Bronchiolitis Clinical Presentation

  • Author: John Udeani, MD, FAAEM; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Jun 9, 2011
 

History

Profuse coryza, congestion, pharyngitis, nasal discharge, and fever usually characterize the clinical syndrome in children. Primary RSV infections are confined to the upper airways in more than 50% of patients. Symptoms reach a peak in 2-5 days, with involvement of the lower respiratory tract. Typical symptoms include the following:

  • Cough
  • Dyspnea
  • Wheezing
  • Poor feeding
  • Hypothermia or hyperthermia
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Physical

Physical findings for bronchiolitis are not restricted to the airway. They may include the following:

  • Hypothermia or hyperthermia
  • Otitis media
  • Tachypnea
  • Nasal flaring
  • Intercostal retractions
  • Irritability
  • Fine rales
  • Wheezing
  • Hypoxia
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Causes

RSV is the most commonly isolated agent. It is found in 75-90% of children younger than 2 years who are hospitalized for bronchiolitis. Abundant evidence suggests that complex immunologic mechanisms play a role in the pathogenesis of RSV bronchiolitis. Type I allergic reactions mediated by the immunoglobulin E antibody may account for clinically significant bronchiolitis. Babies breastfed with colostrum rich in immunoglobulin A appear relatively protected from bronchiolitis.

Other agents that cause bronchiolitis include the following:

  • Parainfluenza virus types 1, 2, and 3
  • Influenza B
  • Echovirus
  • Rhinovirus
  • Adenovirus types 1, 2, and 5: These viruses cause bronchiolitis obliterans, a particularly destructive type of bronchiolitis.
  • Mycoplasma: Bronchiolitis from this cause primarily occurs in school-aged children.
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Contributor Information and Disclosures
Author

John Udeani, MD, FAAEM  Assistant Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science, University of California, Los Angeles, David Geffen School of Medicine

John Udeani, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Charles I Ojielo, MD  Assistant Professor of Medicine, Rush Medical College; Consulting Staff, Resident Education Coordinator, Department of Pulmonary and Critical Care Medicine, John H Stroger Hospital of Cook County/Rush University Medical Center

Charles I Ojielo, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP  Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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