Related articles: Bronchiolitis
Definition
Bronchiolitis is an acute viral infection of the lower respiratory tract. The disease mainly affects children younger than two years, with greater prevalence in the first 6 months of life.
Respiratory syncytial virus (RSV) is responsible for most cases of bronchiolitis. This viral agent particularly damages the thinnest branches of the respiratory tree (bronchioles) causing mucosal edema, mucus hypersecretion and necrosis of bronchial epithelial cells. All this leads to a considerable reduction of the bronchial lumen, which in the small child is already, as a rule, very restricted. The respiratory syncytial virus spreads primarily through direct contact with infected secretions and causes small epidemics, especially in winter. The infectiousness phase typically lasts 6 to 10 days.
Less frequently, bronchiolitis is due to influenza viruses (A and B), parainfluenza (1, 2 and 3) and adenovirus.
Most common symptoms and signs *
- Respiratory acidosis
- Apnea
- Asthenia
- Pulmonary atelectasis
- Cyanosis
- Dehydration
- Dyspnoea
- Temperature
- Hypoxia
- Lethargy
- Closed nose
- Pallor
- Cold
- rales
- Wheezing breath
- Sense of suffocation
- Drowsiness
- Squeal
- Tachycardia
- tachypnoea
- Cough
Further indications
The onset of bronchiolitis is acute: after 1 or 2 days in which the symptoms of a common cold occur, with little cough and modest fever (rarely above 38 ° C), a progressively worsening dyspnea appears which precipitates the conditions of the child. Within a few hours, the breathing becomes more and more frequent and tachycardia, pallor, persistent cough and other signs of respiratory difficulties appear: wheezing and fine rattling rattles, perioral cyanosis, nasal fin extermination, recurrent apnea seizures, prolonged expiratory and inspiratory recurrence to the jugolo (base of the neck), intercostal and epigastric. In these conditions, the child is frequently dehydrated, both for respiratory distress, and for the simultaneous difficulty in taking food and liquid by mouth.
Patients can become increasingly lethargic as the infection progresses. With fatigue, the breath becomes increasingly superficial and ineffective, causing respiratory acidosis. In many children, there is a concomitant acute otitis media.
The diagnosis is suspected on the basis of the anamnesis, the physical examination and on the appearance of the disease during a known epidemic; the main cause - the respiratory syncytial virus - can be identified with a rapid test performed on a swab or nasal wash. In children, symptoms similar to bronchiolitis are caused by asthma and gastro-esophageal reflux with inhalation of gastric contents.
The therapy is supportive and involves the administration of oxygen, hydration and nutrition through the vein. The administration of antibiotics is foreseen if bacterial complications have occurred, while the bronchodilator and / or cortisone drugs can improve respiratory function.
The prognosis is generally excellent, if medical care is adequate: most children recover in 3-5 days without consequences, despite the wheezing and coughing can last for 2 weeks. Only in some patients does respiratory failure develop.
