Resfriado común

Introducción
• Condición aguda y benigna del tracto respiratorio
alto.
• Sinónimos “catarro, gripa, infección respiratoria
alta, rinosinusitis viral”
• Grupo heterogéneo de enfermedades causadas
por diferentes virus.
• Carga económica, ausencia escolar y laboral.
• Niños susceptibles por baja inmunidad, y
practicas higiénicas deficientes.
Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Epidemiología
• Causa más frecuente de consulta.
• Varía según localización geográfica.
• Patrón estacionario, predominio invierno y otoño.
• Zonas tropicales, en época de lluvias.
• Incidencia inversamente proporcional edad.
• Promedio 3-8 episodios al año.
• 5-7 preescolares.
• 10-15% 12 episodios año.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Epidemiología
• Niños más episodios, edad adulta esposa 1
episodio más que esposo.
• Diseminación escuelas y colegios, niños
introducen la infección.
• Creciente uso de jardines y programas
preescolares infecciones edades más
tempranas.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Transmisión
• Exposición a secreciones
fisiológicas a corta distancia.
• Secreción respiratoria nasal mayor
concentración viral, saliva y otras
en menor cantidad.
• Estornudos y contaminación
objetos.
• Niños mayor carga vira y por más
tiempo.
• Diseminación partículas pequeñas
↓5um aerosolizadas por
inhalación. (influenza-coronavirus).
• Partículas ↑10um en gotas
alcanzan mucosa nasal o conjuntiva
(rinovirus) o contacto directo
mano-mano (VRS).

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Etiología
• Rinovirus 30-50%.
• Coronavirus 10-15%.
• VSR.
• Influenza.
• Parainfluenza.
• Adenovirus.
• Enterovirus no- polio virus.
• Reo virus.
• Mycoplasma pneumoniae – Chlamydia pneumoniae.
• B. pertussis, histoplasma capsulatum, coccidiodes immitis,
presentarse en fase catarral.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
Marcdante K. et al. Nelson pediatría esencial. España 2011.
 Rinovirus
• ARN, cadena simple.
• Familia picornavirus.
• 3 subgrupos, 100 serotipos , subtipo
1ª, mide 30nm.
• 4 proteínas estructurales VP1-VP4.
• Cañón superficie viral que sirve para
unión y liberación ARN.
• Base de cañón zona hidrofóbica
unión antivirales.
• Replicación 33-35°.
• Adenoides inicio de infección.
• 90% unen por ICAM-1 (91 de 102
serotipos)
• Asocia complicaciones

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
Imagen: http://vichozo.blogspot.com/
 Coronavirus
• Familia Coronaviridae, ARN de
cadena simple.
• Enfermedad respiratoria y
enteral.
• 3 grupos, 2 infectan humanos.
• Viriones 100-200nm.
• Envoltura lipídica, 2
glicoproteínas: Spike y la
estearasa de hemaglutinina, dan
aspecto de corona.
• Serotipos OC43,229E.
• Múltiples cepas, reinfección
común.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
Imagen: http://vichozo.blogspot.com/
 Patogénesis
• Interacción virus y respuesta inflamatoria huésped.
• Susceptibilidad nariz a virus no inmunes.
• Virus recuperan secreciones a las 8-10h de inoculación, pico 2-
3d.
• Sitio primario puede ser conjuntiva.
• Virus infecta células epitelio respiratorio, diseminación y
aumento secreciones nasales.
• Virus cultivos senos paranasales, oído medio y epitelio
bronquial.
• Daño e irritación celular causa de clínica.
• Regeneración epitelial 10d, pico de lesión 5d.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Patogénesis
• Neutrófilos en epitelio y lámina propia, rinorrea
mucopurulenta entre 2-7d.
• Viremia es rara en resfriado típico.
• Daño epitelio ligero, blanco liberación de mediadores
• Coronavirus, luego de exposición a secreciones
respiratorias virus se une por glicoproteína S, media
fusión de envoltura viral a membrana plasmática,
liberación virión en citoplasma.
• Glicoproteína HE promueve liberación de viriones
formados.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Patogénesis
• Enfermedad de senos paranasales 87% adultos, 88% niños
anomalías radiológicas.
• Exudo viscoso contenido en burbujas de aire propulsado
al “sonarse nariz” o exostosis de moco.
• Anormalidad presión oído medio 76%, detecta rinovirus,
coronavirus y VRS solo o combinado con bacterias en
OMA.
• Inmunidad por rinovirus IgA IgG 80% a serotipo
específico.
• Protección puede ser superada por carga viral significativa

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Manifestaciones Clínicas

• Síntomas aparecen
después de periodo de
incubación.
• Rinovirus 10-12h.
• Influenza 1-7d.
• Severidad aumenta pico
2-3d.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Manifestaciones Clínicas
• ↓6 años:
• Fiebre 38-39°.
• Linfadenopatías cervicales anteriores.
• Congestión nasal.
• Trastorno del sueño, irritables y cansados.
• Rinorrea amarillenta.
• Duración 10-14d.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Complicaciones
• En menores 5 años, inmunocomprometidos, asma, EPOC, FQ,
mayores 65 años.
• Otitis media.
• Sinusitis.
• Faringoamigdalitis.
• Adenitis cervical.
• Laringitis.
• Bronquiolitis, bronquitis y neumonía.
• Conjuntivitis.
• Epistaxis.
• Sibilancias. Exacerbación 50%.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Diagnóstico
• Historia clínica, historia epidemiológica.
• Examen físico.
• Laboratorio no útiles ni prácticos.
• Establecer presencia adenovirus, VSR,
parainfluenza, influenza ameritan ingreso
hospitalario limitar regreso a escuelas.
• ELISA aspirado nasofaríngeo.
• Excluir casos rinitis no infecciosa, identificación
sobreinfección
Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Diagnóstico
• Lactantes febril, distinguir con enfermedades
bacterianas invasivas.
• Molestias faríngeas descartar etiología
estreptocócica.
• Influenza: comienzo agudo fiebre alta, cefalea,
mialgias, debilidad, inapetencia, tos con o sin
congestión nasal.
• Cuerpo extraño.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Tratamiento
• Múltiples alternativas pocos beneficios.
• Hidratación, descanso y limpieza nasal son medidas
aliviantes.
• Analgésico antipiréticos: Paracetamol 10-15mg/kg/do c/6h.
• Descongestionantes antihistamínicos no se han evaluado
con seguridad y eficacia.
• Drogas vasoconstrictoras, efecto rebote.
• No evidencia antitusígenos y expectorantes.
• Antibióticos no están indicados, no reducen riesgo de
sobreinfección.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Terapia antiviral
• Antivirales para influenza.
• Pleconaril picornavirus, efecto discreto, y
efectos secundarios.
• IFN-a nasal mas AINE bajo estudio en
complicaciones cono OMA y sinusitis.
• Inhibidor proteínas virales AG 7088 fase de
pruebas.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Prevención
• Lavado de manos.
• Evitar contacto dedo-ojo, dedo-nariz.
• Uso de pañuelos desechables.
• Evitar conglomerados contacto con personas
afectadas.
• Posibilidad vacuna remota por muchos serotipos.
• Vacuna influenza única aceptada 6-24m.
• VSR palivizumab profilaxis en población en riesgo.
• Suplementación vitamina C no diferencia con placebo.

Reyes M. et al. Neumología Pediátrica. 5ª. Ed. Bogotá. Medica internacional, 2006.
 Zinc for the treatment of the common cold: a systematic review
and meta-analysis of randomized controlled trials.

• Abstract
• Results of randomized controlled trials evaluating zinc for the treatment of the common cold are conflicting. We conducted
a systematic review and meta-analysis to evaluate the efficacy and safety of zinc for such use.
• METHODS:
• We searched electronic databases and other sources for studies published through to Sept. 30, 2011. We included all
randomized controlled trials comparing orally administered zinc with placebo or no treatment. Assessment for study
inclusion, data extraction and risk-of-bias analyses were performed in duplicate. We conducted meta-analyses using a
random-effects model.
• RESULTS:
• We included 17 trials involving a total of 2121 participants. Compared with patients given placebo, those receiving zinc had
a shorter duration of cold symptoms (mean difference -1.65 days, 95% confidence interval [CI] -2.50 to -0.81); however,
heterogeneity was high (I(2) = 95%). Zinc shortened the duration of cold symptoms in adults (mean difference -2.63, 95% CI
-3.69 to -1.58), but no significant effect was seen among children (mean difference -0.26, 95% CI -0.78 to 0.25).
Heterogeneity remained high in all subgroup analyses, including by age, dose of ionized zinc and zinc formulation. The
occurrence of any adverse event (risk ratio [RR] 1.24, 95% CI 1.05 to 1.46), bad taste (RR 1.65, 95% CI 1.27 to 2.16) and
nausea (RR 1.64, 95% CI 1.19 to 2.27) were more common in the zinc group than in the placebo group.
• INTERPRETATION:
• The results of our meta-analysis showed that oral zinc formulations may shorten the duration of symptoms of the common
cold. However, large high-quality trials are needed before definitive recommendations for clinical practice can be made.
Adverse effects were common and should be the point of future study, because a good safety and tolerance profile is
essential when treating this generally mild illness.

Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. Science M, Johnstone J, Roth DE, Guyatt G, Loeb M.
CMAJ. 2012 Jul 10;184(10):E551-61. doi: 10.1503/cmaj.111990. Epub 2012 May 7. Review.
 Placebo effects and the common cold: a
randomized controlled trial.
• Abstract
• PURPOSE:
• We wanted to determine whether the severity and duration of illness caused by the common cold are influenced by randomized assignment to
open-label pills, compared with conventional double-blind allocation to active and placebo pills, compared with no pills at all.
• METHODS:
• We undertook a randomized controlled trial among a population with new-onset common cold. Study participants were allocated to 4 parallel
groups: (1) those receiving no pills, (2) those blinded to placebo, (3) those blinded to echinacea, and (4) those given open-label echinacea. Primary
outcomes were illness duration and area-under-the-curve global severity. Secondary outcomes included neutrophil count and interleukin 8 levels
from nasal wash at intake and 2 days later.
• RESULTS:
• Of 719 randomized study participants, 2 were lost and 4 exited early. Participants were 64% female, 88% white, and aged 12 to 80 years. Mean
illness duration for each group was 7.03 days for those in the no-pill group, 6.87 days for those blinded to placebo, 6.34 days for those blinded to
echinacea, and 6.76 days for those in the open-label echinacea group. Mean global severity scores for the 4 groups were no pills, 286; blinded to
placebo, 264; blinded to echinacea, 236; and open-label echinacea, 258. Between-group differences were not statistically significant. Comparing
the no-pill with blinded to placebo groups, differences (95% confidence interval [CI]) were -0.16 days (95% CI, -0.90 to 0.58 days) for illness
duration and -22 severity points (95% CI, -70 to 26 points) for global severity. Comparing the group blinded to echinacea with the open-label
echinacea group, differences were 0.42 days (95% CI, -0.28 to 1.12 days) and 22 severity points (95% CI, -19 to 63 points). Median change in
interleukin 8 concentration and neutrophil cell count, respectively by group, were 30 pg/mL and 1 cell for the no-pill group, 39 pg/mL and 1 cell for
the group binded to placebo, 58 pg/mL and 2 cells for the group blinded to echinacea, and 70 pg/mL and 1 cell for the group with open-label
echinacea, also not statistically significant. Among the 120 participants who at intake rated echinacea's effectiveness as greater than 50 on a 100-
point scale for which 100 is extremely effective, illness duration was 2.58 days shorter (95% CI, -4.47 to -0.68 days) in those blinded to placebo
rather than no pill, and mean global severity score was 26% lower but not significantly different (-97.0, 95% CI, -249.8 to 55.8 points). In this
subgroup, neither duration nor severity differed significantly between the group blinded to echinacea and the open-label echinacea group.
• CONCLUSIONS:
• Participants randomized to the no-pill group tended to have longer and more severe illnesses than those who received pills. For the subgroup who
believed in echinacea and received pills, illnesses were substantively shorter and less severe, regardless of whether the pills contained echinacea.
These findings support the general idea that beliefs and feelings about treatments may be important and perhaps should be taken into
consideration when making medical decisions.

Barrett B,. Et al. Placebo effects and the common cold: a randomized controlled trial. Ann Fam Med. 2011 Jul-Aug;9(4):312-22. doi: 10.1370/afm.1250.
PubMed PMID: 21747102; PubMed Central PMCID: PMC3133578.
 Perception of empathy in the therapeutic
encounter: effects on the common cold
• OBJETIVE
• To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold.
• METHODS:
• We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized
to three groups: no patient-practitioner interaction, "standard" interaction or an "enhanced" interaction. Cold
severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and
Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were
obtained from nasal wash at baseline and 48 h later.
• RESULTS:
• Patients' perceptions of the clinical encounter were associated with reduced cold severity and duration.
Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p=0.04) and
duration (perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more
significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count
(perfect: 49, sub-perfect: 12, p=0.09).
• CONCLUSIONS:
• When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration
and objective measures (IL-8 and neutrophils) of the common cold significantly change.
• PRACTICE IMPLICATIONS:
• This study helps us to understand the importance of the perception of empathy in a therapeutic encounter.

Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, Scheder J. Perception of empathy in the therapeutic encounter: effects on the
common cold. Patient Educ Couns. 2011 Dec;85(3):390-7. doi: 10.1016/j.pec.2011.01.009. Epub 2011 Feb 5. PubMed PMID: 21300514; PubMed
Central PMCID: PMC3107395.