Bronchiolitis (See Also: Respiratory Syncytial Virus)
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Acute infection of the lower respiratory tract in infants and young children leading to mononuclear infiltration of the bronchiolar epithelium, causing edema and mucus plugging of the small airways
- Peak season is November through April, with some variation by state in the United States (begins earlier in the Southeast).
- Most common cause of infant hospitalization
- ~150,000 hospitalizations per year in the United States
- Hospitalization rates tripled from 1980 to 1997 with the advent of pulse oximetry but have decreased slightly over the last decade.
- Most recent estimate ~15 hospitalizations per 1,000 person-years for children <2 years of age
- Approximately 1/3 of all children will get bronchiolitis in the first 2 years of life.
- Hand hygiene is the only preventative measure for otherwise healthy infants and children.
- Palivizumab can be given to high-risk infants and young children (see “Respiratory Syncytial Virus” [RSV] section for discussion of RSV immunoprophylaxis).
- RSV is the most common causative organism, but other organisms include the following:
- Human rhinovirus
- Human metapneumovirus
- Influenza viruses
- Parainfluenza viruses
- Mycoplasma pneumoniae
- Human bocavirus
- Majority of bronchiolitis cases are caused by one virus, but viral coinfections (two or more viruses) may occur in ~1/4 of cases.
- Patients at high risk of severe bronchiolitis:
- Premature infants (<36 weeks’ gestation)
- Young infants (<2 to 3 months of age)
- Congenital heart disease
- Chronic lung disease (including bronchopulmonary dysplasia [BPD])
- Low birth weight
- Cystic fibrosis
- Neuromuscular diseases
- Trisomy 21
- Exposure to cigarette smoke is a risk factor for more severe disease.