Continuing Medical Education

Acute viral bronchiolitis in South Africa: Diagnostic flow

Debbie A White, Heather J Zar, Shabir A Madhi, Prakash Jeena, Brenda Morrow, Refiloe Masekela, Samuel Risenga, Robin Green

Abstract


Bronchiolitis may be diagnosed on the basis of clinical signs and symptoms. In a young child, the diagnosis can be made on the clinical
pattern of wheezing and hyperinflation.
Clinical symptoms and signs typically start with an upper respiratory prodrome, including rhinorrhoea, low-grade fever, cough and poor
feeding, followed 1 - 2 days later by tachypnoea, hyperinflation and wheeze as a consequence of airway inflammation and air trapping.
The illness is generally self limiting, but may become more severe and include signs such as grunting, nasal flaring, subcostal chest wall
retractions and hypoxaemia. The most reliable clinical feature of bronchiolitis is hyperinflation of the chest, evident by loss of cardiac
dullness on percussion, an upper border of the liver pushed down to below the 6th intercostal space, and the presence of a Hoover sign
(subcostal recession, which occurs when a flattened diaphragm pulls laterally against the lower chest wall).
Measurement of peripheral arterial oxygen saturation is useful to indicate the need for supplemental oxygen. A saturation of <92% at
sea level and 90% inland indicates that the child has to be admitted to hospital for supplemental oxygen. Chest radiographs are generally
unhelpful and not required in children with a clear clinical diagnosis of bronchiolitis.
Blood tests are not needed routinely. Complete blood count tests have not been shown to be useful in diagnosing bronchiolitis or guiding
its therapy. Routine measurement of C-reactive protein does not aid in management and nasopharyngeal aspirates are not usually done.
Viral testing adds little to routine management.
Risk factors in patients with severe bronchiolitis that require hospitalisation and may even cause death, include prematurity, congenital
heart disease and congenital lung malformations.


Authors' affiliations

Debbie A White, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Heather J Zar, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and MRC Unit on Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

Shabir A Madhi, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa

Prakash Jeena, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Brenda Morrow, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

Refiloe Masekela, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Samuel Risenga, Department of Pulmonology, Faculty of Health Sciences, University of Limpopo, Polokwane, and Pietersburg Hospital, South Africa

Robin Green, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, and Steve Biko Academic Hospital, Pretoria, South Africa

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Keywords

Acute viral bronchiolitis; Diagnostic flow

Cite this article

South African Medical Journal 2016;106(4):328-329. DOI:10.7196/SAMJ.2016.v106i4.10441

Article History

Date submitted: 2015-12-08
Date published: 2016-03-03

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