Bronquiolitis Aguda

Descripción General

Definición

La bronquiolitis aguda es un conjunto de síntomas respiratorios (aumento del trabajo respiratorio, sibilancias y crepitantes) causada por una inflamación aguda de las vías respiratorias de menor calibre (bronquios y bronquiolos pequeños), normalmente secundaria a infecciones víricas.

Epidemiología

• Estadísticas de población:
  • Pico de incidencia entre los LOS Neisseria 2 y 6 meses de edad
  • Principal causa de hospitalización infantil en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum EE. UU.
    • Representa 2,1 millones de visitas ambulatorias anuales
    • Representa el 18 % de las hospitalizaciones pediátricas
    • Representa el 10 % de las admisiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum UCI
  • Carga mundial: ~3,2 millones de hospitalizaciones pediátricas y 59 000 muertes al AL Amyloidosis año
• Preferencia estacional (relacionada con el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology sincitial respiratorio ( RSV RSV Respiratory syncytial virus (RSV) is an enveloped, single-stranded, linear, negative-sense RNA virus of the family Paramyxoviridae and the genus Orthopneumovirus. Two subtypes (A and B) are present in outbreaks, but type A causes more severe disease. Respiratory syncytial virus causes infections of the lungs and respiratory tract. Respiratory Syncytial Virus, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)): otoño e invierno
• Factores de riesgo para enfermedad grave:
  • Factores individuales:
    • Prematuridad (nacidos con < 32-34 semanas de edad gestacional)
    • < 12 semanas de edad
    • Bajo peso al AL Amyloidosis nacer (< 2,5 kg)
    • Inmunodeficiencia
    • Cardiopatía congénita
    • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans quística
    • Displasia broncopulmonar
  • Factores ambientales:
    • Hacinamiento (guardería o casa)
    • Inhalación pasiva de humo
    • Contacto con los LOS Neisseria hermanos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum edad escolar
    • Bajo nivel socioeconómico
    • Sin lactancia materna

Etiología

• Infección viral:
  • RSV RSV Respiratory syncytial virus (RSV) is an enveloped, single-stranded, linear, negative-sense RNA virus of the family Paramyxoviridae and the genus Orthopneumovirus. Two subtypes (A and B) are present in outbreaks, but type A causes more severe disease. Respiratory syncytial virus causes infections of the lungs and respiratory tract. Respiratory Syncytial Virus: ⅓ de los LOS Neisseria casos
  • Rinovirus
  • Menos común:
    • Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la parainfluenza
    • Metapneumovirus humano
    • Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la influenza Influenza Influenza viruses are members of the Orthomyxoviridae family and the causative organisms of influenza, a highly contagious febrile respiratory disease. There are 3 primary influenza viruses (A, B, and C) and various subtypes, which are classified based on their virulent surface antigens, hemagglutinin (HA) and neuraminidase (NA). Influenza typically presents with a fever, myalgia, headache, and symptoms of an upper respiratory infection. Influenza Viruses/Influenza
    • Adenovirus Adenovirus Adenovirus (member of the family Adenoviridae) is a nonenveloped, double-stranded DNA virus. Adenovirus is transmitted in a variety of ways, and it can have various presentations based on the site of entry. Presentation can include febrile pharyngitis, conjunctivitis, acute respiratory disease, atypical pneumonia, and gastroenteritis. Adenovirus
    • Mycoplasma pneumoniae Mycoplasma pneumoniae Short filamentous organism of the genus mycoplasma, which binds firmly to the cells of the respiratory epithelium. It is one of the etiologic agents of non-viral primary atypical pneumonia in man. Mycoplasma
    • Tosferina

Fisiopatología y Presentación Clínica

Fisiopatología

Los LOS Neisseria cambios patológicos se observan a las 24 horas del contacto con un patógeno:

• El virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology entra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células epiteliales de los LOS Neisseria bronquiolos terminales.
• La inoculación provoca inflamación → edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, secreción de moco y desprendimiento del epitelio
• Descamación y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema → estrechamiento y obstrucción de las vías respiratorias pequeñas
• El estrechamiento provoca atelectasia y los LOS Neisseria síntomas comienzan a aparecer.

Presentación clínica

Los LOS Neisseria síntomas se encuentran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un espectro basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la gravedad de la enfermedad:

• Inicial 1–3 días (síntomas del tracto respiratorio superior):
  • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome
  • Congestión
  • Rinorrea
• Picos entre los LOS Neisseria días 3–5, con una duración de hasta 10 días (síntomas del tracto respiratorio inferior):
  • Sibilancias y crepitantes difusos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen pulmonar
  • Fiebre
  • Dificultad para respirar
• Casos graves:
  • Apnea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria lactantes, especialmente durante el sueño
  • Insuficiencia respiratoria:
    • Taquipnea
    • Cianosis
    • Aleteo nasal
    • Gruñidos
    • Retracción intercostal
    • Hipoxia < 92% de saturación

Diagnóstico y Tratamiento

Diagnóstico

• Diagnóstico basado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sospecha clínica:
  • Síntomas característicos del tracto respiratorio inferior
  • Pacientes < 2 años
  • Presentación durante las temporadas de otoño e invierno
• Más investigación:
  • Fiebre alta
  • Presentación severa
  • Antecedentes de comorbilidades
• Se desaconseja cualquier tipo de examen de rutina, ya que no añade ningún valor terapéutico adicional.
• Investigar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos graves para evaluar comorbilidades o infecciones agregadas:
  • Hemograma: leucocitosis
  • Radiografía de tórax: hiperinflación con atelectasia
  • Pruebas de RSV RSV Respiratory syncytial virus (RSV) is an enveloped, single-stranded, linear, negative-sense RNA virus of the family Paramyxoviridae and the genus Orthopneumovirus. Two subtypes (A and B) are present in outbreaks, but type A causes more severe disease. Respiratory syncytial virus causes infections of the lungs and respiratory tract. Respiratory Syncytial Virus en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el aspirado

Tratamiento

El tratamiento depende de la gravedad:

• Casos leves a moderados → de soporte:
  • Educación del cuidador sobre la posición vertical durante el sueño y la alimentación
  • Uso de humidificador de vapor frío y antipirético
  • Aspiración con perilla de las secreciones orales y nasales
  • Mantener la hidratación y la alimentación
  • Seguimiento si el paciente empeora
• Grave (< 28 días de edad, apnea, dificultad respiratoria, letargo):
  • Admitir para atención intrahospitalaria
  • Oxígeno humidificado y solución salina hipertónica nebulizada
  • Succión de secreciones
  • Hidratación intravenosa
  • No hay evidencia que apoye el uso de albuterol Albuterol A short-acting beta-2 adrenergic agonist that is primarily used as a bronchodilator agent to treat asthma. Sympathomimetic Drugs, epinefrina o corticosteroides
• Pueden producirse complicaciones, como la neumonía y la insuficiencia respiratoria, las cuales deben tratarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum consecuencia.

Prevención y Pronóstico

Prevención

• Fomentar la lactancia materna.
• Evitar la exposicion pasiva al AL Amyloidosis humo.
• Higiene de las manos
• Palivizumab Palivizumab A humanized monoclonal antibody and antiviral agent that is used to prevent respiratory syncytial virus infections in high risk pediatric patients. Respiratory Syncytial Virus (anticuerpo monoclonal) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes de alto riesgo:
  • Cumplir los LOS Neisseria criterios de la Academia Americana de Pediatría (AAP, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) para la enfermedad pulmonar crónica neonatal:
    • Nacidos con < 32 semanas de gestación
    • Requerir oxígeno suplementario durante los LOS Neisseria primeros 28 días de vida
  • > 1 año de edad al AL Amyloidosis inicio de la temporada del RSV RSV Respiratory syncytial virus (RSV) is an enveloped, single-stranded, linear, negative-sense RNA virus of the family Paramyxoviridae and the genus Orthopneumovirus. Two subtypes (A and B) are present in outbreaks, but type A causes more severe disease. Respiratory syncytial virus causes infections of the lungs and respiratory tract. Respiratory Syncytial Virus o > 2 años de edad pero que requiere medicarse por enfermedad pulmonar crónica neonatal

Pronóstico

• La bronquiolitis es autolimitada y dura entre 7–10 días.
• Solo el 3% de los LOS Neisseria pacientes requieren hospitalización, y se recuperan completamente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 28 días.

Diagnóstico Diferencial

• Asma ASMA Autoimmune Hepatitis: enfermedad inflamatoria de las vías respiratorias que provoca un estrechamiento de la luz bronquial y, por lo tanto, una obstrucción del flujo de aire. Se caracteriza por tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome, sibilancias y disnea. El asma ASMA Autoimmune Hepatitis suele diagnosticarse después de los LOS Neisseria 2 años y tiene desencadenantes conocidos, con reversibilidad de los LOS Neisseria síntomas con el uso de broncodilatadores en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria casos, lo que diferencia esta enfermedad de la bronquiolitis.
• Neumonía: infección de las vías respiratorias inferiores que provoca síntomas muy similares a los LOS Neisseria de la bronquiolitis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria lactantes. Los LOS Neisseria pacientes con bronquiolitis pueden desarrollar una neumonía atípica debido a infecciones bacterianas agregadas o a un empeoramiento de la infección vírica. Los LOS Neisseria hallazgos de la radiografía de tórax suelen mostrarse posteriormente a la presentación clínica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estos casos, por lo que el diagnóstico se realiza cuando el paciente presenta una hipoxia sostenida con un aumento de la administración de oxígeno, consolidaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen pulmonar y aumento del trabajo respiratorio.
• Enfermedad por reflujo gastroesofágico (ERGE): el reflujo ácido hacia el esófago en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la infancia y la niñez puede presentarse con tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome intermitente y sibilancias. También puede ir acompañada de una falta de aumento de peso y una mayor irritabilidad. La enfermedad por reflujo gastroesofágico puede diferenciarse de la bronquiolitis si los LOS Neisseria síntomas se correlacionan con la rutina de alimentación y no con la estacionalidad. La bronquiolitis suele presentarse con antecedentes de síntomas respiratorios superiores antes de las sibilancias.