viral bronchiolitis

ウイルス性細気管支炎

WordNet

1. relating to or caused by a virus; "viral infection"
2. inflammation of the membranes lining the bronchioles

PrepTutorEJDIC

1. ウィルスの;ウィルスが原因の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/18 16:43:48」(JST)

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Not to be confused with bronchitis.

Bronchiolitis
Classification and external resources
An x ray of a child with RSV showing the typical bilateral perihilar fullness of bronchiolitis.
ICD-10	J21
ICD-9	466.1
DiseasesDB	1701
MedlinePlus	000975
eMedicine	emerg/365
MeSH	D001988

Bronchiolitis is inflammation of the bronchioles, the smallest air passages of the lungs. It usually occurs in children less than two years of age with the majority being aged between three and six months. It presents with coughing, wheezing and shortness of breath which can cause some children difficulty feeding. This inflammation is usually caused by respiratory syncytial virus (70% of cases) and is much more common in the winter months. Treatment is typically supportive and may involve the use of nebulized epinephrine or hypertonic saline. Bronchiolitis is common with up to one third of children being affected in their first year of life.

Signs and symptoms

In a typical case, an infant under two years of age develops cough, wheeze, and shortness of breath over one or two days. Crackles and/or wheeze are typical findings on listening to the chest with a stethoscope. The infant may be breathless for several days. After the acute illness, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheeze.

Some signs of severe disease include:

• poor feeding (less than half of usual fluid intake in preceding 24 hours)
• lethargy
• history of apnea
• respiratory rate >70/min
• presence of nasal flaring and/or grunting
• severe chest wall recession
• cyanosis

Causes

The term usually refers to acute viral bronchiolitis, a common disease in infancy. This is most commonly caused by respiratory syncytial virus (RSV, also known as human pneumovirus). Other viruses which may cause this illness include metapneumovirus, influenza, parainfluenza, coronavirus, adenovirus, and rhinovirus.

Studies have shown there is a link between voluntary caesarean birth and an increased prevalence of bronchiolitis. A recent study by Perth's Telethon Institute for Child Health Research has shown an 11% increase in hospital admissions for children delivered this way. Children born prematurely (less than 35 weeks), with a low birth weight or who suffer from congenital heart disease may have higher rates of Bronchiolitis and are more likely to require hospital admission. There is evidence that breastfeeding provides some protection against bronchiolitis.

Diagnosis

The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude pneumonia, but not indicated in routine cases.

Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended. RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%. Identification of those who are RSV-positive can help for: disease surveillance, grouping ("cohorting") people together in hospital wards to prevent cross infection, predicting whether the disease course has peaked yet, reducing the need for other diagnostic procedures (by providing confidence that a cause has been identified).

Infant with bronchiolitis between the age of two and three months have a second infection by bacteria (usually a urinary tract infection) less than 6% of the time.

Prevention

Prevention of bronchiolitis relies strongly on measures to reduce the spread of the viruses that cause respiratory infections (that is, handwashing, and avoiding exposure to those symptomatic with respiratory infections). In addition to good hygiene an improved immune system is a great tool for prevention. One way to improve the immune system is to feed the infant with breast milk, especially during the first month of life. Immunizations are available for premature infants who meet certain criteria (some cardiac and respiratory disorders) such as Palivizumab (a monoclonal antibody against RSV). Passive immunization therapy requires monthly injections every winter.

Management

Treatment and management of bronchiolitis is usually focused on the symptoms instead of the infection itself (supportive therapies) since the infection will run its course and complications are typically from the symptoms themselves.

Inhaled epinephrine

Nebulized and inhaled epinephrine (both racemic and levo(1)-epinephrine) has been shown to decrease hospitalization rates.

Inhaled hypertonic saline

Inhaled hypertonic saline (3%) appears to be effective in improving clinical outcomes and shortening the duration of hospital stay.

Other medications

Currently other medications do not yet have evidence to support their use.

Non-effective treatments

Ribavirin is an antiviral drug which does not appear to be effective for bronchiolitis. Antibiotics are often given in case of a bacterial infection complicating bronchiolitis, but have no effect on the underlying viral infection. Corticosteroids have no proven benefit in bronchiolitis treatment and are not advised. DNAse has not been found to be effective.

Epidemiology

90% of the patients are aged between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life. It is epidemic in winters.

References

External links

• Bronchiolitis. Patient information from NHS Choices
• Bronchiolitis in children - A national clinical guideline PDF (1.74 MB) from the Scottish Intercollegiate Guidelines Network
• Diagnosis and Management of Bronchiolitis from the AAP

UpToDate Contents

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• 1. 幼児および小児における細気管支炎：治療、転帰および予防 bronchiolitis in infants and children treatment outcome and prevention
• 2. 幼児および小児における細気管支炎：臨床的特徴および診断 bronchiolitis in infants and children clinical features and diagnosis
• 3. 成人における細気管支炎 bronchiolitis in adults
• 4. ウイルス誘発性の喘鳴および喘息：概要 virus induced wheezing and asthma an overview
• 5. 新生児における院内ウイルス感染症 nosocomial viral infections in the neonate

English Journal

• Atypical respiratory complications of dengue fever.

• Kumar N, Gadpayle A, Trisal D.SourceDepartment of Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi 110067, India. Electronic address: docnaveen2605@yahoo.co.in.
• Asian Pacific journal of tropical medicine.Asian Pac J Trop Med.2013 Oct;6(10):839-40. doi: 10.1016/S1995-7645(13)60149-2.
• In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and br
• PMID 23870477

• [Management of acute bronchiolitis in spanish emergency wards: variability and appropriateness analysis (aBREVIADo project)].

• Ochoa Sangrador C, González de Dios J; Grupo Investigador del Proyecto aBREVIADo (BRonquiolitis-Estudio de Variabilidad, Idoneidad y ADecuación).SourceServicio de Pediatría, Hospital Virgen de la Concha, Zamora, España. Electronic address: cochoas@meditex.es.
• Anales de pediatría (Barcelona, Spain : 2003).An Pediatr (Barc).2013 Sep;79(3):167-76. doi: 10.1016/j.anpedi.2013.01.015. Epub 2013 Mar 6.
• INTRODUCTION: The management of acute bronchiolitis (AB) is controversial. The aim of this multicenter nationwide study in Spain is to determine the variability in the management of AB in Primary Care centers.METHODS: A cross-sectional observational study (from October 2007 to March 2008) was conduc
• PMID 23481463

• Prevention of airway allograft tolerance by polyinosinic:polycytidylic acid requires type I interferon responsiveness for mouse airway obliteration.

• Miller HL, Shah PD, Orens JB, McDyer JF.SourceDivision of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
• The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.J Heart Lung Transplant.2013 Sep;32(9):914-24. doi: 10.1016/j.healun.2013.06.017.
• BACKGROUND: Respiratory RNA viruses are associated with bronchiolitis obliterans syndrome (BOS) in lung transplant recipients (LTRS); however, the immune mechanisms that regulate airway obliteration remain incompletely understood.METHODS: Using the mouse heterotopic tracheal transplant model of obli
• PMID 23953819

Japanese Journal

• Current research on pediatric patients with bronchiolitis obliterans in Brazil

• Intractable & Rare Diseases Research 4(1), 7-11, 2015
• NAID 130005008104

• Current research on pediatric patients with bronchiolitis obliterans in Brazil

• Intractable & Rare Diseases Research advpub(0), 2014
• NAID 130005008108

• ウイルス感染による小児気管支喘息の発症と増悪―ライノウイルスとRSウイルスについて

• 日本小児アレルギー学会誌 26(1), 190-199, 2012
• NAID 130004504279

Related Links

• Bronchiolitis - KidsHealth

Bronchiolitis is usually caused by a viral infection, most commonly respiratory syncytial virus (RSV). RSV infections are responsible for more than half of all cases of bronchiolitis and are most widespread in the winter and early spring.

• Bronchiolitis - Wikipedia, the free encyclopedia

The term usually refers to acute viral bronchiolitis, a common disease in infancy. This is most commonly caused by respiratory syncytial virus (RSV, also known as human pneumovirus). Other viruses which may cause this illness include ...

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「viral」

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• adj.

• ウイルス性の、ウイルスの

関

virally、virogenic、virus