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By

Ida Bagus Subanada


Respirology Division, Department of Child Health,
Udayana University Medical School/Sanglah Hospital
Denpasar
bronchiolitis

DEFINITION
Acute bronchiolitis
is an acute inflammatory of
the lower respiratrory tract
(bronchioles) caused
predominantly by RSV.
PERCABANGAN SALURAN NAPAS
GENERASI

TRAKEA 0

TULANG 1
RAWAN
2
BRONKUS

SALURAN NAPAS
KONDUKSI 10

11
|
MEMBRAN BRONKIOLUS
13

Bronchiolitis 16

BRONKIOLUS 17
RESPIRASI |
19
SALURAN NAPAS BAGIAN ALVEOLI
RESPIRASI AKHIR Pneumonia 20
22
KANTUNG
ALVEOLI 23
24

Gambar 1. Percabangan saluran respiratori.


bronchiolitis

ETIOLOGY

RSV*, hMPV, parainfluenza virus,


adenovirus, Mycoplasma, and
occasionally other viruses.
bronchiolitis

EPIDEMIOLOGY

By the age 2 years nearly all


children have been infected.
Severe disease more common
among infants aged 1-3 months.
Seasonal with peak incidence
during winter, early spring, rainy
season.
More common in male, breastfed (-),
crowded conditions.
bronchiolitis

PATHOPHYSIOLOGY

Not all infected infants developed


LRTI.

Clinical severity depend on host


anatomic and immunological factors.

RSV infection incites a complex


immune responses (eosinophils, IgE,
IL-8, MIP-1, RANTES, IFN-,
leukotrienes).
bronchiolitis
PATHOPHYSIOLOGY
Virus

Bronchiolar wall

Edema, mucus, cellular debris

Bronchiolar obtruction (ball valve respiratory obstruction)

Air trapping and overinflation


(if complete obstruction atelectasis)

Impair normal pulmonary gas exchange (hypoxemia, hypercarbia)


bronchiolitis

CLINICAL MANIFESTATION

Initially URI signs and symptoms: sneeze,


runny noose, cough, and low grade fever.

Followed by obstructed bronchioles signs


and symptoms: RR , nasal flare,
retraction/chest indrawing, expiratory
effort/prolonged expiratory phase, chest
overedistention/hyperinflated lung,
hypersonor, ronchi or wheezing.
bronchiolitis

LABORATORY INVESTIGATION

Complete blood count (CBC)


usually normal.

Chest X-ray: hyperinflated lung,


patchy atelectasis.
bronchiolitis

DIAGNOSIS

Based on clinical manifestation.


bronchiolitis

DIFFERENTIAL DIAGNOSIS
Asthma.
Foreign body in the trachea.
Tracheo or bronchomalacia.
Vascular ring.
Congestive Heart Failure
Cystic fibrosis.
Pertussis.
bronchiolitis

THERAPY

Supportive.
Respiratory distress.

Hospitalized.
Bronchodilators, steroids,
antibiotics ?
Ribavirin?
bronchiolitis

COURSE AND PROGNOSIS


During the first 48-72 hours after
onset cough and dyspnea.

Highest risk for further respiratory


compromise.

Case fatality rate 1%, with death


attributable to apnea,
uncompensated respiratory
acidosis, or severe dehydration.
course and prognosis bronchiolitis

Severe disease:
* CHD, BPD
* Immunodeficiency

Recurrent wheezing and asthma.


bronchiolitis

PREVENTION

RSV-IVIG.
Palivizumab.
Meticulous handwashing.
bronchiolitis

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