Bronchiolitis

        It is one of the common serious acute lower respiratory infection in infants affected infants are between the ages of 1 and 6 months but the disease can affect upto 2 year.
Respiratory syncytial virus (RSV) is implicated in most cases. 
In short, it is the inflammation of the bronchioles.
Other causative organisms include:

  • Parainfluenza virus.
  • Adenovirus
  • Influenza virus.
  • Rarely mycoplasma pneumonae.
Pathogenesis:
          Inflammation of the bronchiolar mucosa leads to edma, thickening, formation of mucus plugs and cellular debris. Bronchiolar spasm occurs in some cases. The bronchial lumen is further reduced. The bronchioles are partially collapsed. Trapping of air inside alveoli causes emphysematous changes. The trapped air may cause atelectasis.
         Due to diminished ventilation and diffusion hypoxemia is produced in almost all of these infants. The presence of eosinophils in the blood and respiratory secretion suggest that the virus infection initiates the wheezing attacks.
Clinical Features :
  • Tachypnoea
  • Fever is moderately high, retraction of lower intercostal spaces.
  • Fine rales and rhonchi are auscultated.
  • Breath sound may be faint or inaudible in severe causes.
  • Cynosis
  • Respiratory distress develops.
  • If emphysema, liver and spleen are pushed down.
  • When chest is over inflated, anteroposterior diameter of chest is increased.
  • Hyper resonance on percussion.
Investigation:
  • Chest x-ray
  • HB%,TC,DC,ESR
       ( Rapid test against RSV can be done at bed side)
Prognosis:
  • Generally self limiting illness, symptoms subside in 3-7 days.
  • Death 1% in severly ill patients.
Treatment:
  • Nursed with humid atmosphere in sitting position at angle 30⁰ to 40⁰.
  • Head and neck elevated.
  • With mild disease can be cared at home.
  • If respiratory distress increases hospitalization should be done.
  • O2 therapy even in absence of cyanosis or according to oximeter.(maintain O2 saturation > 95%)
  • Fluids and electolyte balance.
  • Use of bronchodilators may provide some benefit.
  • Asthaline and ipravent nebulization may be used.
  • CPAP( Continous Positive Airway Pressure) may be required to control respiratory failure.

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