Bronchiolitis natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural History Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases[1]
- Patients usually develop symptoms 1 week after the contact with a symptomatic patient.
- The first 2-3 days the patient presents mild upper respiratory symptoms (cough, rhinorrhea and low fever).
- Acute phase (shortness of breath, wheezing, persistent prominent cough, tachypnea, chest wall retraction and nasal flaring) usually develops between the third and seventh day.
- Symptoms gradually disappear within the next 2 weeks (the cough may take longer)
Complications Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases[2]
Complications are usually observerd in patients younger than 2 months, premature infants and patients with associated conditions (congenital heart disease, chronic pulmonary disease and immunodeficiencies). A list of common complications is listed below:
- Apnea: More common in children under 2 months of age and premature infants, it is observed in 3% to 25% of the patients. Several times it appears as the presenting manifestation, however it may be the consequence of previous mild respiratory symptoms.[2][3]
- Aspiration:
- Reccurrent wheezing episodes: 30%-50% of hospitalized patients with bronchiolitis present recurrent wheezing episodes, however, episodes usually deseappear before adolescence.
- Associated bacterial infections: Most common association is with urinary tract infections (UTI) and acute otitis media (AOM), usually not related with the respiratory infection. Bacterial coinfections appear in 0%-7% of patients with bronchiolitis.
Prognosis Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases[4]
Prognosis is generally good, as most children show gradual symptomatic improvement within 2 weeks after symptoms begin. Though the rate of hospitalizations is high (71 per 1000 infants for 2003) and has increased in the las 2 decades, the mortality rate is very low (2 deaths per 100 000 livebirths in the U.S. and 1.82 per 100 000 livebirths in th UK).
References
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
- ↑ 2.0 2.1 Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.
- ↑ Wright M, Mullett CJ, Piedimonte G (2008). "Pharmacological management of acute bronchiolitis". Ther Clin Risk Manag. 4 (5): 895–903. PMC 2621418. PMID 19209271.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier.