Obliterating bronchiolitis

Obliterating bronchiolitis – this form is characterized by a frequent transition to a chronic disease. 

A widespread lesion of the epithelium of bronchioles occurs with the subsequent organization of exudate and granulomatous reaction, and then obliteration of their lumen.

Etiology. In childhood, obliterating bronchiolitis is most often observed with adenovirus infection; individual cases are described for whooping cough and measles. 

Clinic . As a rule, children of the first 2-3 years of life suffer. The acute period is characterized by severe respiratory distress against the background of persistent febrile temperature, often with signs of adenovirus infection such as conjunctivitis and rhinopharyngitis. Respiratory failure persists and even increases within 1-2 weeks, at febrile temperature. Auscultatory listening to asymmetric small-bubbly and crepitating rales.

The x-ray picture may be different. Total blackouts of one pulmonary field with a picture of an air bronchogram, indicating the predominance of atelectasis, are described. Often the changes are reminiscent of pneumonic infiltration combined with air areas – a “cotton” lung. 

Hematological changes – moderate leukocytosis, neutrophilic shift, increased ESR. 

In a typical obliterating bronchiolitis, severe obstructive disorders persist after normalization of the temperature (usually at the 3rd week of illness). This period lasts 3-4 weeks. Auscultatory changes are defined as rales of different sizes, wheezing exhale on the affected side. Obstruction may periodically worsen, sometimes resembling an asthmatic attack. In parallel, radiological changes disappear, the pulmonary fields are cleared of shadows. However, signs of respiratory failure usually persist, indicating persistent changes in the bronchioles and arterioles of the affected area of ​​the lung, the evolution of which after 6-8 weeks leads to the phenomenon of “translucent lung” ( Macleod’s syndrome ).  

Diagnosis of a typical obliterating bronchiolitis in the acute period is simple – persistent febrile temperature, a bright clinic of bronchiolitis, asymmetry of wheezing, the appearance of “cotton” shadows on the radiograph, severe respiratory failure. With the appearance of a similar picture and suspicion of an obliterating bronchiolitis, the patient must be urgently hospitalized. 

Recurrent bronchitis is a recurrence of episodes of acute bronchitis without obstruction 2-3 times within 1-2 years against the background of acute respiratory viral infections. The duration of clinical manifestations is characteristic – 2 or more weeks. This group includes most of the so-called “often sick” children. Within 3-4 years, the relapse rate decreases, by 6-7 years they cease. At the same time, up to 80% of children have signs of allergy, but a reaction to aeroallergens is detected in only 15% of cases. In ecologically unfavorable zones at the age of 3-6 years, the frequency of this pathology is 5-6 times higher than in favorable areas. 

event_note May 12, 2020

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