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. 2011 Feb 2;37(2):86–94. doi: 10.1080/00050060210001706726

Common Respiratory Tract Infections as Psychological Entities: A Review of the Mood and Performance Effects of Being Ill

Tania Mahoney 1, Peter Ball
PMCID: PMC7159681  PMID: 32313294

Abstract

The clinical manifestations associated with colds and influenza overshadow the equally important mood and performance impairments. While decreased alertness and increased anxiety can be considered side effects of symptomatology, symptoms alone may not be responsible for the psychomotor and attention deficits of colds and influenza, respectively. An alternative hypothesis, as proposed in this review, suggests that the immune response, in the form of a cytokine cascade, may be responsible for both the physical and psychological symptoms. In particular, patterns of cytokine production for each infection will dictate the symptoms and performance deficits both within and between viruses. This hypothesis can be extended to incorporate infectious mononucleosis, as well as colds and influenza. The efficacy of symptom‐based overthe‐counter medications is then called into question.

References

  1. Andersson J. Andersson U. (1993) Characterization of cytokine production in infectious mononucleosis studied at a single‐cell level in tonsil and peripheral blood Clinical and Experimental Immunology 92 7–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barrett B. Vohmann M. Calabrese C. (1999) Echinacea for upper respiratory infection Journal of Family Practice 48 628–635. [PubMed] [Google Scholar]
  3. Beare A.S. Reed S.E. (1977) The study of anti‐viral compounds in volunteers, In Oxford J. S. (Ed.) Chemoprophylaxis and virus infections of the Respiratory Tract Vol 2, (2nd ed. pp. 27–55). Cleveland, OH, CRC Press. [Google Scholar]
  4. Biglino A. Sinicco A. Forno B. Pollono A.M. Sciandra M. Martini C. Pich P. Gioannini P. (1996) Serum cytokine profiles in acute primary HIV‐1 infection and in infectious mononucleosis Clinical Immunology and Immunopathology 78 61–69. [DOI] [PubMed] [Google Scholar]
  5. Burger R.A. Torres A.R. Warren R.P. Caldwell V.D. Hughes B.G. (1997) Echinacea‐induced cytokine production by human macrophages International Journal of lmmunopharmacology 19 371–379. [DOI] [PubMed] [Google Scholar]
  6. Bye C.E. Cooper J. Empey D.W. Fowle A.S. Hughes D.T. Letley E. O’Grady J. (1980) Effects of pseudoephedrine and triprolidine, alone and in combination, on symptoms of the common cold British Medical Journal 281 189–190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Capuron L. Lamarque D. Dantzer R. Goodall G. (1999) Attentional and mnemonic deficits associated with infectious disease in humans Psychological Medicine 29 291–297. [DOI] [PubMed] [Google Scholar]
  8. Capuron L. Ravaud A. Dantzer R. (2001) Timing and specificity of the cognitive changes induced by interleukin‐2 and interferon‐A treatments in cancer patients Psychosomatic Medicine 63 376–386. [DOI] [PubMed] [Google Scholar]
  9. Caraceni A. Martini C. Belli F. Mascheroni L. Rivoltini L. Arienti F. Cascinelli N. (1992) Neuropsychological and neurophysiological assessment of the central effects of interleukin‐2 administration European Journal of Cancer 29A 1266–1269. [DOI] [PubMed] [Google Scholar]
  10. Corney T. Hale R. Ball P. (1994) Two experiments on mental functioning under common health‐related conditions: Glandular fever and the premenstrual phase, In Fourez J. & Page N. (Eds.) Treatment issues and long‐term outcomes: Proceedings of the 18th Annual Brain Impairment Conference, Hobart, Australia 1994, pp. 169–175, Bowen Hills, Qld, Australian Academic Press. [Google Scholar]
  11. Crocker C.T. Ball P. Montgomery I. (1997) Neurobehavioural dysfunction associated with acute and chronic infectious mononucleosis: A progress report, In Ponsford J., Snow P. & Anderson V. (Eds.) International Perspectives in Traumatic Brain Injury: Proceedings of the 5th International Conference of the Association for the Study of Traumatic Brain Injury and 20th Conference of the Australian Society for the Study of Brain Impairment, Melbourne, Australia 1997, pp. 160–166, Bowen Hills, Qld, Australian Academic Press. [Google Scholar]
  12. Dinarello C.A. (1997) Cytokines as endogenous pyrogens, In Mackowiak P.A. (Ed.) Fever: Basic mechanisms and management (2nd ed., pp. 87–116). Philadelphia, Lippincott‐Raven. [Google Scholar]
  13. Douglass J.A. Dhami D. Gurr C.E. Bulpitt M. Shute J.K. Howarth P.H. Lindley I.J. Church M.K. Holgate S.T. (1994) Influence of interleukin‐8 challenge in the nasal mucosa in atopic and nonatopic subjects American Journal of Respiratory and Critical Care Medicine 150 1108–1113. [DOI] [PubMed] [Google Scholar]
  14. Drake C.L. Roehrs T.A. Royer H. Koshorek G. Turner R.B. Roth T. (2000) Effects of an experimentally induced rhinovirus cold on sleep, performance, and daytime alertness Physiology and Behavior 71 75–81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gabay C. Kushner I. (1999) Acute‐phase proteins and other systemic responses to inflammation New England Journal of Medicine 340 448–454. [DOI] [PubMed] [Google Scholar]
  16. Graves L. Pack A. Abel T. (2001) Sleep and memory: A molecular perspective Trends in Neuroscience 24 237–243. [DOI] [PubMed] [Google Scholar]
  17. Hall S.R. (1995) Behavioural effects of acute and chronic viral illness, Unpublished doctoral dissertation, University of Cardiff Wales, UK.
  18. Hall S.R. Smith A.P. (1996a) An investigation of the effects and after‐effects of naturally occurring upper respiratory tract illnesses on mood and performance Physiology and Behaviour 59 569–577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hall S.R. Smith A.P. (1996b) Behavioural effects of infectious mononucleosis Neuropsychobiology 33 202–209. [DOI] [PubMed] [Google Scholar]
  20. Harris J.M. Gwaltney J.M. (1996) Incubation periods of experimental rhinovirus infection and illness Clinical Infectious Diseases 23 1287–1290. [DOI] [PubMed] [Google Scholar]
  21. Hart B.L. (1988) Biological basis of the behaviour of sick animals Neuroscience and Biobehavioural Reviews 12 123–137. [DOI] [PubMed] [Google Scholar]
  22. Hayden F.G. Fritz R.S. Lobo M.C. Alvord W.G. Strober W. Straus S.E. (1998) Local and systemic cytokine responses during experimental human influenza A virus infection: Relation to symptom formation and host defence Journal of Clinical Investigation 101 643–649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hendley J.O. (1998) The host response, not the virus, causes the symptoms of the common cold Clinical Infectious Diseases 26 847–848. [DOI] [PubMed] [Google Scholar]
  24. Hornef M.W. Wagner H.‐J. Kruse A. Kirchner H. (1995) Cytokine production in a whole‐blood assay after epstein‐barr virus infection in vivo Clinical and Diagnostic Laboratory Immunology 2 209–213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Jawad S.S.M. Eccles R. (1998) Effect of pseudoephedrine on nasal airflow in patients with nasal congestion associated with common cold Rhinology 36 73–76. [PubMed] [Google Scholar]
  26. Kirkpatrick G.L. (1996) The common cold Primary Care 23 657–675. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Kuby J. (1997) Immunology (3rd ed.)., New York, W.H. Freeman. [Google Scholar]
  28. Lacosta S. Merali Z. Anisman H. (1999) Influence of acute and repeated interleukin‐2 administration on spatial learning, exploratory behaviors, and anxiety Behavioral Neuroscience 113 1030–1041. [DOI] [PubMed] [Google Scholar]
  29. Mackiewicz A. Speroff T. Ganapathi M.K. Kushner I. (1991) Effects of cytokine combinations of acute phase protein production in two hepatoma cell lines Journal of Immunology 146 3032–3037. [PubMed] [Google Scholar]
  30. Melchart D. Linde K. Worku F. Sarkady L. Holzmann M. Jurcic K. Wagner H. (1995) Results of five randomized studies on the immunomodulatory activity of preparations of echinacea Journal of Alternative and Complementary Medicine 1 145–160. [DOI] [PubMed] [Google Scholar]
  31. Mullington J. Korth C. Hermann D. M. Orth A. Galanos C. Holsboer F. Pollmacher T. (2000) Dose‐dependent effects of endotoxin on human sleep American Journal of Physiology 278 R947–955. [DOI] [PubMed] [Google Scholar]
  32. Nicholson K. G. (1998) Human influenza, In Nicholson K. G., Webster R. G. & Hay A. J. (Eds.) Textbook of influenza, pp. 219–264, Oxford, London, Blackwell Science, Ltd. [Google Scholar]
  33. Noah T.L. Henderson F.W. Wortman I.A. Devlin R.B. Handy J. Koren H.S. Becker S. (1995) Nasal cytokine production in viral acute upper respiratory infection in childhood Journal of Infectious Diseases 171 584–592. [DOI] [PubMed] [Google Scholar]
  34. Pilcher J.J. Huffcutt A.I. (1996) Effects of sleep deprivation on performance: A meta‐analysis Sleep 19 318–326. [DOI] [PubMed] [Google Scholar]
  35. Pilcher J.J. Schoeling S.E. Prosansky C.M. (2000) Selfreport sleep habits as predictors of subjective sleepiness Behavioural Medicine 25 161–168. [DOI] [PubMed] [Google Scholar]
  36. Poutiainen E. Hokkanen L. Niemi M.‐L. Firkkil M. (1994) Reversible cognitive decline during high‐dose ce‐interferon treatment Pharmacology, Biochemistry and Behaviour 47 901–905. [DOI] [PubMed] [Google Scholar]
  37. Proud D. Reynolds C.J. LaCapra S. Kagey‐Sobotka A. Lichtenstein L.M. Naclerio R.M. (1988) Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat American Review of Respiratory Disease 137 613–616. [DOI] [PubMed] [Google Scholar]
  38. Roth T. Roehrs T. (2000) Sleep organization and regulation Neurology 54 S2–S7. [PubMed] [Google Scholar]
  39. Sanders S.P. Siekierski E.S. Porter J.D. Richards S.M. Proud D. (1998) Nitric oxide inhibits rhinovirus‐induced cytokine production and viral replication in a human respiratory epithelial cell line Journal of Virology 72 934–942. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Savory M.A. (1992) Selective effects of colds and influenza on human performance efficiency: A critical appraisal Neuropsychobiology 25 153–160. [DOI] [PubMed] [Google Scholar]
  41. Schuster V. Herold M. Wachter H. Reibnegger G. (1993) Serum concentrations of interferon gamma, interleukin‐6 and neopterin in patients with infectious mononucleosis and other epstein‐barr virus‐related lymphoproliferative diseases Infection 12 210–213. [DOI] [PubMed] [Google Scholar]
  42. Shibayama Y. Skoner D. Suehiro S. Konishi J. Fireman P. Kaplan A.P. (1996) Bradykinin levels during experimental nasal infection with rhinovirus and attenuated influenza virus Immunopharmacology 33 311–313. [DOI] [PubMed] [Google Scholar]
  43. Skoner D.P. Gentile D.A. Patel A. Doyle W.J. (1999) Evidence for cytokine mediation of disease expression in adults experimentally infected with influenza A virus Journal of Infectious Diseases 180 10–14. [DOI] [PubMed] [Google Scholar]
  44. Smith A.P. (1995) Colds, flu and performance Occupational Health Review 58 29–32. [Google Scholar]
  45. Smith A.P. Rich N. Sturgess W. Brice C. Collison C. Bailey J. Wilson S. Nutt D. (1999) Effects of the common cold on subjective alertness, simple and choice reaction time and eyemovements Journal of Psychophysiology 13 145–151. [Google Scholar]
  46. Smith A.P. Thomas M. Kent J. Nicholson K. (1998) Effects of the common cold on mood and performance Psychoneuroendocrinology 23 733–739. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Smith A.P. Thomas M. Whitney H. (2000) Effects of upper respiratory tract illnesses on mood and performance over the working day Ergonomics 43 752–763. [DOI] [PubMed] [Google Scholar]
  48. Smith A.P. Tyrrell D.A.J. Al‐Nakib W. Barrow G.I. Higgins P.G. Leekam S. Trickett S. (1989) Effects and aftereffects of the common cold and influenza on human performance Neuropsychobiology 21 90–93. [DOI] [PubMed] [Google Scholar]
  49. Smith A.P. Tyrrell D.A.J. Al‐Nakib W. Barrow G. I. Higgins P. Wenham R. (1991) Effects of zinc gluconate and nedocromil sodium on performance deficits produced by the common cold Journal of Psychopharmacology 5 251–254. [DOI] [PubMed] [Google Scholar]
  50. Smith A.P. Tyrrell D.A.J. Al‐Nakib W. Coyle K.B. Donovan C.B. Higgins P. G. Willman J.S. (1987) Effects of experimentally‐ induced virus infections and illnesses on psychomotor performance Neuropsychobiology 18 144–148. [DOI] [PubMed] [Google Scholar]
  51. Smith A.P. Tyrrell D.A.J. Al‐Nakib W. Coyle K.B. Donovan C. B. Higgins P. G. Willman J. S. (1988) The effects of experimentally induced respiratory virus infections on performance Psychological Medicine 18 65–71. [DOI] [PubMed] [Google Scholar]
  52. Smith A. P. Tyrrell D. A.J. Barrow G. I. Coyle K. B. Higgins P. G. Trickett S. Willman J. S. (1990) Effects of experimentally induced colds on aspects of memory Perceptual and Motor Skills 71 1207–1215. [DOI] [PubMed] [Google Scholar]
  53. Smith A.P. Tyrrell D.A.J. Barrow G.I. Higgins P.G. Willman J.S. Bull S. Coyle K.B. Trickett S. (1992) Mood and experimentally‐induced respiratory virus infections and illnesses Psychology and Health 6 205–212. [Google Scholar]
  54. Smith A.P. Tyrrell D.A.J. Coyle K.B. Higgins P.G. (1988) Effects of interferon alpha on performance in man: A preliminary report Psychopharmacology 10 195–203. [DOI] [PubMed] [Google Scholar]
  55. Smith A.P. Tyrrell D.A.J. Coyle K.B. Higgins P.G. (1991) Effects and after‐effects of interferon alpha on human performance, mood and physiological functioning Journal of Psychopharmacology 5 243–250. [DOI] [PubMed] [Google Scholar]
  56. Smith A.P. Tyrrell D.A.J. Coyle K.B. Higgins P.G. Willman J.S. (1988) Diurnal variation in the symptoms of colds and influenza Chronobiology International 5 411–416. [DOI] [PubMed] [Google Scholar]
  57. Smith A.P. Tyrrell D.A.J. Coyle K. Willman J.S. (1987) Selective effects of minor illnesses on human performance British Journal of Psychology 78 183–188. [DOI] [PubMed] [Google Scholar]
  58. Smith M.B.H. Feldman W. (1993) Over‐the‐counter medications. A critical review of clinical trials between 1950 and 1991 JAMA 269 2258–2263. [DOI] [PubMed] [Google Scholar]
  59. Sperber S.J. (1994) The common cold Infections in Medicine 11 235–242. [Google Scholar]
  60. Taga H. Taga K. Wang F. Chretien J. Tosato G. (1995) Human and viral interleukin‐10 in acute epstein‐barr virusinduced infectious mononucleosis Journal of Infectious Diseases 171 1347–1350. [DOI] [PubMed] [Google Scholar]
  61. Taverner D. Danz C. Economos D. (1999) The effects of oral pseudoephedrine on nasal patency in the common cold: A double‐blind single‐dose placebo‐controlled trial Clinical Otolaryngology 24 47–51. [DOI] [PubMed] [Google Scholar]
  62. Terajima M. Yamaya M. Sekizawa K. Okinaga S. Suzuki T. Yamada N. Nakayama K. Ohrui T. Oshima T. Numazaki Y. Sasaki H. (1997) Rhinovirus infection of primary cultures of human tracheal epithelium: Role of ICAM‐1 and IL‐ 1 P American Journal of Physiology 273 L749–L759. [DOI] [PubMed] [Google Scholar]
  63. Turner R.B. Wecker M.T. Pohl G. Witek T.J. McNally E. St George R. Winther B. Hayden F.G. (1999) Efficacy of tremacamra, a soluble intercellular adhesion molecule 1, for experimental rhinovirus infections JAMA 281 1797–1804. [DOI] [PubMed] [Google Scholar]
  64. Turner R.B. Weingand K.W. Yeh C‐H. Leedy D.W. (1998) Association between interleukin‐8 concentrations in nasal secretions and severity of symptoms in experimental rhinovirus colds Clinical Infectious Diseases 26 840–846. [DOI] [PubMed] [Google Scholar]
  65. Tyrrell D.A.J. Cohen S. Schlarb J.E. (1993) Signs and symptoms in common colds Epidemiology and Infection 111 143–156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Vollmer‐Conna U. (2001) Acute sickness behaviour: an immune system‐to‐brain communication? Psychological Medicine 31 761–767. [DOI] [PubMed] [Google Scholar]
  67. Walker L.G. Wesnes K.P. Heys S.D. Walker M.B. Lolley J. Eremin O. (1996) The cognitive effects of recombinant interleukin‐2 (rIL‐2) therapy: A controlled clinical trial using computerised assessments European Journal of Cancer 32A 2275–2283. [DOI] [PubMed] [Google Scholar]
  68. White P.D. Dash A.R. Thomas J.M. (1998) Poor concentration and the ability to process information after glandular fever Journal of Psychosomatic Research 44 269–278. [DOI] [PubMed] [Google Scholar]
  69. Wright‐Browne V. Schnee A.M. Jenkins M.A. Thall P.F. Aggarwal B.B. Talpaz M. Estrov Z. (1998) Serum cytokine levels in infectious mononucleosis at diagnosis and convalescence Leukemia and Lymphoma 30 583–589. [DOI] [PubMed] [Google Scholar]
  70. Yamaya M. Sekizawa K. Suzuki T. Yamada N. Furukawa M. Ishizuka S. Nakayama K. Terajia M. Numazaki Y. Sasaki H. (1999) Infection of human respiratory submucosal glands with rhinovirus: Effects on cytokine and ICAM‐1 production American Journal of Physiology 277 L362–L371. [DOI] [PubMed] [Google Scholar]
  71. Yoon H.J. Zhu Z. Gwaltney J.M. Elias J.A. (1999) Rhinovirus regulation of IL‐1 receptor antagonist in vivo and in vitro: A potential mechanism of symptom resolution Journal of Immunology 162 7461–7469. [PubMed] [Google Scholar]
  72. Zhu Z. Tang W. Gwaltney J.M., Jr. Wu Y. Elias J.A. (1997) Rhinovirus stimulation of interleukin‐8 in vivo and in vitro: Role of NF‐KB American Journal of Physiology 273 L814–824. [DOI] [PubMed] [Google Scholar]

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