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BRONSIOLITA ACUTA BRONSIOLITA ACUTA Mihai Craiu Mihai Craiu Sef de Lucrari UMF Sef de Lucrari UMF Medic primar pediatru Medic primar pediatru Medic specialist pneumologie Medic specialist pneumologie pediatrica pediatrica Clinica I IOMC Clinica I IOMC

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BRONSIOLITA ACUTABRONSIOLITA ACUTA

Mihai CraiuMihai CraiuSef de Lucrari UMFSef de Lucrari UMF

Medic primar pediatruMedic primar pediatruMedic specialist pneumologie Medic specialist pneumologie

pediatricapediatricaClinica I IOMCClinica I IOMC

BRONSIOLITA ACUTA BRONSIOLITA ACUTA DEFINITIEDEFINITIE

Afectiune acuta la copiii Afectiune acuta la copiii cu cu varsta < 2 ani cuvarsta < 2 ani cu

afectarea cailor aeriene afectarea cailor aeriene mici & mijlociimici & mijlocii

la acest nivel apare la acest nivel apare

obstructie bronsicaobstructie bronsica prin : prin : Edem si necroza de Edem si necroza de

mucoasa bronsicamucoasa bronsica Secretii bronsice Secretii bronsice

abundenteabundente +/-+/- bronhospasm bronhospasm

BRONSIOLITA ACUTABRONSIOLITA ACUTA

FrecventaFrecventa 11,4 din 100 copii (SUA) dezvolta 11,4 din 100 copii (SUA) dezvolta

bronsiolita in primul an de viatabronsiolita in primul an de viata Frecventa maxima intre 2 – 6 luniFrecventa maxima intre 2 – 6 luni

BRONSIOLITA ACUTABRONSIOLITA ACUTA Acute respiratory tract infections among a birth Acute respiratory tract infections among a birth

cohort of children from Cali, Colombia, who were cohort of children from Cali, Colombia, who were studied through 17 months of age. studied through 17 months of age. Borrero I, Fajardo Borrero I, Fajardo L, Bedoya A, Zea A, Carmona F, de Borrero MF -Rev L, Bedoya A, Zea A, Carmona F, de Borrero MF -Rev Infect Dis. 1990 Nov-Dec;12 Suppl 8:S950-6.Infect Dis. 1990 Nov-Dec;12 Suppl 8:S950-6.

Incidenta IACR a fost Incidenta IACR a fost 6.6 cazuri6.6 cazuri pe copil-an. pe copil-an. Incidenta IACRS a fost Incidenta IACRS a fost 4.94.9 cazuri pe copil-an si cazuri pe copil-an si

cea a Inf “joase” a fost 1.7 cazuri pe copil-an. cea a Inf “joase” a fost 1.7 cazuri pe copil-an. VSR a fost agentul viral cel mai frecvent izolat VSR a fost agentul viral cel mai frecvent izolat

in culturi de aspirat nazofaringian la copiii cu in culturi de aspirat nazofaringian la copiii cu Inf “joase” la varste < 18 luniInf “joase” la varste < 18 luni

BRONSIOLITA ACUTABRONSIOLITA ACUTA Etiologie VIRALA (1)Etiologie VIRALA (1)

VSRVSR (~ 70-90% din cazuri) (~ 70-90% din cazuri) Rhinovirusuri (29% din cazuri – forme severe !)Rhinovirusuri (29% din cazuri – forme severe !) Virusuri paragripaleVirusuri paragripale Virusuri gripale A & BVirusuri gripale A & B Metapneumovirusul uman Metapneumovirusul uman ** AdenovirusuriAdenovirusuri Enterovirusuri (herpangina & BDA – VARA !)Enterovirusuri (herpangina & BDA – VARA !) Asocieri virale (19,5% – cel mai des VSR si Asocieri virale (19,5% – cel mai des VSR si

rhinov)rhinov)

BRONSIOLITA ACUTABRONSIOLITA ACUTA Etiologie VIRALA (2)Etiologie VIRALA (2)

Metapneumovirusul umanMetapneumovirusul uman

2,3% din viroze 2000-01 (Canada); 2,3% din viroze 2000-01 (Canada); 6,2% copii cu ARI in Massachusetts, 6,2% copii cu ARI in Massachusetts,

2004; 2004; 21% din copii spitaliz Norvegia in 200421% din copii spitaliz Norvegia in 2004

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Etiologie BACTERIANAEtiologie BACTERIANA RARISIMA !RARISIMA ! Mycoplasma pneumoniaeMycoplasma pneumoniae Ureaplasma urealiticumUreaplasma urealiticum Chlamydia pneumoniaeChlamydia pneumoniae

BRONSIOLITA ACUTABRONSIOLITA ACUTA

EpidemiologieEpidemiologie Afectiune acuta aparuta iarna si la Afectiune acuta aparuta iarna si la

inceputul primaveriiinceputul primaverii Prodrom de tip Prodrom de tip “viral”“viral” cu durata 1-3 zile cu durata 1-3 zile

TuseTuse CorizaCoriza StranutStranut Febra +/-Febra +/-

BRONSIOLITA ACUTABRONSIOLITA ACUTASimptome (1)Simptome (1)

Tahipnee Tahipnee Apnee, mai > la sugarii mici (varsta Apnee, mai > la sugarii mici (varsta

< 44 sapt Post-Conceptual)< 44 sapt Post-Conceptual)

BRONSIOLITA ACUTABRONSIOLITA ACUTAAcute lower respiratory infection in Argentinian children: Acute lower respiratory infection in Argentinian children:

a 40 month clinical and epidemiological study. a 40 month clinical and epidemiological study. Murtagh Murtagh P, Cerqueiro C, Halac A, Avila M, Salomon H, P, Cerqueiro C, Halac A, Avila M, Salomon H, Weissenbacher M. Pediatr Pulmonol. 1993 Jul;16(1):1-8. Weissenbacher M. Pediatr Pulmonol. 1993 Jul;16(1):1-8.

FR > 50/min. (numaratoare pe 60 secunde !) Mai crescuta la pacienti < 1 an si la pac cu

bronsiolita. Tirajul (Retractions) a avut o mult mai mica

dependenta de varsta, fiind prezent in cazurile severe, indiferent de dg clinic.

Tirajul, singur sau asociat cu cianoza, a fost indicatorul cel mai bun de severitate in IACR.

BRONSIOLITA ACUTABRONSIOLITA ACUTASimptome (2)Simptome (2) E:\E:\tirajtiraj amplu2.avi amplu2.avi E:\E:\tirajtiraj costal.AVIcostal.AVI E:\E:\tirajtiraj sc.AVIsc.AVI

BRONSIOLITA ACUTABRONSIOLITA ACUTASimptome (3)Simptome (3)

Sindrom bronho-obstructivSindrom bronho-obstructiv Expir prelungit + WheezingExpir prelungit + Wheezing Torace cu diam >>Torace cu diam >> Hipersonor la percutie Hipersonor la percutie Ficat & splina coborateFicat & splina coborate

BRONSIOLITA ACUTABRONSIOLITA ACUTA

InvestigatiiInvestigatii Pulsoximetrie & ASTRUPPulsoximetrie & ASTRUP RxRx CBC – utila pt dg difCBC – utila pt dg dif ELISA pt VSRELISA pt VSR

BRONSIOLITA ACUTABRONSIOLITA ACUTAClinical findings and severity of acute bronchiolitis. Clinical findings and severity of acute bronchiolitis.

Mulholland EK, Olinsky A, Shann FA. -Lancet. 1990 Mulholland EK, Olinsky A, Shann FA. -Lancet. 1990 May 26;335(8700):1259-61. May 26;335(8700):1259-61.

The best method for initial assessment The best method for initial assessment of bronchiolitis was pulse-oximetry.of bronchiolitis was pulse-oximetry.

Subcrepitantele si cianoza se coreleaza Subcrepitantele si cianoza se coreleaza cu nevoile crescute de oxigen, la cei cu nevoile crescute de oxigen, la cei spitalizatispitalizati..

BRONSIOLITA ACUTABRONSIOLITA ACUTA

RadiologieRadiologie Hiperinflatie difuza (TIPIC)Hiperinflatie difuza (TIPIC) Tulburari de ventilatie (~ 20% din pac int)Tulburari de ventilatie (~ 20% din pac int)

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Dg diferentialDg diferential Afectiune acuta resp de CRIAfectiune acuta resp de CRI Astm bronsicAstm bronsic Aspiratie de CSAspiratie de CS F/CF/C RGERGE MCC cu sunt sistemico-pulmMCC cu sunt sistemico-pulm Malform Cai aerieneMalform Cai aeriene

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Dg diferential (2)Dg diferential (2) Malform Cai aerieneMalform Cai aeriene E:\E:\tirajtiraj amplu.AVIamplu.AVI

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Tratament (1)Tratament (1) Mentinerea oxigenarii (Ox flux liber, masca, Mentinerea oxigenarii (Ox flux liber, masca,

VM)VM) Umidifiere secr (SF sau NaCl ½ M)Umidifiere secr (SF sau NaCl ½ M) BronhodilatatieBronhodilatatie

Adrenalina 0,15 – 0,5 mg/kg/doza Adrenalina 0,15 – 0,5 mg/kg/doza Sugari max 2,5 mg, prescolari max 5 mgSugari max 2,5 mg, prescolari max 5 mg

Ribavirina (Viratek-SPAG)Ribavirina (Viratek-SPAG)

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Tratament (2)Tratament (2) Tratamentul cu ANTIBIOTICE este : Tratamentul cu ANTIBIOTICE este :

INUTILINUTIL POTENTIAL PERICULOSPOTENTIAL PERICULOS

– Macrolidele noi – favorizeaza “selectia” DRSPMacrolidele noi – favorizeaza “selectia” DRSP– Cefalosporinele gen II-III – selecteaza gram neg Cefalosporinele gen II-III – selecteaza gram neg

ESBLESBL lactami + inhib de lactami + inhib de -lactamaza – selecteaza MRSA-lactamaza – selecteaza MRSA

NU MODIFICA EVOLUTIA BOLIINU MODIFICA EVOLUTIA BOLII

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Tratament (3)Tratament (3) Tratamentul cu CORTICOSTEROIZI este : Tratamentul cu CORTICOSTEROIZI este :

CONTROVERSATCONTROVERSAT

BRONSIOLITA ACUTABRONSIOLITA ACUTA Tratament (4)Tratament (4)

Tratamentul cu CORTICOSTEROIZI este : Tratamentul cu CORTICOSTEROIZI este : INEFICIENTINEFICIENT Cochrane Database Syst Rev. 2004;Cochrane Database Syst Rev. 2004;

(3):CD004878 (3):CD004878 Glucocorticoids for acute viral Glucocorticoids for acute viral bronchiolitis in infants and young children.bronchiolitis in infants and young children.

A total of 1,198 children aged 0 to 30 months A total of 1,198 children aged 0 to 30 months were treated with the equivalent of 0.5 to 10 were treated with the equivalent of 0.5 to 10 mg/kg of systemic prednisone for two to seven mg/kg of systemic prednisone for two to seven days. days.

LOS unchanged by Glucocorticoid treatment!LOS unchanged by Glucocorticoid treatment!

BRONSIOLITA ACUTABRONSIOLITA ACUTA Tratament (5)Tratament (5)

Tratamentul cu CORTICOSTEROIZITratamentul cu CORTICOSTEROIZI este eficient la acei pacienti care este eficient la acei pacienti care

raspund la ßraspund la ß22-agonisti cu durata -agonisti cu durata scurta de actiune (ventolin) – scurta de actiune (ventolin) – viitori pacienti cu ASTM ??viitori pacienti cu ASTM ??

BRONSIOLITA ACUTABRONSIOLITA ACUTA Profilaxie (1)Profilaxie (1)

Afectiune foarte contagioasaAfectiune foarte contagioasa Un pacient care stranuta elibereaza VSR in Un pacient care stranuta elibereaza VSR in

picaturile Pflugge pe o raza de aprox 2 metripicaturile Pflugge pe o raza de aprox 2 metri Spalat pe mainiSpalat pe maini

VSR persista circa ½ ora pe mainile nespalateVSR persista circa ½ ora pe mainile nespalate Pe jucarii si alte suprafete VSR persista viabil Pe jucarii si alte suprafete VSR persista viabil

mai multe oremai multe ore

BRONSIOLITA ACUTABRONSIOLITA ACUTA Profilaxie (2)Profilaxie (2)

Ig-specifice VSRIg-specifice VSR Copii < 2 ani cu Oxigen la domiciliuCopii < 2 ani cu Oxigen la domiciliu Pac cu displazie bronho-pulmonara (BDP)Pac cu displazie bronho-pulmonara (BDP) Fosti prematuri < 32 s VG si varsta actuala < Fosti prematuri < 32 s VG si varsta actuala <

6 L, in anotimpul rece (iarna)6 L, in anotimpul rece (iarna) Sugari cu MCCSugari cu MCC

BRONSIOLITA ACUTABRONSIOLITA ACUTA Profilaxie (3)Profilaxie (3)

Un anticorp monoclonal VSR-specific Un anticorp monoclonal VSR-specific (Palivizumab) a fost dezvoltat pt (Palivizumab) a fost dezvoltat pt profilaxie.profilaxie.

Impact of respiratory syncytial virus infection as a cause of lower Impact of respiratory syncytial virus infection as a cause of lower respiratory tract infection in children younger than 3 years of age respiratory tract infection in children younger than 3 years of age in Japan. in Japan. Kaneko M, Watanabe J, Kuwahara M, Ueno E, Hida M, Kaneko M, Watanabe J, Kuwahara M, Ueno E, Hida M, Kinoshita A, Sone T. - Infect. 2002 May;44(4):240-3. Kinoshita A, Sone T. - Infect. 2002 May;44(4):240-3.

Meissner HC, Long SS; American Academy of Pediatrics Committee Meissner HC, Long SS; American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newbornon Infectious Diseases and Committee on Fetus and Newborn. . Revised indications for the use of palivizumab and respiratory Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics. 2003 Dec;112(6 respiratory syncytial virus infections. Pediatrics. 2003 Dec;112(6 Pt 1):1447-52.Pt 1):1447-52.

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Criterii de Severitate*Criterii de Severitate*

Wainwright C, Altamirano L, Wainwright C, Altamirano L, Cheney M et al - A Cheney M et al - A Multicenter, Randomized, Multicenter, Randomized, Double-Blind, Controlled Trial Double-Blind, Controlled Trial of Nebulized Epinephrine in of Nebulized Epinephrine in Infants with Acute Infants with Acute Bronchiolitis. Bronchiolitis. NEJM 2003; NEJM 2003; 349:27-35 349:27-35

BRONSIOLITA ACUTABRONSIOLITA ACUTA Criterii de InternareCriterii de Internare

Detresa respiratorieDetresa respiratorie FR > 50/minFR > 50/min Tiraj (Retractions)Tiraj (Retractions) Cianoza – sau hipoxemie documentataCianoza – sau hipoxemie documentata

Imposibilitate supt/bautImposibilitate supt/baut Maladie asociata (MCC, neuro, b pulm cr)Maladie asociata (MCC, neuro, b pulm cr) Varsta < 3 luniVarsta < 3 luni Febra > 39 CFebra > 39 C

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (1)Prognostic in faza acuta (1)

Hipoxemia la internare este cel mai Hipoxemia la internare este cel mai bun predictor de evolutie grava*bun predictor de evolutie grava**Hypoxaemia in young Kenyan children with acute *Hypoxaemia in young Kenyan children with acute lower respiratory infection. lower respiratory infection. Onyango FE, Steinhoff Onyango FE, Steinhoff MC, Wafula EM, Wariua S, Musia J, Kitonyi J.- BMJ. MC, Wafula EM, Wariua S, Musia J, Kitonyi J.- BMJ. 1993 Mar 6;306(6878):612-5.1993 Mar 6;306(6878):612-5.

59% din copii internati erau hipoxemici. 59% din copii internati erau hipoxemici. 10% din cei internati au decedat. 10% din cei internati au decedat. 90.4% din cei decedati aveau saturatii in oxigen intre 40-90.4% din cei decedati aveau saturatii in oxigen intre 40-

88%. 88%. Copii cu hipoxemie au avut un risc de deces, in primele 5 Copii cu hipoxemie au avut un risc de deces, in primele 5

zile de spitalizare, de 4.3 ori mai mare decat cei fara zile de spitalizare, de 4.3 ori mai mare decat cei fara hipoxemiehipoxemie

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (2)Prognostic in faza acuta (2)

Scoruri clinice in bronsiolita *Scoruri clinice in bronsiolita ** Clinical score and arterial oxygen saturation in children * Clinical score and arterial oxygen saturation in children with wheezing associated respiratory illness (WARI). with wheezing associated respiratory illness (WARI). Sritippayawan S, Deerojanawong J, Prapphal N. - J Med Sritippayawan S, Deerojanawong J, Prapphal N. - J Med Assoc Thai. 2000 Oct;83(10):1215-22. Assoc Thai. 2000 Oct;83(10):1215-22.

Scopul studiului - determinarea corelatiei intre Scopul studiului - determinarea corelatiei intre scorul clinic (bazat pe FR, tiraj (retractions), scorul clinic (bazat pe FR, tiraj (retractions), intrarea aerului, wheezing, stare de constienta) si intrarea aerului, wheezing, stare de constienta) si SSaaOO22 masurata cu puls-oximetrul. masurata cu puls-oximetrul.

Stabilirea unui scor total, cu caracter predictiv pt Stabilirea unui scor total, cu caracter predictiv pt hipoxemie (SaOhipoxemie (SaO22 < sau = 94%) la copiii cu WARI < sau = 94%) la copiii cu WARI (wheezing associated respiratory illness).(wheezing associated respiratory illness).

Un scor Un scor >/= 4>/= 4 este strans corelat cu hipoxemia este strans corelat cu hipoxemia

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (3)Prognostic in faza acuta (3)

Boala autolimitata < 10 zile (7 – 14 zile)Boala autolimitata < 10 zile (7 – 14 zile) Tusea poate persista ~ 3 saptTusea poate persista ~ 3 sapt Riscul de suprainfectie bacteriana este extrem de Riscul de suprainfectie bacteriana este extrem de

redusredus* ** **** ** **** Sepsis evaluations in hospitalized infants with bronchiolitis. * Sepsis evaluations in hospitalized infants with bronchiolitis. Antonow JA, Hansen K, Antonow JA, Hansen K,

McKinstry CA, Byington CL - Pediatr Infect Dis J. 1998 Mar;17(3):231-6.McKinstry CA, Byington CL - Pediatr Infect Dis J. 1998 Mar;17(3):231-6.

** Low risk of bacteremia in febrile children with recognizable viral syndromes.** Low risk of bacteremia in febrile children with recognizable viral syndromes. Greenes DS, Harper MB, Pediatric Infectious Disease Journal. 18(3):258-261, 1999.Greenes DS, Harper MB, Pediatric Infectious Disease Journal. 18(3):258-261, 1999.

*** Prevalence of Serious Bacterial Infections in Febrile Infants With Respiratory Syncytial *** Prevalence of Serious Bacterial Infections in Febrile Infants With Respiratory Syncytial Virus Infection Virus Infection M. Olivia Titus, Seth W. Wright M. Olivia Titus, Seth W. Wright PEDIATRICS Vol. 112 No. 2 August 2003, PEDIATRICS Vol. 112 No. 2 August 2003, pp. 282-284pp. 282-284

BRONSIOLITA ACUTABRONSIOLITA ACUTA IntrebariIntrebari

Are risc de a avea o boala bacteriana un sugar Are risc de a avea o boala bacteriana un sugar cu cu tablou clinic tipictablou clinic tipic de bronsiolita ? de bronsiolita ?

Are risc de boala bacteriana un sugar cu Are risc de boala bacteriana un sugar cu bronsiolita, daca are bronsiolita, daca are febra inalta (> 39C) febra inalta (> 39C) ??

Are risc de boala bacteriana un sugar cu Are risc de boala bacteriana un sugar cu bronsiolita si bronsiolita si varsta mica (< 2 luni) varsta mica (< 2 luni) ??

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (3-2)Prognostic in faza acuta (3-2)

1. 1. Sepsis evaluations in hospitalized infants with Sepsis evaluations in hospitalized infants with bronchiolitis. bronchiolitis. Antonow JA, Hansen K, McKinstry CA, Antonow JA, Hansen K, McKinstry CA, Byington CL - Pediatr Infect Dis J. 1998Byington CL - Pediatr Infect Dis J. 1998

o 1,8%1,8% din tot lotul de sugarii cu tablou de bronsiolita au avut infectie din tot lotul de sugarii cu tablou de bronsiolita au avut infectie bacteriana (Salt Lake City, Department of Pediatrics, University of bacteriana (Salt Lake City, Department of Pediatrics, University of Utah) Utah)

o Cel mai putin probabil sa aiba infectie bacteriana au fost cei > 1 Cel mai putin probabil sa aiba infectie bacteriana au fost cei > 1 luna si cei cu tablou tipic de bronsiolitaluna si cei cu tablou tipic de bronsiolita

o Risk of serious bacterial infection is low; the costs of a sepsis Risk of serious bacterial infection is low; the costs of a sepsis evaluation outweigh the benefits in infants with obvious evaluation outweigh the benefits in infants with obvious bronchiolitis.bronchiolitis.

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (3-3)Prognostic in faza acuta (3-3)

2. Low risk of bacteremia in febrile children with recognizable 2. Low risk of bacteremia in febrile children with recognizable viral syndromes.viral syndromes.

Greenes DS, Harper MB, Pediatric Infectious Disease Journal. Greenes DS, Harper MB, Pediatric Infectious Disease Journal. 18(3):258-261, 1999.18(3):258-261, 1999.

o 21.216 copii 3 – 36 luni, internati cu febra > 39C21.216 copii 3 – 36 luni, internati cu febra > 39Co 6% aveau tablouri clinice evocatorii de boli virale 6% aveau tablouri clinice evocatorii de boli virale

(bronsiolita, crup, stomatita aftoasa, varicela)(bronsiolita, crup, stomatita aftoasa, varicela)o Au avut hemoculturi pozitive 2/876 copiiAu avut hemoculturi pozitive 2/876 copii ((1/411 cu 1/411 cu

bronsiolita, bronsiolita, 0/249 cu crup, 0/123 stomatita, 1/93 cu varicela)0/249 cu crup, 0/123 stomatita, 1/93 cu varicela)

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (3-4)Prognostic in faza acuta (3-4)

3. 3. Prevalence of Serious Bacterial Infections in Febrile Infants Prevalence of Serious Bacterial Infections in Febrile Infants With Respiratory Syncytial Virus Infection .With Respiratory Syncytial Virus Infection . M. Olivia Titus, M. Olivia Titus, Seth W. Wright Seth W. Wright PEDIATRICS Vol. 112 No. 2 August 2003, PEDIATRICS Vol. 112 No. 2 August 2003, pp. 282-284pp. 282-284..

o 348 copii < 2 luni, internati cu febra348 copii < 2 luni, internati cu febrao 174 aveau tablou clinic evocatoriu de bronsiolita si 174 aveau tablou clinic evocatoriu de bronsiolita si

serologie VSR pozitivaserologie VSR pozitivao 174 au fost lotul de control cu febra si serologie VSR 174 au fost lotul de control cu febra si serologie VSR

negativanegativao Au avut culturi pozitive 2/174 copiiAu avut culturi pozitive 2/174 copii bronsiolitabronsiolita (ITU), (ITU), o Au avut culturi pozitive 22/174 copiiAu avut culturi pozitive 22/174 copii din lotul martor, fara din lotul martor, fara

VSRVSR (17 ITU).(17 ITU).

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic in faza acuta (4)Prognostic in faza acuta (4)

Unele cazuri pot evolua letal Unele cazuri pot evolua letal Respiratory syncytial virus infection in children hospitalised with acute lower Respiratory syncytial virus infection in children hospitalised with acute lower

respiratory tract infection. respiratory tract infection. Hussey GD, Apolles P, Arendse Z, Yeates J, Hussey GD, Apolles P, Arendse Z, Yeates J, Robertson A, Swingler G, Zar HJ. - S Afr Med J. 2000 May;90(5):509-12. Robertson A, Swingler G, Zar HJ. - S Afr Med J. 2000 May;90(5):509-12.

Suplimentarea cu oxigen si ventilatia mecanica au fost necesare in 68.9% si Suplimentarea cu oxigen si ventilatia mecanica au fost necesare in 68.9% si 8.5% din pacienti, respectiv. 8.5% din pacienti, respectiv.

Singura diferenta semnificativa a fost prezenta hiperinflatiei, care a aparut la Singura diferenta semnificativa a fost prezenta hiperinflatiei, care a aparut la 70.1% din pacientii EIA RSV-pozitivi, comparativ cu 57.1% din cei negativi 70.1% din pacientii EIA RSV-pozitivi, comparativ cu 57.1% din cei negativi

Rata mortalitatii a fost de 2%, in ambele grupuri. Rata mortalitatii a fost de 2%, in ambele grupuri.

Respiratory syncytial virus (RSV) Respiratory syncytial virus (RSV) http://www.nlm.nih.gov/medlineplus/ency/http://www.nlm.nih.gov/medlineplus/ency/ article/001564.htmarticle/001564.htm

In fiecare an in SUA sunt internati circa 125 000 sugari cu infectie VSR grava, In fiecare an in SUA sunt internati circa 125 000 sugari cu infectie VSR grava, 1-2% evolueaza letal1-2% evolueaza letal

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic tardiv (1)Prognostic tardiv (1)

Legatura cu astm ??Legatura cu astm ?? Eozinofilia in faza acuta se coreleaza cu o Eozinofilia in faza acuta se coreleaza cu o

evolutie ulterioara catre astm la 56% din copii, evolutie ulterioara catre astm la 56% din copii, Lipsa eozinofiliei se asociaza doar cu un Lipsa eozinofiliei se asociaza doar cu un

procent de 22%procent de 22%

RSV - DrGreene.com RSV - DrGreene.com www.drgreene.com/21_1175.html - www.drgreene.com/21_1175.html - 101k - 10 Nov 2005101k - 10 Nov 2005

BRONSIOLITA ACUTABRONSIOLITA ACUTA Prognostic tardiv (2)Prognostic tardiv (2)

Unele inf cu adenovirusuri – f grav Unele inf cu adenovirusuri – f grav (bronsiolita obliteranta)(bronsiolita obliteranta)

Evolutia este in general letalaEvolutia este in general letala

BRONSIOLITA ACUTABRONSIOLITA ACUTA

Prognostic tardiv (3)Prognostic tardiv (3) Elaborarea vaccinurilorElaborarea vaccinurilor

Twenty Years of Outpatient Respiratory Twenty Years of Outpatient Respiratory Syncytial Virus Infection A Framework for Syncytial Virus Infection A Framework for Vaccine Efficacy Trials -- Fisher et al_ 99 Vaccine Efficacy Trials -- Fisher et al_ 99 (2) 7 -- Pediatrics.htm(2) 7 -- Pediatrics.htm

BRONSIOLITA ACUTABRONSIOLITA ACUTA

CONCLUZII PRACTICECONCLUZII PRACTICE Aparitia dispneei dupa 1-3 zile NU are Aparitia dispneei dupa 1-3 zile NU are

semnificatie de agravare, ci face parte di semnificatie de agravare, ci face parte di tabloul clinic al boliitabloul clinic al bolii

Cel mai frecvent se asociaza cu o evolutie Cel mai frecvent se asociaza cu o evolutie severa cei care au severa cei care au hipoxemiehipoxemie la debutul la debutul boliibolii

BRONSIOLITA ACUTABRONSIOLITA ACUTA

CONCLUZII PRACTICECONCLUZII PRACTICE

Etiologia este virala in imensa majoritatea a Etiologia este virala in imensa majoritatea a cazurilor, cazurilor, ANTIBIOTICELE fiind inutileANTIBIOTICELE fiind inutile

Raspunsul clinic rapid la Raspunsul clinic rapid la 22-agonisti si -agonisti si steroizi, eozinofilia si episoadele recurente steroizi, eozinofilia si episoadele recurente sunt evocatorii pentru sunt evocatorii pentru evolutia catreevolutia catre ASTMASTM