Understanding Bronchiolitis in Children
Bronchiolitis is an acute inflammatory disease that affects the small airways, commonly seen in young infants. It is often caused by respiratory viruses like RSV and can lead to acute respiratory distress. Learn about the aetiological agents, risk factors, and pathophysiology of bronchiolitis in pediatrics to better understand its impact on children's health.
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Presentation Transcript
BRONCHIOLITIS IN PAEDIATRICS
Introduction Acute infectious inflammatory disease of the URT and LRT that result in obstruction of the small airways Occur in all age gp, larger airways of older children and adults better accommodate mucosal edema, severe respiratory symptoms limited to young infants 90% are aged 1-9 months (rare after 1 year of age), boys affected more than girls Major concern not only the acute effects bronchiolitis but the possible development of chronic airway hyperreactivity (asthma) Infants a affected most often because of their small airways, high closing volumes, and insufficient collateral ventilation
Aetiological agents Respiratory Syncytial Virus (RSV) Isolated agent in 75% of children younger than 2 years and highly contagious Enveloped RNA virus that belongs to the Paramyxoviridae family within the Pneumovirus genus Two RSV subtypes A (severe) and B (structural variations in the G protein) Viral shedding in nasal secretions for 6-21 days after symptoms develop. IP =2-5 days Complex immunologic mechanisms play a role in RSV bronchiolitis. Type I allergic reactions mediated by the IgE antibody account for significant bronchiolitis thus breastfed babies (colostrum-IgA) relatively protected Human metapneumovirus, parainfleunze, influenza, rhinovirus, adenovirus Mycoplasma pneumoniae accounts for 5-15% particularly among older children and adults
Risk factors Low birth weight (PREM) Lower Parental smoking socioeconomic gp Chronic lung disease- bronchopulmonary dysplasia Crowded condition, daycare CHD + pulmonary hypertension Congenital/ acquired immunedeficiency disease <3 months old Aiways anomalies
Pathophysiology Proliferation of goblet cells > excessive mucus production Necrosis of respiratory epithelium (<24h) Acquisition of infection Nonciliated epithelium cell regeneration > impaired secretion elimination (removed by macrophages) Cytokine and chemokines released > Increased cellular recruitment Lymphocytic infiltration > submucosal edema Obstruction due to inflammatory cells debris + fibrin + mucus + edema fluid (not due to bronchoconstriction) Bronchioles obstruction lead to hyperinflation + increase airways resistance + atelactasis + V/Q mismatch Recovery with bronchiolar epithelium regeneration after 3-4 days
Clinical presentation History Physical Coryza rhinorrhea, fever Sharp and dry cough Tachypnoea and tachycardia Dry cough Hyperinflated chest sternum prominent + liver displaced Progressive breathlessness Recession Wheezing High pitched wheezes- expiratory > inspiratory Fine end inspiratory crackles Feeding difficulty Hypothermic (<1 month) Respiratory distress- tachypnea, nasal flare, recession, irritability and cyanosis Cyanosis / pallor
Differential diagnosis Aspiration syndrome Asthma Pertussis (bronchitis) Pneumonia
Investitigation Lymphocytosis FBC Nasopharyngeal swab/ nasal wash To detect RSA antigen in epithelial cell from secretion Direct immunofluorescent antibody (IFA) staining or ELISA, PCR Hyperinflated lung due to airways obstruction, air trapping and focal atelectasis (arterial desaturation) Increased interstitial marking and peribronchiol cuffing Chest Xray In severe cases show lowered arterial oxygen and raised CO2 tension Blood gas analysis May display arrhythmias or cardiomegaly ECG, ECHO
A chest radiography revealing lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16- day-old infant with severe bronchiolitis
Management Supportive (viral) provide adequate fluid (NG/IV) to maintain hydration and monitor for apnea (infant) Humidified O2 delivered via nasl cannulae determined by pulse oximetry Mist/ antibiotics/ steroids not helpful Nebulised bronchodilator (salbutamol/ipratropium) often used but not reduce severity / illness duration Prophylaxis- good hand hygiene and monoclonal antibody prophylaxis (im palivizumab) Following adenovirus infection > permanent airways damage (bronchiolitis obliterans) Prognosis Half will have recurrent cough + wheeze Recover with 2w
Bronchitis (whooping cough / pertussis) Highly infectious caused by bordetella pertussis Inflammation of brochi produce mixture of wheeze and coarse crackles Main symptoms: cough(<2w if >2w caused by pertussis/ mycoplasma) and fever Complication: pneumonia, convulsion, bronchiectasis and death (infants with apnea) Phases Catarrhal phase (1w): coryza Paroxysmal phase (3-6w): paroxysmal/spasmodic cough then inspiratory whoop, cough worse at night + vomit, can go red/blue, mucus flow from nose and mouth, apnea (infant), epistaxis (nosebleed) and sunconjuctival haemorrhage Convalescent phase (persist months): symptoms decrease Investigation Culture of nasal swab FBC: marked lymphocytosis Treatment and management Erythromycin for eradicates organism, closed contact and prophylaxis Immunisation reduce risk developed pertussis but not 100%
