Viral and Bacterial Rhinitis

In contradistinction to the poetically inspired disjunction between the name and quality of a rose recited by Juliet in the famous quote from Shakespeare's play, disease labels used in the medical sciences need to have exact meaning to ensure that they communicate an accurate diagnosis and a valid treatment approach. Above, we presented a consistent nosology for rhinitis consequent to infection. There, we argued that the term "rhinitis" should be used to describe the condition of nasal mucosal pathology and that the rSSC be used to describe the appreciated expression of that pathology. In discussing viral and bacterial rhinitis, we conclude that former is consistent with a strict application of our nosology where the accompanying rSSC is usually referred to as cold or flu, but that the latter is not. Lacking direct evidence for bacterial infection of the nasal mucosa, bacterial rhinitis is better referred to as an acute bacterial infection of an adjacent compartment complicated by rhinitis (e.g., sinusitis complicated by rhinitis) or as "toxic rhinitis" complicated by bacterial infection. Interestingly, bacterial infection of the adjacent compartments is a frequent complication of viral rhinitis making "bacterial" rhinitis a complication of a complication of viral rhinitis. The antiviral and antibacterial host-defense mechanisms available to the nasal mucosa are multilayered and formidable. For this reason, nasal mucosal infection with extracellular bacterial pathogens is rarely established and infection with a broad range of upper respiratory viruses is self-limited with short duration morbidity and no mortality. However, in select subpopulations, those infections predispose to more serious complications associated with secondary bacterial, and perhaps viral, infection of the sinuses, middle ears, and lungs. The morbidity and mortality of these complications remains a concern, and strategies to decrease their frequency need to be formulated and tested in clinical trials. Because the viruses causing rhinitis are spread by interpersonal contact, the most appropriate and least expensive prophylactic measures are good hygiene and contact avoidance. Prophylactic efficacy for vaccination and passive immunoglobulin therapy was demonstrated for influenza and RSV infections, respectively. However, these approaches hold little promise for other viruses and are associated with some risks, making them less acceptable for populations "at low risk" for the more serious complications of viral rhinitis. Existing pharmacological treatments for viral rhinitis target the effector chemicals of the rSSC and therefore are largely palliative, whereas antiviral treatment has limited theoretical and realized efficacy, and no treatment has been shown to decrease the risk of complications. Indeed, given the small treatment window available (time between rSSC onset and typical resolution) and the poor understanding of the immune/inflammatory pathways of host defense, it is doubtful that the general population's demand for a cure will be satisfied in the near future, but then, viral rhinitis by any other name is still just a cold.