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nchiolitis
Bronchiolitis
B ronch iolitis is an epid em ic and seasonal v iral infection of th e low er respiratory tract in
ch ild ren less th an 2 years of ag e, ch aracterised by bronch iolar obstruction.
R espiratory syncytial v irus ( R SV ) is responsible for 7 0 % of cases of bronch iolitis.
T ransm ission of R SV is d irect, th roug h inh alation of d roplets (coug h ing , sneezing ), and
ind irect, th roug h contact w ith h and s or m aterials contam inated by infected secretions.
I n th e m ajority of cases, bronch iolitis is benig n, resolv es spontaneously (relapses are
possible), and can be treated on an outpatient basis.
Sev ere cases m ay occur, w h ich put th e ch ild at risk d ue to exh austion or second ary
bacterial infection. H ospitalisation is necessary w h en sig ns/ criteria of sev erity are
present (1 0 to 2 0 % of cases).
Clinical features
– T ach ypnoea, d yspnoea, w h eezing , coug h ; profuse, froth y, obstructiv e secretions.
– O n auscultation: prolong ed expiration w ith d iffuse, bilateral w h eezes; som etim es
d iffuse fine, end -inspiratory crackles.
R h inoph aryng itis, w ith d ry coug h , preced es th ese features by 2 4 to 7 2 h ours; fev er is
absent or m od erate.
– Sig ns of sev erity:
• Sig nificant d eterioration in g eneral cond ition, toxic appearance ( pallor, g reyish
colouration)
• A pnoea, cyanosis (ch eck lips, buccal m ucosa, fing ernails)
• R espiratory d istress (nasal flaring , sternal and ch est w all ind raw ing )
• A nxiety and ag itation (h ypoxia), altered lev el of consciousness
• R espiratory rate > 6 0 / m in
• D ecreased respiratory d istress and slow respirations (< 3 0 / m in below th e ag e of
1 year and < 2 0 / m in below th e ag e of 3 years, exh austion) . E xercise caution in
interpreting th ese sig ns as ind icators of clinical im prov em ent.
• Sw eats, tach ycard ia at rest and in th e absence of fev er
• Silence on auscultation (sev ere bronch ospasm )
• D ifficulty d rinking or sucking (red uced tolerance for exertion)
Treatment
T reatm ent is sym ptom atic. O bstructiv e sig ns and sym ptom s last for about 1 0 d ays;
coug h m ay persist for 2 w eeks long er.
H ospitalise ch ild ren w ith one of th e follow ing criteria:
– P resence of any sig n of sev erity
– P re-existing path olog y (card iac or pulm onary d isease, m alnutrition, H I V , etc.)
C onsid er h ospitalisation on a case-by-case basis in th e follow ing situations:
– A ssociated acute path olog y (v iral g astro-enteritis, bacterial infection, etc.)
– A g e less th an 3 m onth s
64
Bronchiolitis
B ronch iolitis is an epid em ic and seasonal v iral infection of th e low er respiratory tract in
ch ild ren less th an 2 years of ag e, ch aracterised by bronch iolar obstruction.
R espiratory syncytial v irus ( R SV ) is responsible for 7 0 % of cases of bronch iolitis.
T ransm ission of R SV is d irect, th roug h inh alation of d roplets (coug h ing , sneezing ), and
ind irect, th roug h contact w ith h and s or m aterials contam inated by infected secretions.
I n th e m ajority of cases, bronch iolitis is benig n, resolv es spontaneously (relapses are
possible), and can be treated on an outpatient basis.
Sev ere cases m ay occur, w h ich put th e ch ild at risk d ue to exh austion or second ary
bacterial infection. H ospitalisation is necessary w h en sig ns/ criteria of sev erity are
present (1 0 to 2 0 % of cases).
Clinical features
– T ach ypnoea, d yspnoea, w h eezing , coug h ; profuse, froth y, obstructiv e secretions.
– O n auscultation: prolong ed expiration w ith d iffuse, bilateral w h eezes; som etim es
d iffuse fine, end -inspiratory crackles.
R h inoph aryng itis, w ith d ry coug h , preced es th ese features by 2 4 to 7 2 h ours; fev er is
absent or m od erate.
– Sig ns of sev erity:
• Sig nificant d eterioration in g eneral cond ition, toxic appearance ( pallor, g reyish
colouration)
• A pnoea, cyanosis (ch eck lips, buccal m ucosa, fing ernails)
• R espiratory d istress (nasal flaring , sternal and ch est w all ind raw ing )
• A nxiety and ag itation (h ypoxia), altered lev el of consciousness
• R espiratory rate > 6 0 / m in
• D ecreased respiratory d istress and slow respirations (< 3 0 / m in below th e ag e of
1 year and < 2 0 / m in below th e ag e of 3 years, exh austion) . E xercise caution in
interpreting th ese sig ns as ind icators of clinical im prov em ent.
• Sw eats, tach ycard ia at rest and in th e absence of fev er
• Silence on auscultation (sev ere bronch ospasm )
• D ifficulty d rinking or sucking (red uced tolerance for exertion)
Treatment
T reatm ent is sym ptom atic. O bstructiv e sig ns and sym ptom s last for about 1 0 d ays;
coug h m ay persist for 2 w eeks long er.
H ospitalise ch ild ren w ith one of th e follow ing criteria:
– P resence of any sig n of sev erity
– P re-existing path olog y (card iac or pulm onary d isease, m alnutrition, H I V , etc.)
C onsid er h ospitalisation on a case-by-case basis in th e follow ing situations:
– A ssociated acute path olog y (v iral g astro-enteritis, bacterial infection, etc.)
– A g e less th an 3 m onth s
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