Cough in Children: A Merck Manual of Patient Symptoms podcast

(See also Respiratory Disorders in Neonates, Infants, and Young Children: Bronchiolitis, see Respiratory Disorders in Neonates, Infants, and Young Children: Croup, and see Pneumonia.)

Viral infections commonly affect the upper or lower respiratory tract. Although these infections can be classified by the causative virus (eg, influenza), they are generally classified clinically according to syndrome (eg, the common cold, bronchiolitis, croup). Although specific pathogens commonly cause characteristic clinical manifestations (eg, rhinovirus typically causes the common cold, respiratory syncytial virus [RSV] typically causes bronchiolitis), each can cause many of the viral respiratory syndromes (see Table 1: Respiratory Viruses: Causes of Common Viral Respiratory Syndromes).

Table 1
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Causes of Common Viral Respiratory Syndromes Syndrome Common Causes Less Common Causes Bronchiolitis RSV Influenza viruses Parainfluenza viruses Adenoviruses Rhinoviruses Common cold Rhinoviruses Coronaviruses Influenza viruses Parainfluenza viruses Enteroviruses Adenoviruses Human metapneumoviruses RSV Croup Parainfluenza viruses Influenza viruses RSV Influenza-like illness Influenza viruses Parainfluenza viruses Adenoviruses Pneumonia Influenza viruses RSV Adenoviruses Parainfluenza viruses Enteroviruses Rhinoviruses Human metapneumoviruses RSV = respiratory syncytial virus.

Severity of viral respiratory illness varies widely; severe disease is more likely in the elderly and infants. Morbidity may result directly from viral infection or may be indirect, due to exacerbation of underlying cardiopulmonary conditions or bacterial superinfection of the lung, paranasal sinuses, or middle ear.

Diagnosis

Detection of viral pathogens by PCR, culture, or serologic tests is generally too slow to be useful for patient care but is useful for epidemiologic surveillance. More rapid diagnostic tests are available for influenza and RSV, but the utility of these tests for routine care is not clear; they should be reserved for situations in which pathogen-specific diagnosis affects clinical management. Management decisions are usually based on clinical data and epidemiology.

Treatment

Treatment of viral respiratory infections is usually supportive. Antibacterial drugs are ineffective against viral pathogens, and prophylaxis against secondary bacterial infections is not recommended. Antibiotics should be given only when secondary bacterial infections develop. In patients with chronic lung disease, antibiotics may be given with less restriction.

AspirinSome Trade Names
BUFFERIN
ECOTRIN
GENACOTE
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should not be used in patients who are ≤18 yr and have respiratory infections because Reye's syndrome is a risk.

Some patients continue to cough for weeks after resolution of an URI; these symptoms may lessen with use of an inhaled bronchodilator or corticosteroids.

In some cases, antiviral drugs are useful. AmantadineSome Trade Names
SYMMETREL
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, rimantadineSome Trade Names
FLUMADINE
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, oseltamivirSome Trade Names
TAMIFLU
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, and zanamivir are effective for influenza. RibavirinSome Trade Names
VIRAZOLE
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, a guanosine analog that inhibits replication of many RNA and DNA viruses, may be considered for severely immunocompromised patients with lower respiratory tract infection due to RSV.

Last full review/revision October 2009 by Ronald B. Turner, MD

Content last modified February 2012