Acute viral bronchiolitis in South Africa : diagnostic flow

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dc.contributor.author White, D.A.
dc.contributor.author Zar, H.J.
dc.contributor.author Madhi, S.A
dc.contributor.author Jeena, P.
dc.contributor.author Morrow, B.
dc.contributor.author Masekela, R.
dc.contributor.author Risenga, S.
dc.contributor.author Green, Robin J.
dc.date.accessioned 2016-05-26T12:33:25Z
dc.date.available 2016-05-26T12:33:25Z
dc.date.issued 2016-04
dc.description.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. en_ZA
dc.description.department Paediatrics and Child Health en_ZA
dc.description.librarian am2016 en_ZA
dc.description.uri http://www.samj.org.za en_ZA
dc.identifier.citation White, DA, Zar, HJ, MAdhi, SA, Jeena, P, Morrow, B, Masekela, R, Risenga, S & Green, RJ 2016, 'Acute viral bronchiolitis in South Africa : diagnostic flow', South African Medical Journal, vol. 106, no. 4, pp. 328-329. en_ZA
dc.identifier.issn 0256-9574 (print)
dc.identifier.issn 2078-5135 (online)
dc.identifier.other 10.7196/SAMJ.2016.v106i4.10441
dc.identifier.uri http://hdl.handle.net/2263/52768
dc.language.iso en en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.rights © 2016 Health & Medical Publishing Group. This work is licensed under a Creative Commons Attribution-NonCommercial Works License (CC BY-NC 3.0). en_ZA
dc.subject Bronchiolitis en_ZA
dc.subject Blood tests en_ZA
dc.subject Patients en_ZA
dc.subject Symptoms en_ZA
dc.title Acute viral bronchiolitis in South Africa : diagnostic flow en_ZA
dc.type Article en_ZA


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