Bronchiolitis overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Bronchiolitis is the most common lower respiratory tract infection in pediatric patients between 1 month and 2 years of age. It is usually caused by the respiratory syncytial virus (RSV) and is characterized by inflamation, edema and necrosis of the bronchiole's epithelium. Typical clinical manifestations include rhinitis, cough, wheezing, respiratory rales (crackles), use of respiratory accessory muscles and/or nasal flaring.
Diagnosis
The diagnosis is based on history of symptoms and physical exam with characteristic signs found in patients between 1 month and 2 years of age. Special attention should be made in high risk patients. Chest X ray could help to rule out pneumonia or respiratory tract abnormalities, however findings are usually inspecific. Other diagnostic testing such as CBC have not demostrate any benifit, nevertheless it could be useful for secondary bacterial infections assiciated with bronchiolitis such as UTI, meningitis of bacteremia.
Treatment
There is no specific treatment for RSV, the management of these patients will depend on the severity of the disease and is based on suportive measures. Prevention in patients who have high risk of severe infection (premature infants, congenital heart disease and chronic lung disease) is important.
Primary Prevention
Prevention will relay in mantain propper measures to prevent the viral dissemination during the RSV season (handwash and avoid contact with patients with symptomatic respiratory infections) and prevention of tobacco smoke exposure. In patients with high risk of developing severe infections, paasive immunization with Palivizumanb is recommended.