Bronchiolitis

• acute inflammation of very small airways

• about 10-15% infants develop bronchiolitis to some degree

• 80% caused by respiratory syncitial virus, commoner in winter

• other causes

  • influenza

  • parainfluenza

  • adenovirus

• rarer causes

  • rhinovirus

  • Mycoplasma pneumoniae

Pathology

• type 3 hypersensitivity reaction

Presentation

• most cases over 3 months
• initially upper respiratory coryzal symptoms
• progress over few days to lower respiratory
  • tachypnoea
  • cough
  • wheezing
• systemic upset
• fever
• recession
• central cyanosis
• auscultation
  • wheeze
  • extensive fine crackles
• CXR
  • hyuperinflation
  • patchy / streaky atelectasis

Differential

• asthma in older children

Management

• watch at home if not too severe
• or admit
• fluid intake
• supplemental oxygen
• antipyretics
• inhaled ribavirin
• NOT corticosteroids

Prognosis

• severe attack may lead to recurrent wheeze for many years

[ Home ] [ Up ]