Acute infective illness
Respiratory syncytial virus (RSV) causes 80%
Other viruses include influenza, parainfluenza, adenovirus
Occasionally rhinovirus, Mycoplasma pneumoniae
More common in winter and in RSV outbreaks
Inflammation of the bronchioles
Antigen probably causes a type 3 hypersensitivity reaction in the bronchioles
Most cases are over 3 months but less than 18 months of age
Often a self limiting condition
Possible bacterial secondary infection with consolidation
A disease of infancy
Cough
Bubbly spittle on the lips
Fever
`Cold` (coryzal) features
Sore throat
Tachypnoea – principle feature
Wheeze
Fine crackles throughout both lung fields
Feeding difficulties from pressure on diaphragm
Irritability
CXR shows hyperinflation
Is a life threatening condition
Diaphramatic breathing – reduced effective chest wall movement
Tachycardia
Head nodding (or bobbing) with each breath
Nasal flaring
Subcostal, intercostal and suprasternal recession
Use of accessory muscles
Nose may be blocked with `cold` features – remember babies are obligate nose breathers
Grunting breath – a very bad sign as babies are trying to give themselves their own CPAP
Cyanosis
Low O2 saturations
Children compensate well for a time then suddenly fail to compensate and die. Intervene before decompensation is reached. Recognise the danger signs early.
Management
Oxygen
Give parenteral fluids, normally iv.
Do not feed – or small frequent feeds
Position – sitting up
Antipyretics
Sometimes inhaled ribavirin (antiviral)
Anti-asthma drugs if there is an asthmatic component
Systemic corticosteroids are contraindicated
Ventilatory support
NG feeds