RHINITIS

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 Rini Savitri Daulay, Dr,M.Ked Ped, Sp.A

Defenisi
RHINITIS

Common cold Cold

Acute, highly infectious viral disease Caracterized : nasal stuffines sneezing coryza throat irritation little / no fever many times / yrs/ person

Etiology
RHINITIS

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

Pathophysiology
RHINITIS

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

RHINITIS

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 5th day

Clinical manifestation
RHINITIS

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

RHINITIS

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

Complication
RHINITIS

Acute otitis media Tonsillitis Sinusitis LRTI

Investigation
RHINITIS

Clinical feature & exposure hystory are specific No investigation !! Virus : Nasopharingeal culture Recurrent cold allergic rhinitis Persistent nasal symptom adenoiditis/sinusitis

Management
RHINITIS

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

RHINITIS

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