment of colds,

controlled trials reveal minimal therapeutic benefit and
no preventive qualities.

has been found to inhibit rhinovirus replication

in vitro
but no proven benefit has been shown in vivo on virus
activity or immune modulation

Zinc

TREATMENT

Echinacea purpurea
has recently been studied and did
not show any differences in rates
of infection or severity of illness
when compared with placebo

TREATMENT
Patients may limit their activity
during the course of the infection,
with clinical improvement
occurring 48-72 hours after the
prodrome of symptoms.

MEDICATION
Drugs used in the symptomatic
treatment include:
nonsteroidal anti-inflammatory drugs
(NSAIDs)
antihistamines
anticholinergic nasal solutions
These agents have no

preventive activity and

appear to have no impact on complications.

MEDICATION
The combined effect of NSAIDs
and antihistamines often relieves
nasal obstruction;
therefore, decongestion therapy is rarely
needed.

Oral (pseudoephedrine) and topical

(oxymetazoline and phenylephrine)
decongestants are commonly used for
symptomatic relief.

MEDICATION
First-generation antihistamines reduce
rhinorrhea by 25-35%, as do:
topical anticholinergics
ipratropium bromide (spray)

Second-generation or nonsedating antihistamines

appear to have no effect on common cold symptoms.

Corticosteroids

may actually increase viral replication and have no

impact on cold symptoms.

Complications

Sinusitis: Viral infection of the sinus

mucosa leads to alterations of sinus cavities,
resulting in obstruction and entrapment of
bacteria, such as

Streptococcus pneumoniae
unencapsulated strains of Haemophilus
influenzae
leading to bacterial sinusitis.
The maxillary
frequently.

sinuses are involved most

Complications
Otitis media: Rhinoviruses have been
suggested as both rare
pathogens
copathogens with bacteria
in the etiology of otitis media.

They have been recovered in middle ear fluid

of people with otitis media and potentially allow

secondary bacterial infection from

obstruction secondary to mucosal changes in
the eustachian tubes.

Complications
Precipitation of asthma:
People with asthma have a greater number
of viral respiratory infections than people
without asthma.
Rhinoviruses are also detected at the onset of symptoms;
however, in a rhinovirus challenge model, exacerbations
of wheezing was shown in a minority of adults,

only 20% had a 10% or greater decrease in

forced expiratory volume in 1 second (FEV1).

Complications
Acute infectious episodes in
patients with chronic bronchitis:
Although rhinoviral invasion of the
bronchial tree is unclear, alterations in
ventilation and exacerbations of
bronchitis have been described with
rhinovirus infections.

Complications
Deep respiratory tract infections:
have been described in patients who are
immunosuppressed
elderly persons
infants and children with cystic fibrosis
however, determining the true impact of
rhinovirus is difficult because it may be a marker
of disease severity or an inciting event for other
infectious process.

THANKS FOR YOUR

!!!ATTENTION

Coronavirus

ssRNA Virus
Enveloped,
pleomorphic
morphology
2 serogroups: OC43
and 229E

Influenza Virus

RNA virus, genome consists of 8

segments
enveloped
virus,
with
haemagglutinin
and
neuraminidase spikes
3 types: A, B, and C
Type A undergoes antigenic
shift and drift.
Type B undergoes antigenic
drift only and type C is
relatively stable

Influenza A Virus

Undergoes antigenic shifts and antigenic drifts

with the haemagglutinin and neuraminidase
proteins.
Antigenic shifts of the haemagglutinin results in
pandemics. Antigenic drifts in the H and N
proteins result in epidemics.
Usually causes a mild febrile illness.
Death may result from complications such as
viral/bacterial pneumonia.

Epidemiology

Pandemics - influenza A pandemics arise when a

virus with a new haemagglutinin subtype emerges as
a result of antigenic shift. As a result, the population
has no immunity against the new strain. Antigenic
shifts had occurred 3 times in the 20th century.

Epidemics - epidemics of influenza A and B arise

through more minor antigenic drifts as a result of
mutation.

Past Antigenic Shifts

1918 H1N1 Spanish Influenza
1957 H2N2 Asian Flu

20-40 million deaths

1-2 million deaths

1968 H3N2 Hong Kong Flu

700,000 deaths

1977 H1N1 Re-emergence

No pandemic

At least 15 HA subtypes and 9 NA subtypes occur in nature. Up until

1997, only viruses of H1, H2, and H3 are known to infect and cause
disease in humans.

Avian Influenza
H5N1

An outbreak of Avian Influenza H5N1 occurred in Hong Kong in 1997 where

18 persons were infected of which 6 died.
The source of the virus was probably from infected chickens and the outbreak
was eventually controlled by a mass slaughter of chickens in the territory.
All strains of the infecting virus were totally avian in origin and there was no
evidence of reassortment.
However, the strains involved were highly virulent for their natural avian
hosts.

H9N2

Several cases of human infection with avian H9N2 virus occurred in Hong
Kong and Southern China in 1999.
The disease was mild and all patients made a complete recovery
Again, there was no evidence of reassortment

Theories Behind Antigenic Shift

1. Reassortment of the H and N genes between
human and avian influenza viruses through a
third host. There is good evidence that this
occurred in the 1957 H2N2 and the 1968 H3N2
pandemics.
2. Recycling of pre-existing strains this probably
occurred in 1977 when H1N1 re-surfaced.
3. Gradual adaptation of avian influenza viruses to
human transmission. There is some evidence that
this occurred in the 1918 H1N1 pandemic.

Reassortment
Avian H3

Human H2

Human H3

Laboratory Diagnosis

Detection of Antigen - a rapid diagnosis can be made

by the detection of influenza antigen from nasopharyngeal
aspirates and throat washings by IFT and ELISA

Virus Isolation

Serology

- virus may be readily isolated from

nasopharyngeal aspirates and throat swabs.
- a retrospective diagnosis may be made by
serology. CFT most widely used. HAI and EIA may be used
to give a type-specific diagnosis

Management

Amantidine

is effective against influenza A if

given early in the illness. However, resistance to
amantidine emerges rapidly
Rimantidine is similar to amantidine but but
fewer neurological side effects.
Ribavirin is thought to be effective against both
influenza A and B.
Neuraminidase inhibitors are becoming
available. They are highly effective and have fewer
side effects than amantidine. Moreover, resistance
to these agents emerge slowly

Prevention

Inactivated split/subunit vaccines are available against

influenza A and B.
The vaccine is normally trivalent, consisting of one A
H3N2 strain, one A H1N1 strain, and one B strain.
The strains used are reviewed by the WHO each year.
The vaccine should be given to debilitated and elderly
individuals who are at risk of severe influenza infection.
Amantidine can be used as an prophylaxis for those who
are allergic to the vaccine or during the period before the
vaccine takes effect.

Adenovirus

ds DNA virus

non-enveloped

At least 47 serotypes
are known

classified into 6
subgenera: A to F

Clinical Syndromes
1. Pharyngitis 1, 2, 3, 5, 7
2. Pharyngoconjunctival fever 3, 7
3. Acute respiratory disease of recruits 4, 7, 14, 21
4. Pneumonia 1, 2, 3, 7
5. Follicular conjunctivitis 3, 4, 11
6. Epidemic keratoconjunctivitis 8, 19, 37
7. Pertussis-like syndrome 5
8. Acute haemorrhaghic cystitis 11, 21
9. Acute infantile gastroenteritis 40, 41
10.Intussusception 1, 2, 5
11. Severe disease in AIDS and other immunocompromized patients 5,
34, 35
12. Meningitis 3, 7

Laboratory Diagnosis

Detection of Antigen

Virus Isolation - virus may be readily isolated from

- a rapid diagnosis can be

made by the detection of adenovirus antigen from
nasopharyngeal aspirates and throat washings.

nasopharyngeal aspirates, throat swabs, and faeces.

Serology

- a retrospective diagnosis may be made by

serology. CFT most widely used.

Treatment and Prevention

There is no specific antiviral therapy.

A vaccine is available against Adult

Respiratory Distress Syndrome.
It consists live adenovirus 4, 7, and 21 in
enterically coated capsules.
It is given to new recruits into various arm
forces around the world.

Parainfluenza Virus

ssRNA virus
enveloped, pleomorphic
morphology
5 serotypes: 1, 2, 3, 4a
and 4b
No common group
antigen
Closely related to
Mumps virus

Clinical Manifestations

Croup (laryngotraheobroncitis)
most common manifestation of
parainfluenza virus infection.

However other viruses may induce croup

e.g. influenza and RSV.

Clinical Manifestations

Other conditions that may be

caused by parainfluenza
viruses include:
Bronchiolitis
Pneumonia
Flu-like tracheobronchitis
Coryza-like illnesses

Laboratory Diagnosis

Detection of Antigen

Virus Isolation - virus may be readily isolated from

- a rapid diagnosis can be

made by the detection of parainfluenza antigen from
nasopharyngeal aspirates and throat washings.

nasopharyngeal aspirates and throat swabs.

Serology

- a retrospective diagnosis may be made by

serology. CFT most widely used.

Management
antiviral

No specific
available.

chemotherapy

Severe cases of croup should be admitted to

hospital and placed in oxygen tents.

No vaccine is available.

Respiratory Syncytial Virus (RSV)

ssRNA eveloped virus.

belong to the genus Pneumovirus of the Paramyxovirus

family.

Considerable strain variation exists, may be classified

into subgroups A and B by monoclonal sera.

Both subgroups circulate in the community at any one

time.

Causes a sizable epidemic each year.

Clinical Manifestations

Most common cause of severe lower respiratory

tract disease in infants, responsible for 50-90% of
Bronchiolitis and 5-40% of Bronchopneumonia

Other manifestations include croup (10% of all

cases).

In older children and adults, the symptoms are

much milder:

it may cause a coryza-like illness or

bronchitis.

Infants at Risk of Severe Infection

1. Infants with congenital heart disease - infants who
were hospitalized within the first few days of life with
congenital disease are particularly at risk.
2. Infants with underlying pulmonary disease infants with underlying pulmonary disease, especially
bronchopulmonary dysplasia, are at risk of developing
prolonged infection with RSV.
3. Immunocompromized infants - children who are
immunosuppressed or have a congenital immunodeficiency
disease may develop lower respiratory tract disease at any age.

Laboratory Diagnosis

Detection of Antigen

Virus Isolation

Serology

- a rapid diagnosis can be

made by the detection of RSV antigen from nasopharyngeal
aspirates. A rapid diagnosis is important because of the
availability of therapy
- virus may be readily isolated from
nasopharyngeal aspirates. However, this will take several
days.
- a retrospective diagnosis may be made by
serology. CFT most widely used.

Treatment and Prevention

Aerosolised ribavirin can be used for

infants with severe infection, and for those at
risk of severe disease.

There is no vaccine available.

RSV immunoglobulin can be used to

protect infants at risk of severe RSV disease .