True regarding BRONCHIOLITIS OBLITERANS without cyanosis?
Ans. c (Continuous O2 therapy is mainstay of treatment) (Ref. Nelson 17th/pg. l233; OP Ghai , 6th/pg. 352)MANAGEMENT OF BRONCHIOLITIS# There is no evidence to support the use of humidified air.# Oxygen remains the mainstay of treatment. It is administered even in absence of cyanosis. Very sick infants need a oncentration of 60% oxygen given through hood. Oxygen saturation should be kept above 95%.# There is no specific evidence to support the use of salbutamol in bronchiolitis.# Antibiotics have no role.# Ribavirin is an antiviral agent that can be used in acute infection although it has no definitive role in treatment of infants who were previously healthy. Ribavirin, however, shortens the course of illness in infants with underlying congenital heart disease, chronic lung disease, and immunodeficiency.# Controlled trials have failed to demonstrate any proven benefit from glucocorticoids.# In at-risk infants (immunodeficiency, cystic fibrosis, BPD, prematurity etc) RSV immunoglobulin given monthly has been shown to provide passive immunity.Common respiratory diseases in childhoodDiseasesCase Vignette/Key cluesCommon causative agentsPathogenesisDiagnosisTreatmentEpiglottisInflammed epiglottis patient often 2-3 years old and unvaccinatedHaemophilus influenzaeCapsule (polyribitol phosphate) inhibits phagocytosis:and NAD IgA proteaseGramQrod, chocolate agar requires hemin--CroupInfant with fever, sharp barking cough inspiratory stidor, hoarse phonationParainfluenza virus (croup)Viral cytolysis: multinucleated giant cells formedDetect virus in respiratory washingsRibavirinLaryngotra- cheitis, laryn- gotracheobron- chitisHoarseness, burning restrosternal painParainfluenza virusViral cyclosis; multinucleated giant cells formedDetect virus in respiratory washingsRibavirinBronchitisWheezy; infant of child 5 years oldRSVFusion protein creates syncytiaDirect immune - fluoresence for viral AgsRibavirin > 5 years oldMycoplasma pneumoniae virusesRelease of O2 radicals causes necrosis of epitheliumSlow growth on Eaton medium, cold agglutininsSymptomatic
Most commonly caused by parainfluenza virus
Ribavarin 16 hrs/ day for 4-5 days is useful
Continuous 02 therapy is mainstay of treatment
Ipratropium bromide is contraindicated
Respiratory System