bronchiolitis
BRONCHIOLITIS
Bronchiolitis is a clinical diagnosis preceding upper respiratory illness and/or rhinorrhea.
Signs of respiratory illness which may include wheezing, retractions, oxygen desaturation, color change, nasal flaring.
There is also presence of apnea especially in premature or low birthweight infants, signs of dehydration and exposure to persons with viral upper respiratory infections.
Symptoms are usually worst on the 3rd-5th day of illness and then improve gradually.

Diagnosis

  • Bronchiolitis is diagnosed based on patient history & presentation

Diagnostic criteria for bronchiolitis include, but are not limited to, the following:

  • Exposure to persons with viral upper respiratory infection
  • Preceding upper respiratory illness
  • Signs of lower respiratory illness which may include wheezing, retractions, oxygen (O2) desaturation, nasal flaring, & other signs & symptoms described above
  • Apnea, especially in premature or low birth-weight infants
  • Signs of dehydration

Physical Examination

  • Wheezes or fine inspiratory crackles with prolonged expiratory phase of breathing
  • Barely discernible breath sounds due to bronchiolar obstruction suggest severe disease
  • Palpable liver & spleen due to hyperinflation of the lungs

Laboratory Tests

  • Eg Complete blood count (CBC) & chest x-ray (CXR) offer little helpful information in bronchiolitis patients
    • Chest X-ray (CXR) image may show hyperinflation due to air trapping
    • Chest X-ray (CXR) may be done when the diagnosis is uncertain to rule out other diseases
  • Arterial blood gas (ABG) should be considered in patients with severe symptoms of bronchiolitis
  • Viral cultures of nasopharyngeal secretions are not recommended

Differential Diagnosis

  • Viral infections
  • Asthma
  • Foreign body aspiration
  • Anatomic abnormalities (ie tracheoesophageal fistula, laryngeal cleft, airway hemangioma, mediastinal tumor, bronchial cyst, vascular ring)
  • Congenital heart disease
  • Immunodeficiency states (ie IgA deficiency, AIDS, bronchiectasis)
  • Mucociliary clearance disorders (ie cystic fibrosis, primary ciliary dyskinesia)
  • Aspiration syndrome (ie gastroesophageal reflux disease, phayngeal dysfunction)
  • Anaphylaxis
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