Bronchitis

Bronchitis

1. mixture of wheeze & coarse crackles

2. different to chronic bronchitis of adults

   • main sx in children
     • cough
       • persists about 2 weeks
       • lasts > 2 weeks
         • pertussis
         • Mycoplasma infections
     • fever
   • No evidence of speeding recovery
     • Abx
     • Cough suppressants
     • Expectorants

3. Whooping cough (pertussis)

   • highly contagious resp infection
   • causative pathogen
     • Bordetella pertussis
   • epidemics
     • every 3-4 mths
   • Clinical features
     • initially coryza
       • 1 week
       • ff by
         • characteristic paroxysmal or spasmodic cough
           • followed by
             • characteristic inspiratory whoop (paroxysmal phase)
               • may be absent in infants
                 • apnoea a key feature in infants
           • spasms worse @ night
           • often -> vomiting
           • vigorous coughing often followed by
             • epistaxis & subconjunctival haemorrhages
     • during a paroxysm
       • child goes red or blue in face
       • mucus flows from nose & mouth
     • paroxysmal phase
       • 3-6 weeks duration
     • convalescent phase
       • sx gradually decrease
         • but may persist for many months
   • complications
     • uncommon
       • pneumonia
       • convulsions
       • bronchiectasis
     • mortality
       • significant
         • esp in infants
           • those who haven't completed primary vaccination @ 4mths esp vulnerable
   • Mx
     • infants & young children
       • severe spasms of cough or cyanotic attacks
         • admit to hospital
           • isolate from other children
     • Ix
       • culture of org on per-nasal swab
       • blood count
         • characteristic lymphocytosis (> 15 x 10^9)
     • Rx
       • Abx
         • erythromycin
           • decreases sx only if started during catarrhal phase
           • prophylaxis for close contacts
       • vaccination of unvaccinated infant contacts
         • reduces risk of developing pertussis
         • reduces severity of disease in those affected
         • doesn't guarantee protection