by rhinovirus, human metapneumovirus (HMPV), influenza, adenovirus and parainfluenza (Burns et al., 2017). Early symptoms of bronchiolitis usually start with that of common cold, runny nose, sneezing, low grade to moderate fever of 1-2 days, followed by tachypnea, tachycardia, wheezing, rales; use of accessory muscles, and/or nasal ﬂaring and retractions are observed along with shallow, rapid breathing (Dains et al., 2016). ). Cough increases as inflammation increases, and the child appears lethargic and has circumoral cyanosis; wheezes are usually predominant with prolonged expiration ; crackles and rhonchi may be heard diffusely throughout the lung fields (Dains et al., 2016). The child may also seem fussy and dehydration may develop from vomiting and decreased oral intake due to trouble sucking and swallowing (Burns et al., 2017). Risk factors for bronchiolitis include: chronic lung disease, premature birth, and immunodeficiency (Burns et al., 2017). Epidemiology Bronchiolitis is the leading cause of emergency room visits and hospitalizations of infants in their first year of life (Friedman et al., 2014). It commonly affects young children from infancy to two years of age (Burns et al., 2017). As reported by Ralston et al. (2014), approximately 100000 bronchiolitis admissions occur annually in the United States at an estimated cost of $1.73 billion. In addition, a study by CDC reported an average RSV
hospitalization rate to be 5.2 per 1000 children younger than 24 months of age during the 5-year period between 2000 and 2005, reflecting a significant morbidity and impact on families (Ralston et al., 2014). Bronchiolitis is highly contagious and is spread through self- inoculation of nasopharyngeal or ocular mucous membranes after direct contact with respiratory secretions or fomites and contaminated; source of infection is usually older family members, other children attending the same childcare center, and some hospital staff. The highest incidence of bronchiolitis usually occurs in the late fall through early spring; and majority of cases resolve completely (Burns et al., 2017). Even though reinfection is common, symptoms are usually mild (Burns et al., 2017). Diagnosis of Bronchiolitis The diagnosis of bronchiolitis is based on presenting symptoms and directed history and physical examination, with consideration of risk factors such as: age less than 12 weeks, a history of prematurity, underlying cardiopulmonary disease, or immunodeficiency (Ralston et al., 2014). Diagnostic studies such as chest x-rays are not indicated for most children with bronchiolitis since infants with RSV often reveals nonspecific, patchy hyperinflation and areas of atelectasis, which may be misinterpreted as consolidation ( Friedman et al., 2014). However, a chest x-ray is considered when the diagnosis of bronchiolitis is unclear, the rate of improvement is not as expected or the severity of disease raises other diagnostic possibilities such as bacterial pneumonia ( Friedman et al., 2014). As reported by Burns et al. (2017), immunofluorescence analysis of sputum, throat swabs or nasal washing are used to confirm diagnosis of RSV, only if required for cohorting in hospitalized patients.
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- urinary tract infection, Burns, Upper respiratory tract infection, pediatric Primary care