Bronchiolitis

Etiology

Many diseases have bronchiolitis like clinical displays, vast majority from them virus ethiology. A respiratory-syncytial virus (РС) consider as the most frequent reason bronchiolitis. It is established, that from 40 up to 75 % of children acts in hospital with the diagnosis bronchiolitis, caused this virus. Other activators can be rhinovirus, a virus parainfluenza (type 3), adenovirus (type 3, 7 and 21), a virus of a flu and, occasionally, a virus of an epidemic parotitis. Though in children of advanced age Mycoplasma pneumoniae usually causes disease of the bottom respiratory ways, but at chest age it seldom causes bronchiolitis.

Epidemiology

Using widely widespread clinical term «the whistling child at a respiratory infection», Henderson and co-author. Have noted, that the highest frequency of disease was at children of the first year of a life: 11,4 cases on 100 children in a year. On the second to year of a life frequency decreased to 6 cases on 100 children in a year. In Houston frequency РС bronchiolitis, demanding hospitalization, in families with a low social level made 5 cases on 100 chest babies in a year. About 80 % of the hospitalized children 6 months Therefore authors were more younger have come to conclusion: the the child is more younger, the more hard at it disease proceeds and is more often hospitalization is required.

Babies with heavy forms bronchiolitis have a low level of the antibodies transferred from mother. From the hospitalized children with the proved Óß-infection at 18-20 % can arise apnoea to which contribute prematurity and early age of the child. Other group of high risk for occurrence of the Óß-infection is made by patients with VPS. At the general lethality 1-2 % in this group at the Óß-infection it reaches 37 %.

Epidemic of the Óß-virus develops annually in the winter while frequency contamination viruses parainfluenza decreases a little. The disease caused by the Óß-virus, is very infectious, if in collective there is a patient, as a rule, all contact children (98 %) fall ill. Transfer of the Óß-virus to family as is significant. Reasonably to be ill to one member of family that 46 % of the others were infected.

Frequency of hospital infections is high. During flash of the Óß-infection of 45 % of tentatively not infected hospitalized children were ill with this infection. The risk of disease raised with an increase of duration of hospitalization. Probably, its basic source in hospital is the medical personnel which distributed a virus, catching through the secrets allocated by infected patients. Infection occured approximately in 42 %.

Clinical aspects

Usually the baby catches from the senior children or adults with an infection of respiratory ways.

Diagnosis: bronchiolitis

Cough, cold, ptarmus are the first symptoms of disease. In the subsequent at patients on a background of irritability respiratory frustration with polypnea, participation in breath of auxiliary muscles, dry rattles progress. There can be an insignificant fever. The appreciable short wind causes difficulty of the certificate sucking. Physical survey reveals signs of sharp inflammatory disease of respiratory ways: polypnea, cyanosis, inflating of wings of a nose and impaction compliant seats of a chest wall. Lungs emphysematous, the edge of a liver can act on some fingers from under a costal arch. At lungs auscultation - dry diffuse and damp rattles, lengthening of an exhalation.

Indispensable laboratory researches at the patient with heavy bronchiolitis include: the roentgenogram of a thorax; the clinical analysis of blood; research of arterial gases of blood; virologic definition of the Óß-virus and antibodies to it; crop of blood on microflora if it is impossible to exclude a bacterial pneumonia.

Radiological inspection of the child with sharp bronchiolitis shows availability sharp emphysema lungs at the majority of patients. At half of children define peribronchial sealings. Leukocytosis usually is absent. RS the virus can be identified by reaction of linkage complement or indirect immunofluorescence antibodies in film, taken with a mucous membrane of a nose.

For diagnostics of respiratory insufficiency at bronchiolitis it is necessary to investigate arterial gases of blood. On the basis of a series from 32 patients the Hall and co-authors have established, that average saturation by oxygen of hemoglobin has made 87 %. Hypoxemia persistence, proceeding 3-7 weels, even on a background of clinical improvement of a condition.