INTERNAL MEDICINE I

CMT 05102
COMMON COLD AND
COVID-19
OBJECTIVES
At the end of this session student should be able to
a) Define common cold and COVID-19
b) Explain risk factors/etiology of common cold and COVID-19
c) Explain clinical features and complications of common cold
and COVID-19
d) Perform clinical assessment for a patient with common
cold and COVID-19
a) Establish provisional and differential diagnoses
b) Determine appropriate investigations to be performed to
patients with common cold and COVID-19
c) Treat, conduct follow up and refer patients with common
cold and covid- 19 as appropriate
d) Provide preventive measures to patient with common cold
and COVID-19
COMMON COLD
Common cold/coryza
• Definition- is a benign self limited syndrome
representing a group of diseases caused by members
of several families of viruses
• It is mild upper respiratory viral illness.
Etiology of common cold
• Seasonal patterns of infection can be observed for some of the
viruses that cause the common cold
• Rhinovirus, parainfluenza in late spring
• Respiratory syncytial virus(RSV) and coronaviruses produce epidemics
in winter and spring
• Enteroviruses in summer
• Adenovirus is not seasonal but outbreak can occur in military
facilities, daycare centers and hospital wards
Transmission
• Hand contact(via direct contact with an infected person or via indirect
contact with contaminated environmental surface
• Small particles droplets(droplet nuclei aerosols) that become
airborne from sneezing and coughing
• Large particle droplets(droplet transmission) require close contact
with an infected person.
• Incubation period- 24hrs- 72hrs
• Common cold usually persist 3 to 10days in the normal host
Risk factors
• Exposure to children in daycare centers
• Psychological stress
• Insomnia
• Underlying chronic diseases
• Congenital immunodeficiency disorders
• Malnutrition
• Cigaratte smoking
Clinical features
• Rhinitis • Sore throat
• Nasal obstruction • Cough
• Nasal discharge(clear or • Malaise
purulent) • Sneezing
• Cough after onset of nasal • Headache
discharge and obstruction
• Pressure or discomfort in
• Low grade fever the ears and face
Physical examination
• Conjuctival injection
• Nasal mucosal swelling
• Nasal congestion
• Pharyngeal erythema
Differential diagnosis
• Allergic rhinitis
• Acute bacterial sinusitis
• Nasal foreign body
• Pertusis
• Covid-19
• Bronchitis
• Bacterial pharyngitis or tonsillitis
Diagnosis and investigation
• Clinical diagnosis based upon reported symptoms and/or
observed signs
Treatment
• It is mild and self limiting viral illness
• Supportive care
• Maintaining adequate hydration
• Ingestion of warm fluids(tea, soup)
• Topical saline
Treatment
• Symptom-based treatment (e.g., with decongestants,
NSAIDs, dextromethorphan, throat lozenges) is
typically all that is required.
• Because secondary bacterial URI complicates only
0.5–2% of colds, antibiotics are not indicated.
• Purulent nasal and throat secretions are poor
predictors of bacterial infection.
COVID-19
INTRODUCTION
• COVID-19-Coronavirus Disease-2019
• The spectrum of COVID-19 in adults ranges from
asymptomatic infection to mild respiratory tract symptoms
to severe pneumonia with acute respiratory distress
syndrome( ARDS) and multiorgan dysfunction
• Caused by the virus causing Severe Acute Respiratory
Syndrome (SARS) of 2003
• This virus belongs to the family Coronaviridae, of the
order Nidovirales suspected to originate from an
animal host (zoonotic origin) followed by human-to-
human transmission.
 Transmission
• COVID-19 spreads between people through direct, indirect (through
contaminated objects or surfaces), or
• close contact with infected people via mouth and nose secretions
(saliva, respiratory secretions or secretion droplets).
• People with the virus in their noses and throats may leave infected
droplets on objects and surfaces (called fomites) when they sneeze,
cough on, or touch surfaces, such as tables, doorknobs and
handrails.
• Other people may become infected by touching these objects or
surfaces, then touching their eyes, noses or mouths before cleaning
their hands
Transmission…..
• It can also be transmitted longer distances through
the airborne route(inhalation of particles that remain
over time and distance
• Incubation period within 14days following infection
 Symptoms of COVID-19
• Most common symptoms:
• • Fever, Dry Cough and Tiredness.
• Less common symptoms:
• Headache, Sore throat, Loss of taste or smell, Chills, Runny nose, Chest
pain,Muscle aches, Diarrhea,, Conjunctivitis, Skin rash , or Discoloration of
fingers or toes
• Serious symptoms- Severe Acute Respiratory Infection (SARI):
• • Difficulty breathing or shortness of breath
• • Chest pain or pressure
• • Loss of speech or movement
Complications
• Respiratory failure (ARDS)
• Cardiac and cardiovascular complications
• Thromboembolic complications eg DVT and
pulmonary embolism
• Encephalopathy
• Secondary infections
• Sepsis and septic shock
Differential diagnosis
• Asthma
• Severe pneumonia
• Chronic obstructive pulmonary disease
• Pneumocystiis jirovecii pneumonia
• Aspiration pneumonia
• Pulmonary tuberculosis
• Common cold
Investigation
• Collect specimens from BOTH the upper respiratory tract
(URT; nasopharyngeal and oropharyngeal) AND lower
respiratory tract (LRT; expectorated sputum, endotracheal
aspirate, or
• Broncho alveolar lavage) for SARS-CoV-2 testing by RT-PCR.
• Blood cultures for bacteria that cause pneumonia and sepsis
• FBP- neutrophilia, mild anemia, thrombocytopenia and
lymphocytopenia
• Elevated inflammatory markers, -CRP, ESR, D-dimer,
procalcitonin
Investigation………
• Echocardiogram- depressed LV function
• Chest x-ray- patchy consolidation and focal
consolidation
• Chest CT scan
Treatment
• Assess ACBDE and manage accordingly
• Initiate oxygen therapy at 5 L/min and titrate flow
rates to reach target SpO2≥90% pregnant adults.
• Azithromycin 500mg (PO) day 1 following initial
assessment, then followed by 500mg (PO) 8hourly on
Days 2-5 when sepsis or superimposed pneumonia is
suspected.
• Tabs Prednisolone 10mg to 20mg (PO) once a day for
7 days OR Dexamethasone 6mg (PO/ IV) once a day
for up to 7days.
• Supplements
• Magnesium 300mg or 400mg (PO) once a day for
7days
• Zinc 7mg (PO) 25mg (PO) for adults
• Vitamin C dose of 70-150mg 24hourly for 7 days
• Monitor signs of SARI, clinical deterioration, like
rapidly Progressive respiratory failure and sepsis, and
apply supportive care interventions immediately.
Prevention and control measures.
• Respiratory hygiene; use of Personal protective
equipment (PPE) depending on risk.
• Mobilize the community for early detection and
care and conduct community education.
• Conduct contact follow-up and active searches
for additional community cases.
• Vaccination
Key points
• Common cold is self limiting disease present with
rhinitis, nasal congestion and nasal discharge
• COVID-19 manifestation ranges from common cold,
mild symptoms to severe symptoms
THANK YOU