Review Question - QID 103340

A 7-month-old child with an upper respiratory infection (URI) with low fevers and wheezing on exam is most likely suffering bronchiolitis, from a viral infection caused by the Respiratory syncytial virus (RSV). The child can be treated without viral cultures and nasal washings.

Bronchiolitis is especially common in children younger than 2 years old. Though the most common organism is RSV, many other viruses such as parainfluenza virus, influenza virus, and adenovirus that may also be responsible. Most children are treated supportively with antipyretics along with fluids. In severe cases, therapy with bronchodilators (typically inhaled beta agonists) has also shown to be beneficial and does not require knowing the organism (via viral cultures or nasal washings).

Dawson-Caswell et al. discuss the topic of RSV infections in children. They state that children typically present with cough, coryza, and wheezing. It is usually a clinical diagnosis thus laboratory testing and chest radiography are not necessary to make the diagnosis. They also note that neither antibiotics nor corticosteroids are helpful for bronchiolitis due to it's viral predominance. Bronchidilators may be helpful in severe cases.

Ralston et al. present a systematic review of hospitalization in bronchiolitis cases They report that quality improvement literature resulted in 16 fewer patients (per 100 hospitalized) exposed to repeated doses of bronchodilators, 5.3 fewer doses of bronchodilator given per patient, 5 (per 100) fewer patients exposed to steroids, 9 (per 100) fewer exposed to chest radiography, and 4 (per 100) given antibiotics.

Incorrect Answers:

Answer 1: Parainfluenza virus most commonly causes croup with a barking cough and inspiratory stridor. It is also a less common cause of a bronchiolitis in a child than RSV.
Answer 2: Adenovirus can cause an upper respiratory infection and most commonly presents with conjunctivitis and pharyngitis. It is transferred in a fecal-oral manner. It is also a less common cause of a bronchiolitis in a child than RSV.
Answer 3: The patient is unlikely to be infected with the influenza virus due to his vaccine. Furthermore, the flu would most likely present with higher fevers. It is also a less common cause of a bronchiolitis in a child than RSV.
Answer 5: Echoviruses are common causes of viral meningitis in infants. It typically does not bronchiolitis.