Diagnosis of bronchitis in children

Diagnosis of bronchitis is established on the basis of his clinical picture (for example, the presence of obstructive syndrome) and in the absence of signs of pulmonary tissue damage (there are no infiltrative or focal shadows on the roentgenogram). Often, bronchitis is combined with pneumonia, in which case it is diagnosed with a significant addition to the clinical picture of the disease. Unlike pneumonia, bronchitis in ARVI always has a diffuse character and usually evenly affects the bronchi of both lungs. With the prevalence of local bronchial changes in any part of the lung, the appropriate definitions are used: basal bronchitis, unilateral bronchitis, bronchitis of the leading bronchus, and others.

Clinical examination

Acute bronchitis (simple). The main symptom is a cough. At first, the cough is dry, after 1-2 days it becomes wet, it persists for 2 weeks. A longer cough is observed after a previous tracheitis. In the event that coughing attacks (especially in schoolchildren) continue for 4-6 weeks in the absence of other symptoms, one should think about another possible cause, such as pertussis, a foreign body in the bronchus, etc.

Sputum in the beginning of the disease has a mucous nature. At the second week of the disease, sputum may acquire a greenish color due to the admixture of fibrin dehydration products, rather than the attachment of a secondary bacterial infection, and does not require the administration of antibiotics.

Children of the first year of life may experience mild dyspnea (respiratory rate (FND) up to 50 per minute). Percutally sometimes defined boxed shade of pulmonary sound, or there are no changes. When auscultation in the lungs are heard diffuse dry and wet large and medium bubbling rales, which can vary in number and character, but do not disappear when coughing. Some children have wheezing in their exhalations in a dream. The asymmetry of auscultative changes should be alarming in terms of pneumonia.

Acute obstructive bronchitis. Syndrome of bronchial obstruction is characterized by shortness of breath (CRP to 60-70 per minute), increased persistent dry cough, the appearance of dry wheezing in the background of prolonged exhalation, not only during auscultation, but also audible at a distance. Half of the patients also listen to wet, uneventful small bubbling rales. The thorax is swollen. The temperature is moderate or absent. The child's anxiety is noted.

Acute bronchiolitis usually develops as the first obstructive episode on the 3rd-4th day of acute respiratory viral infection, more often PC-viral etiology. Bronchial obstruction is more associated with mucosal edema, and not bronchoconstriction. Body temperature is usually normal or subfebrile. For bronchiolitis, dyspnoea is characterized by retraction of the concave parts of the chest (jugular fossa and intercostal spaces), swelling of the wings of the nose in young children, with PFD up to 70-90 per minute, prolonged exhalation (with tachypnea may be absent). Cough is dry, sometimes with a "high" spastic sound. Perioral cyanosis is noted.

Acute obliterating bronchiolitis (postinfection bronchiolitis obliterans). The disease is characterized by extremely severe course and a vivid clinical picture. In an acute period, severe respiratory disorders are observed against a background of persistent febrile temperature and cyanosis. Noisy "wheezing" breath is noted. When auscultation against the background of an elongated exhalation, an abundance of creping and finely bubbling wet wheezing is heard. Usually asymmetric.

Mycoplasma bronchitis often develops in school-age children. A distinctive feature of mycoplasmal bronchitis is a high temperature reaction from the first days of the disease, conjunctivitis, usually without effusion, an obsessive cough, a pronounced obstructive syndrome (exhaling, wheezing) in the absence of toxicosis and disturbance of general well-being. Catarrhal phenomena are not very pronounced.

Mycoplasma infection affects small bronchi, so when auscultation, crepitating rales and a mass of small bubbles moist are heard, which are localized asymmetrically, which indicates uneven bronchial lesions.

Mycoplasma bronchitis can occur atypically: without obstructive syndrome and dyspnea. To suspect this etiology of bronchitis allows the presence of asymmetric wheezing and conjunctivitis.

Chlamydia bronchitis in children of the first months of life is caused by Chlamidia trachomatis. Infection occurs during labor from a mother who has a chlamydial infection of the genitals. Against the background of good health and normal temperature at the age of 2-4 months, there is a picture of bronchitis. There is a cough, which is amplified for 2-4 weeks. In some cases, it becomes paroxysmal, like in whooping cough, but unlike the latter it occurs without reprises. The phenomena of obstruction and toxicosis are few, dyspnea moderate. Against the background of hard breathing, small and medium bubbling wet rales are heard.

In the diagnosis of chlamydia bronchitis, a characteristic anamnesis, the presence of conjunctivitis in the first month of life.

In children of school age and adolescents, bronchitis is caused by Chlamidia pheumonia and is characterized by a violation of the general condition, high fever, hoarseness due to concomitant pharyngitis, there may be a sore throat. Often, obstructive syndrome develops, which can promote the development of "late-onset bronchial asthma."

In these cases, the elimination of pneumonia is necessary, which is confirmed by the absence of focal or infiltrative changes in the lungs on the radiograph.

Recurrent bronchitis. The main symptoms of recurrent bronchitis are a moderate increase in temperature during 2-3 days with the subsequent appearance of a cough, often wet, but unproductive. Then the cough becomes productive with the release of mucopurulent sputum. At auscultation, various varicose rhonchuses of a widespread nature are heard. The disease can last from 1 to 4 weeks.

Recurrent obstructive bronchitis. In the early days of acute respiratory viral infection (2-4 days), bronchial obstruction syndrome occurs as an acute obstructive bronchitis, but the obstruction syndrome can persist for a long time with shortness of breath, first with a dry and then moist cough with the discharge of mucopurulent sputum. When auscultation dry dry whistling and variously moist wet rales are listened to against a background of prolonged exhalation, wheezing can be heard at a distance.

Laboratory diagnostics

Acute bronchitis (simple). Changes in the clinical analysis of blood are more often caused by a viral infection, moderate leukocytosis may be observed.

Acute obstructive bronchitis. In the hemogram, characteristic signs of a viral infection are noted.

Acute bronchiolitis. The hemogram - hypoxemia (p _and O ₂.. Is reduced to 55-60 mm Hg) and hyperventilation (p _and O ₂ is reduced).

Acute obliterating bronchiolitis (postinfection bronchiolitis obliterans). In the clinical analysis of the blood, moderate leukocytosis, neutrophil shift, increased ESR. Hyposemia and hypercapnia are also characteristic.

Mycoplasma bronchitis. There is usually no change in the clinical analysis of blood, sometimes an increase in ESR with normal leukocyte count. In the diagnosis of reliable express methods does not exist. Specific IgM appears much later. Increasing the antibody titer allows you to put only a retrospective diagnosis.

Chlamydia bronchitis. In the hemogram, leukocytosis, eosinophilia, increased ESR. Chlamydial antibodies of IgM class are detected in titer 1: 8 and more, class IgG in titer 1:64 and above, provided that the mother is lower than that of the child.

Instrumental methods

Acute bronchitis (simple). Radiographic changes in the lungs are usually represented in the form of intensification of the pulmonary pattern, more often in the basal and lower medial zones, sometimes there is an increase in the airiness of the lung tissue. Focal and infiltrative changes in the lungs are absent.

Acute obstructive bronchitis. On the x-ray - bloating of the lung tissue.

Acute bronchiolitis. On radiographs there are signs of swelling of the lung tissue, strengthening of the bronchovascular pattern, less often - small atelectasis, linear and focal shadows.

Acute obliterating bronchiolitis (postinfection obliterating bronchiolitis). Radiographs reveal soft-fused foci, more often one-sided, without clear contours - a "cotton lung" with a picture of an air bronchogram. Respiratory failure increases in the first two weeks.

Mycoplasma bronchitis. On the roentgenogram, there is an increase in pulmonary pattern, coinciding with the localization of the maximum number of wheezing. Sometimes the shadow is so pronounced that it must be differentiated from the site of inhomogeneous infiltration, typical for mycoplasmal pneumonia.

Chlamydia bronchitis. On the roentgenogram in the case of chlamydial pneumonia, small-focal changes are noted, and in the clinical picture, pronounced dyspnea prevails.

Recurrent bronchitis. Radiographically, there is an increase in bronchoconstrictive pattern, in 10% of children - increased transparency of the lung tissue.

Recurrent obstructive bronchitis. On the radiographs, there is a certain swelling of the lung tissue, an increase in the bronchoconstrictive pattern, the absence of foci of pulmonary tissue infiltration (in contrast to pneumonia). It is necessary to exclude chronic diseases of the lungs, which also occur with obstruction: cystic fibrosis, bronchiolitis obliterans, congenital malformations of the lungs, chronic aspiration of food, etc.

Differential diagnostics

Acute bronchitis (simple). When repeated episodes of obstructive bronchitis should be ruled out bronchial asthma.

Acute obstructive bronchitis. In the case of obstinate obstructive bronchitis that is resistant to therapy, it is necessary to think about other possible causes of it, for example, the developmental defects of the bronchi, the foreign body in the bronchi, the habitual aspiration of food, the resistant inflammatory focus, etc.

[1], [2], [3], [4], [5], [6], [7], [8]