Internal Medicine Conspectus for 5 year 2016-2017 Vol. 1

Acute bronchitis & Tracheobronchitis & Broncheolitis
Acute bronchitis is inflammation of the tracheobronchial tree, commonly following a URI, that occurs in patients without chronic lung disorders. The cause is almost always a viral infection. The pathogen is rarely identified. The most common symptom is cough, with or without fever, and possibly sputum production. Diagnosis is based on clinical findings. Treatment is supportive; antibiotics are usually unnecessary. Prognosis is excellent.

Acute bronchitis is frequently a component of a URI caused by rhinovirus, parainfluenza, influenza A or B virus, respiratory syncytial virus, coronavirus, or human metapneumovirus. Less common causes may be Mycoplasma pneumoniae, Bordetella pertussis, and Chlamydia pneumoniae. Less than 5% of cases are caused by bacteria, sometimes in outbreaks.

Bronchiolitis is an acute viral infection of the lower respiratory tract affecting infants < 24 mo and is characterized by respiratory distress, wheezing, and crackles. Diagnosis is suspected by history, including presentation during a known epidemic; the primary cause, respiratory syncytial virus, can be identified with a rapid assay. Treatment is supportive with oxygen and hydration. Prognosis is generally excellent, but some patients develop apnea or respiratory failure.
Epidemiology

Bronchiolitis often occurs in epidemics and mostly in children < 24 mo, with a peak incidence between 2 mo and 6 mo of age. The annual incidence in the first year of life is about 11 cases/100 children. In the temperate northern hemisphere, most cases occur between November and April, with a peak incidence during January and February.

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