Respiratory Tract

Infections
(Bronchiolitis &
Pneumonia)
Chuah Wei Hong
Tey Shelina
04.01.2016

Learning Objectives
Bronchiolitis
Describe the common casual organisms of bronchiolitis.
Describe the epidemiology and pathophysiology of
bronchiolitis.
Describe the clinical features of bronchiolitis.
Describe the relevant investigations and findings.
Describe the complication of bronchiolitis.
Outline the management of bronchiolitis.

Learning Objectives
Pneumonia
Define pneumonia
Describe the common casual organisms of pneumonia.
Describe the epidemiology and pathophysiology of pneumonia.
Describe the clinical features of pneumonia.
Describe the relevant investigations and findings in
pneumonia.
Describe the complication of pneumonia.
Outline the management of pneumonia.

Anatomy of the Respiratory System

Bronchiolitis
Chuah Wei Hong
4.1.2016

Definition of Bronchiolitis
Acute inflammatory injury of the bronchioles that are
usually caused by RSV (Primary cause, 80%) and human
metapneumovirus.

Epidemiology
Commonest serious respiratory infection of infancy
2-3% of all infants are admitted due to bronchiolitis
every year during annual winter epidemics
Approximately 50% of children experienced during the
first 2 years of life
Peaks at 2-6 months
Boys: Girls, 1.5:1

Pathophysiology of Bronchiolitis

Clinical Features
Mild Coryza
Rhinorrhea
Cough
Feeding Difficulties associate with increasing dyspnoea
Respiratory Distress
Tachypnoea
Chest Wall Recession (Subcostal/Intercostal)
Hyperinflation of the Chest

High Pitched Wheeze

Low Grade Fever
Fine End-Inspiratory crackles
Cyanosis or Pallor

Investigations
Routine Lab Test (Full Blood Count)- Mild Leukocytosis
(not specific)
Pulse Oximetry
Antigen Tests (ELISA or immunofluorescence) of
Nasopharyngeal Aspirate (NPA) for RSV
Polymerase Chain Reaction
Chest X-Ray

Chest X-ray

Differential Diagnosis
Asthma
Foreign body in the airway
Pnuemonia
Congenital airway obstructive lesion
Cystic Fibrosis

Management
Supportive Therapy

Respiratory monitoring
Control of fever
Good hydration
Upper airway suctioning
Oxygen administration (Nasal Cannula)

Indication of Hospitalization
Young age (<6months)
Marked respiratory distress
Hypoxemia (pO2 < 60mmHg or Oxygen saturation
<92%)
Apnoea
Inability to tolerate oral feeding

Complication and Prognosis

Most cases resolve completely
But, minor abnormalities of pulmonary function and
bronchial hyperreactivity may persists for several years.
Recurrence is common but mild.
Incidence of asthma among children with bronchiolitis

References
Nelson Essentials of Paediatrics 6th Edition
Illustrated Textbook of Paediatrics 4th Edition