Presentation
About 5% to 14% of HSCT recipients also develop bronchiolitis obliterans syndrome which is pulmonary graft vs. host disease and can present several months to years after transplantation. [ncbi.nlm.nih.gov]
Residency at high altitude (over 2500 meters) may also contribute to severe disease and increased risk of hospitalization. [47] When severe bronchiolitis is present, it typically develops soon after disease onset. [emedicine.medscape.com]
Entire Body System
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Congestive Heart Failure
This imaging modality is most useful in excluding unexpected congenital anomalies or other conditions [5, 6] ; it may also yield evidence of alternative diagnoses (eg, lobar pneumonia, congestive heart failure, or foreign body aspiration). [emedicine.medscape.com]
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Sepsis
Sepsis evaluations in hospitalized infants with bronchiolitis. Pediatr Infect Dis J. 1998 Mar. 17(3):231-6. [Medline]. Bloomfield P, Dalton D, Karleka A, Kesson A, Duncan G, Isaacs D. [emedicine.medscape.com]
Respiratoric
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Cough
In these patients, symptomatic treatment should be provided with cough suppressants, inhaled bronchodilators, and oxygen supplementation if needed. [ncbi.nlm.nih.gov]
Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis): ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):132S-137S. [Medline]. [emedicine.medscape.com]
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Tachypnea
Diagnosis The diagnosis of bronchiolitis is based on clinical presentation, the patient’s age, seasonal occurrence, and findings from the physical examination, which may reveal the following: Tachypnea Tachycardia Fever (38-39 C) Retractions Fine rales [emedicine.medscape.com]
Cardiovascular
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Tachycardia
Diagnosis The diagnosis of bronchiolitis is based on clinical presentation, the patient’s age, seasonal occurrence, and findings from the physical examination, which may reveal the following: Tachypnea Tachycardia Fever (38-39 C) Retractions Fine rales [emedicine.medscape.com]
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Heart Failure
This imaging modality is most useful in excluding unexpected congenital anomalies or other conditions [5, 6] ; it may also yield evidence of alternative diagnoses (eg, lobar pneumonia, congestive heart failure, or foreign body aspiration). [emedicine.medscape.com]
Workup
See Workup for more detail. [emedicine.medscape.com]
X-Ray
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Atelectasis
A chest radiography revealing lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis. Image courtesy of Wikipedia Commons. [emedicine.medscape.com]
Treatment
Treatment / Management Treatment of bronchiolitis obliterans syndrome after lung transplant involves augmenting immunosuppression since it is thought to be a form of chronic rejection. [ncbi.nlm.nih.gov]
Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics. 1983 Jan. 71(1):13-8. [Medline]. Zwerdling RG, O'Sullivan BP. Treatment of bronchiolitis. N Engl J Med. 2003 Oct 2. 349(14):1384-5; author reply 1384-5. [emedicine.medscape.com]
Prognosis
Pearls and Other Issues Prognosis of patients with bronchiolitis obliterans is poor, and some may have a rapid decline in lung function. [ncbi.nlm.nih.gov]
Prognosis According to the WHO 2015 Global Health Observatory data repository, acute lower respiratory infection in children younger than 5 years of age remains a leading cause of childhood mortality in the world. [emedicine.medscape.com]
Etiology
Etiology Several risk factors can lead to the development of bronchiolitis obliterans. It is one of the most common noninfectious complications after lung transplant and hematopoietic stem cell transplantation. [ncbi.nlm.nih.gov]
Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med. 2012. 166:700-706. [Medline]. van den Hoogen BG, de Jong JC, Groen J, et al. [emedicine.medscape.com]
Epidemiology
Epidemiologic data for underdeveloped countries are incomplete. [emedicine.medscape.com]
Epidemiology Bronchiolitis obliterans syndrome is considered a form of chronic allograft rejection after lung transplantation. The majority of lung transplant recipients who are long term survivors develop bronchiolitis obliterans syndrome. [ncbi.nlm.nih.gov]
Pathophysiology
Pathophysiology In response to injury from inhalational toxins or autoimmune responses, there is inflammation of subepithelial structures and dysregulated repair, leading to fibroproliferation and abnormal regeneration of epithelium of the small airways [ncbi.nlm.nih.gov]
Respiratory syncytial virus puzzle: clinical features, pathophysiology, treatment, and prevention. J Pediatr. 1992 Oct. 121(4):503-10. [Medline]. Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. [emedicine.medscape.com]
Prevention
Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 Oct 27. [Medline]. Liebelt EL, Qi K, Harvey K. [emedicine.medscape.com]