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The main symptoms of acute bronchitis in children are cough and fever. Two infections—Bordetella pertussis and Mycoplasma pneumoniae—may produce symptoms that persist for a number of weeks. Another condition often diagnosed in infants without fever or distress is ‘wheezy bronchitis’, or ‘recurrent bronchitis’. This condition has been the topic of much de-bate over the years as to whether these infants have asthma or not, and whether they should be treated as such.
Bordetella pertussis infection typically induces three stages of illness:
· Catarrhal (1–2wks): mild symptoms with fever, cough, and coryza.
· Paroxysmal (2–6wks): severe paroxysmal cough, followed by inspiratory whoop and vomiting. Convalescent (2–4wks): lessening symptoms that may take a whole month to resolve.
A whooping cough-like syndrome may be caused by Bordetella parapertus-sis, Mycoplasma pneumoniae, Chlamydia, or adenovirus.
There may be a typical history. In young infants, however, whoop is often absent, and apnoea is a more common finding. In older children, and par-ents, there may be a history of persistent and irritating cough.
A thorough examination is needed. In infants you will need to make sure that the problem is not pneumonia. Also, check the following:
· Eyes: subconjunctival haemorrhages are common.
· Blood count: leucocytosis and lymphocytosis.
· Pernasal swab: culture of Bordetella pertussis.
· Infants: admission is required for those with a history of apnoea, cyanosis, or significant paroxysms. Close monitoring is required particularly in infants since there is a risk of seizures, encephalopathy, and death.
· Isolation: patients should be isolated for 5 days after starting treatment with antibiotics.
· Immunization: recommended for children <7yrs who have been in close contact if they are not protected. Immunization reduces the risk of an individual developing infection by 90%, but the level of protection declines steadily through childhood.
· Prophylactic antibiotics: should be given to close contacts.
Erythromycin for 14 days (or clarithromycin for 7 days) to reduce infectivity but this may have minimal effect on the cough.
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