Fast Five Quiz: Rhinovirus Facts vs Fiction

Michael Stuart Bronze, MD

Disclosures

December 09, 2020

Clinical signs and symptoms of the common cold, by definition, are similar regardless of the infectious etiology. Accordingly, if findings from a thorough history and physical examination are consistent with a viral etiology and no complications are noted, an aggressive workup is rarely necessary.

Increasingly, microarray and real-time polymerase chain reaction (PCR) assays are being used to detect rhinovirus in respiratory specimens. PCR assay is faster and more sensitive than culture. Real-time PCR has been shown to be a rapid and effective way of detecting the virus and has been proposed as the clinical detection method of choice. The results of PCR testing must be interpreted carefully. Current commercially available multiplex PCR assays cannot reliably differentiate rhinovirus from enterovirus, so results are reported as rhinovirus/enterovirus. In addition, detected rhinovirus may be related to a past infection rather than a current infection as prolonged viral shredding is known to occur.

Because of the prolonged time to obtain positive culture findings, culture of rhinovirus has rarely been found useful in clinical settings. Identity is confirmed by the acid sensitivity of the isolate. Specialized laboratories can identify serotypes by antibody neutralization, which requires a large battery of antisera. However, with more than 100 different serotypes of rhinovirus alone, assisting the diagnosis by means of serologic methods is economically impractical. If a specific viral diagnosis is desired, the virus can be cultured from nasal secretions; nasal washings are more sensitive than throat specimens although they are suboptimal for some other respiratory viruses and are not recommended unless no other pathogens are being investigated.

Sinus films or CT scanning of the sinuses may be useful in cases of suspected sinusitis, although such imaging cannot differentiate viral processes from bacterial processes. More than 85% of patients with a common cold have sinus abnormalities on CT.

Read more about the workup of patients with suspected rhinovirus infection.

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