Akutni bronhiolitis

Akutni bronhiolitis infekcija je donjega dišnog sustava, zahvaća prvenstveno male dišne putove (bronhiole) te je čest uzrok bolesti i hospitalizacije dojenčadi i male djece. Po definiciji radi se o kliničkom sindromu respiratornog „distresa“, koji se javlja kod djece mlađe od dvije godine, a obilježavaju ga klinički znakovi infekcije gornjega dišnog sustava (npr. rinoreja) praćeni infekcijom donjega dišnog sustava. Obično se javlja s primarnom infekcijom ili reinfekcijom virusnim patogenom. Upala bronhiola nastaje kada virusi ulaze u terminalne bronhiolarne epitelne stanice te uzrokuju njihovo izravno oštećenje i upalu. Edem sluznice, prekomjerno stvaranje sluzi i propadanje epitelnih stanica dovode do začepljenja malih dišnih putova i stvaranja atelektaza. Bronhiolitis je najčešće uzrokovan virusnom infekcijom. Iako udio infekcije određenim virusima varira ovisno o godišnjem dobu, respiratorni sincicijski virus (RSV) je najčešći uzročnik, a potom rinovirus. Manje uobičajeni uzročnici jesu redom: virus parainfluence, humani metapneumovirus, virus influence, adenovirus, koronavirus i humani bocavirus. Molekularnom dijagnostikom virusna etiologija može se potvrditi u više od 95% slučajeva. Klinički se manifestira vrućicom, kašljem i poremećajem disanja (npr. tahipneja, retrakcije interkostalnih prostora i juguluma, piskanje, auskultacijski čujne krepitacije). Često mu prethode klinički znakovi infekcije gornjega dišnog sustava, koji traju jedan do tri dana. Postavljanje dijagnoze uglavnom se temelji na anamnezi i kliničkoj slici; laboratorijska i radiološka dijagnostika pomoćne su metode, a izolacija virusa daje nam konačnu potvrdu bolesti. Trajanje i tijek akutnog bronhiolitisa ovisi o dobi djeteta, težini bolesti, stanjima vezanim uz povećani rizik (npr. nedonoščad, kronična plućna bolest) i uzročniku bolesti. Liječenje je u većini slučajeva suportivno (adekvatna hidracija, toaleta nosa i održavanje prohodnosti dišnih putova, inhalacijska terapija), a kod težih klin
Acute bronchiolitis is infection of lower respiratory system, it primarily affects the small airways (bronchioles) and is a common cause of illness and hospitalization of infants and young children. It is a clinical syndrome of respiratory distress, which occurs in children under 2 years of age, characterized by clinical signs of upper respiratory tract infection followed by lower respiratory tract infection. Bronchiolitis occurs when viruses enter the terminal bronchiolar epithelial cells and cause their direct damage and inflammation. Oedema of mucous membrane, excessive production of mucus and destruction of epithelial cells lead to obstruction of small airways and formation of atelectasis. Bronchiolitis is most often caused by viral infection. Although the proportion of infections with certain viruses varies depending on the season, respiratory syncytial virus (RSV) is the most common cause, followed by rhinovirus. Other causative agents are parainfluenza virus, human metapneumovirus, influenza virus, adenovirus, coronavirus and human bocavirus. Viral etiology can be confirmed with molecular diagnostics in more than 95 percent of cases. Disease is clinically manifested by fever, cough and breathing disorders. It is often preceded by clinical signs of upper respiratory tract infection, which last 1 to 3 days. Diagnosis is mainly based on the anamnesis and clinical features, laboratory and radiological diagnostics are auxiliary methods, isolation of the virus gives us the final confirmation of the disease. Duration and course of acute bronchiolitis depends on the age of the child, severity of disease, conditions associated with increased risk (premature infants, chronic lung disease) and the causative agent of the disease. In most cases, treatment is supportive. In more severe clinical cases, respiratory support (non-invasive and/or invasive) is resorted to. Despite everything, bronchiolitis is still mostly a self-limiting disease and most children do not need hos