Paediatrics: Bronchial disease

Bronchial disease

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.

Whooping cough

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.

History

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.

Examination and investigation

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.

·  CXR.

·  Blood count: leucocytosis and lymphocytosis.

·  Pernasal swab: culture of Bordetella pertussis.

Treatment

Hospital care

·  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.

Contacts

·  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.

Antibiotics 

Erythromycin for 14 days (or clarithromycin for 7 days) to reduce infectivity but this may have minimal effect on the cough.