Understanding the symptoms of the common cold and influenza

Summary The common cold and influenza (flu) are the most common syndromes of infection in human beings. These diseases are diagnosed on symptomatology, and treatments are mainly symptomatic, yet our understanding of the mechanisms that generate the familiar symptoms is poor compared with the amount of knowledge available on the molecular biology of the viruses involved. New knowledge of the effects of cytokines in human beings now helps to explain some of the symptoms of colds and flu that were previously in the realm of folklore rather than medicine—eg, fever, anorexia, malaise, chilliness, headache, and muscle aches and pains. The mechanisms of symptoms of sore throat, rhinorrhoea, sneezing, nasal congestion, cough, watery eyes, and sinus pain are discussed, since these mechanisms are not dealt with in any detail in standard medical textbooks.

[1]  J. Georgitis.  NASOPHARYNGITIS, PHARYNGITIS, AND TONSILLITIS , 1993, Immunology and Allergy Clinics of North America.

[2]  G. Gerken,et al.  The safety of pegylated interferon alpha‐2b in the treatment of chronic hepatitis B: predictive factors for dose reduction and treatment discontinuation , 2005, Alimentary pharmacology & therapeutics.

[3]  M. Netea,et al.  Circulating cytokines as mediators of fever. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  R D Miller,et al.  Computed tomographic study of the common cold. , 1994, The New England journal of medicine.

[5]  M. Kluger.  Phylogeny of fever. , 1979, Federation proceedings.

[6]  R. Eccles,et al.  Effects of acetylsalicylic acid on sore throat pain and other pain symptoms associated with acute upper respiratory tract infection. , 2003, Pain medicine.

[7]  R. Eccles,et al.  Changes in the amplitude of the nasal cycle associated with symptoms of acute upper respiratory tract infection. , 1996, Acta oto-laryngologica.

[8]  R. Turner,et al.  Histopathologic examination and enumeration of polymorphonuclear leukocytes in the nasal mucosa during experimental rhinovirus colds. , 1984, Acta oto-laryngologica. Supplementum.

[9]  R. Packer,et al.  The photic sneeze reflex , 1993, Neurology.

[10]  D. Taylor-Robinson,et al.  Viral and Other Infections of the Human Respiratory Tract , 1996, Springer Netherlands.

[11]  C. Ellenbogen.  The common cold. , 1981, American family physician.

[12]  J. Widdicombe,et al.  Microvascular anatomy of the nose , 1997, Allergy.

[13]  R. Maini,et al.  The natural history of epiphora in childhood , 1998, Eye.

[14]  R. Eccles,et al.  Cough induced by airway vibration as a model of airway hyperreactivity in patients with acute upper respiratory tract infection , 2004, Pulmonary Pharmacology & Therapeutics.

[15]  J. Guieu,et al.  The chill sensation in fever , 1980, Pflügers Archiv.

[16]  J. Hendley.  The host response, not the virus, causes the symptoms of the common cold. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  L. Hansson,et al.  Neurophysiology of the cough reflex. , 1996, The European respiratory journal.

[18]  B. Beutler.  Science review: Key inflammatory and stress pathways in critical illness – the central role of the Toll-like receptors , 2002, Critical care.

[19]  M. Schwarz,et al.  Interferon-alpha, cytokines and possible implications for mood disorders. , 2002, Bipolar disorders.

[20]  Andrew H. Miller,et al.  Cytokines and psychopathology: Lessons from interferon-α , 2004, Biological Psychiatry.

[21]  M. Exton.  Infection-Induced Anorexia: Active Host Defence Strategy , 1997, Appetite.

[22]  R. Turner.  Epidemiology, Pathogenesis, and Treatment of the Common Cold , 1997, Annals of Allergy, Asthma & Immunology.

[23]  David Skoner,et al.  Bradykinin levels during experimental nasal infection with rhinovirus and attenuated influenza virus. , 1996, Immunopharmacology.

[24]  D. Fleming,et al.  Contribution of influenza and respiratory syncytial virus to community cases of influenza-like illness: an observational study , 2001, The Lancet.

[25]  Elizabeth Rea,et al.  Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. , 2003, JAMA.

[26]  S. Ferreira.  Prostaglandins, pain, and inflammation. , 1986, Agents and actions. Supplements.

[27]  N. Mygind,et al.  Role of histamine and antihistamines in the nose. , 1983, European journal of respiratory diseases. Supplement.

[28]  C. Del Mar,et al.  Predictors of an antibiotic prescription by GPs for respiratory tract infections: a pilot. , 2000, Family practice.

[29]  H. Svanholm,et al.  The relationship between body posture and pressure in occluded maxillary sinus of man. , 1989, Rhinology.

[30]  Andrew P. Smith,et al.  EFFECTS OF THE COMMON COLD ON MOOD AND PERFORMANCE , 1998, Psychoneuroendocrinology.

[31]  Feed a Cold, Starve a Fever? , 2002, Clinical and Vaccine Immunology.

[32]  N. Rothwell,et al.  Cytokines and fever. , 1996, International archives of allergy and immunology.

[33]  P. Cauwenberge,et al.  A Clinical Study to Evaluate the Efficacy of the Antihistamine Doxylamine Succinate in the Relief of Runny Nose and Sneezing Associated with Upper Respiratory Tract Infection , 1995, The Journal of pharmacy and pharmacology.

[34]  H. Whittet.  Infraorbital Nerve Dehiscence: The Anatomic Cause of Maxillary Sinus “Vacuum Headache”? , 1992, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[35]  A. Monto,et al.  Epidemiology of viral respiratory infections , 2002, The American Journal of Medicine.

[36]  Andrew H. Miller,et al.  Cytokines and psychopathology: lessons from interferon-alpha. , 2004, Biological psychiatry.

[37]  R. Turner,et al.  Sites of rhinovirus recovery after point inoculation of the upper airway. , 1986, JAMA.

[38]  W. Langhans,et al.  Anorexia of infection: current prospects. , 2000, Nutrition.

[39]  K G Moons,et al.  Clinical signs and symptoms predicting influenza infection. , 2001, Archives of internal medicine.

[40]  R. Naclerio,et al.  Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat. , 1988, The American review of respiratory disease.

[41]  A. Goldberg,et al.  Stimulation of muscle protein degradation and prostaglandin E2 release by leukocytic pyrogen (interleukin-1). A mechanism for the increased degradation of muscle proteins during fever. , 1983, The New England journal of medicine.

[42]  Hendley Jo.  The host response, not the virus, causes the symptoms of the common cold. , 1998 .

[43]  Thomas R. Riley,et al.  A Randomized Double-blind Placebo-controlled Trial , 2004 .

[44]  R. S. Smith.  The cytokine theory of headache. , 1992, Medical hypotheses.

[45]  R. Eccles.  Pathophysiology of Nasal Symptoms , 2000, American journal of rhinology.

[46]  D. Jacoby.  Pathophysiology of airway viral infections. , 2004, Pulmonary pharmacology & therapeutics.

[47]  L. Leon.  Invited review: cytokine regulation of fever: studies using gene knockout mice. , 2002, Journal of applied physiology.

[48]  F. Paulsen,et al.  The cavernous body of the human efferent tear ducts contributes to regulation of tear outflow. , 2003, Investigative ophthalmology & visual science.

[49]  A. Robson,et al.  Epiphora: The Role of Rhinitis , 1998, American journal of rhinology.

[50]  F. Paulsen,et al.  Innervation of the cavernous body of the human efferent tear ducts and function in tear outflow mechanism , 2000, Journal of anatomy.

[51]  H. Kubba,et al.  An Association between Acquired Epiphora and the Signs and Symptoms of Chronic Rhinosinusitis: A Prospective Case–Control Study , 2003, American Journal of Rhinology.

[52]  P. Chang,et al.  The long‐term safety and tolerability of high‐dose interferon β‐1a in relapsing–remitting multiple sclerosis: 4‐year data from the PRISMS study , 2005, European journal of neurology.

[53]  R. Eccles,et al.  Nasal Airflow in Health and Disease , 2000, Acta oto-laryngologica.

[54]  M. Bende,et al.  Mucosal exudation of fibrinogen in coronavirus-induced common colds. , 1993, Acta oto-laryngologica.

[55]  E. D. Kilbourne,et al.  Influenza in Man , 1987 .

[56]  Peter J. Ball,et al.  Common Respiratory Tract Infections as Psychological Entities: A Review of the Mood and Performance Effects of Being Ill , 2002, Australian psychologist.

[57]  R. Eccles,et al.  Voluntary control of cough. , 2002, Pulmonary pharmacology & therapeutics.

[58]  Sore throat following nasal and oropharyngeal bradykinin challenge. , 1994, Acta oto-laryngologica.

[59]  R. Stockley,et al.  Assessment of airway neutrophils by sputum colour: correlation with airways inflammation , 2001, Thorax.

[60]  Sheldon Cohen,et al.  Signs and symptoms in common colds , 1993, Epidemiology and Infection.

[61]  B. Jones,et al.  Duration of cough in acute upper respiratory tract infections. , 2002, Australian family physician.

[62]  F. Hayden,et al.  Effectiveness and Safety of Intranasal Ipratropium Bromide in Common Colds , 1996, Annals of Internal Medicine.

[63]  G. Jackson,et al.  Transmission of the common cold to volunteers under controlled conditions. I. The common cold as a clinical entity. , 1958, A.M.A. archives of internal medicine.

[64]  C G Helman,et al.  “Feed a cold, starve a fever” — folk models of infection in an english suburban community, and their relation to medical treatment , 1978, Culture, medicine and psychiatry.

[65]  G. Jackson,et al.  Transmission of the common cold to volunteers under controlled conditions. III. The effect of chilling of the subjects upon susceptibility. , 1958, American journal of hygiene.

[66]  H. Hensel.  Thermoreception and temperature regulation. , 1981, Monographs of the Physiological Society.