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Abstract(s)
Contextualização: A bronquiolite é a infecção das vias respiratórias inferiores mais comum em crianças com idade inferior a dois anos, sendo uma importante causa de internamento nos meses de Inverno. Resulta da infecção e inflamação da mucosa respiratória das vias aéreas distais por uma grande variedade de vírus sazonais, sendo o Vírus Sincicial Respiratório o agente etiológico mais frequentemente implicado. O diagnóstico é baseado na história clínica típica e no exame físico. O tratamento é essencialmente de suporte, contudo persiste o recurso a terapêuticas cuja prática não é suficientemente sustentada por evidência científica. Apesar de ser uma doença frequente existe pouco consenso acerca da melhor abordagem diagnóstica e terapêutica. Objectivos: O objectivo principal deste estudo foi analisar a orientação diagnóstica e terapêutica das crianças com bronquiolite. Como objectivo secundário foi determinada a frequência dos diversos agentes etiológicos virais isolados e analisada a gravidade da doença em função destes. Metodologia: Foi conduzido um estudo prospectivo descritivo em crianças com bronquiolite, com idade inferior a 24 meses, que recorreram ao Serviço de Urgência Pediátrica do Centro Hospitalar da Cova da Beira, entre 1 de Novembro de 2008 e 31 de Março de 2009. Procedeu-se ao registo de informações relativas aos dados demográficos, manifestações clínicas, exames complementares de diagnóstico solicitados e intervenções terapêuticas efectuadas.
Resultados: Foram incluídas no estudo 78 crianças, 60% eram do sexo masculino e a média de idade foi de 8,5 meses. Cinquenta e três por cento das crianças necessitaram de internamento tendo sido a duração média deste de 7 dias. A prova terapêutica com salbutamol foi realizada a 59% das crianças, tendo sido continuado em 32,4% das tratadas no domicílio e em 56,1% das internadas. A antibioterapia sistémica foi prescrita em 19,2% das crianças. Durante o internamento 95% das crianças necessitaram de oxigénio suplementar, a aspiração de secreções foi realizada em 56%, e em 61% houve necessidade de hidratação endovenosa. A cinesioterapia respiratória foi realizada em 22% das crianças internadas. A radiografia do tórax foi realizada em 38,5%, o hemograma e PCR em 28,2% e a hemocultura em 17,9% das crianças. A pesquisa de vírus respiratórios foi positiva em 78,7%, tendo sido detectada infecção concomitante com dois vírus em 23% das crianças. O VSR foi identificado em 69,3% e o BoVh em 22,7%. Em 88% das crianças com amostras positivas para o BoVh foi detectada simultaneamente infecção com o VSR. As crianças com infecção concomitante com VSR e BoVh necessitaram mais frequentemente de internamento comparativamente às crianças com infecção simples por VSR (80% vs 60%). Conclusões: Tendo em consideração a evidência actual em relação à abordagem diagnóstica e terapêutica da bronquiolite detectaram-se dois aspectos passíveis de optimização que são a redução da administração de salbutamol e do recurso a exames complementares de diagnóstico. Os resultados do estudo confirmam o VSR como o principal agente etiológico da bronquiolite, e destacam o BoVh como um vírus também frequentemente associado a esta doença, demonstrando ainda uma elevada taxa co-detecção deste com o VSR. Neste estudo não foi possível associar a co-infecção com VRS e BoVh a uma maior gravidade da doença, comparativamente à infecção simples por VSR.
Backgroud: The bronchiolitis is the most common lower tract respiratory infection in children under two years and is a major cause of hospitalization during the winter months. It´s the result of infection and inflammation of the distal airways respiratory mucosa the by a variety of seasonal virus, and Respiratory Syncytial Virus is the etiologic agent most frequently implicated. The diagnosis is based on typical clinical history and physical examination. Treatment is essentially supportive however, therapeutics not sufficiently supported by scientific evidence remain being used. Despite being a common disease there is little consensus about the best diagnostic and therapeutic approach. Objectives: The main objective of this study was to analyze therapeutic and diagnostic approaches of children with bronchiolitis. The secondary objective was to determine the frequency of various viral pathogens isolated and analyze the severity of the disease according to these. Methodology: We conducted a prospective descriptive study in children with bronchiolitis, with the age below 24 months, which have been taken at Pediatric Emergency Service of Hospital of Cova da Beira, between 1 November 2008 and 31 March 2009. It has been registrated information related to demographics, clinical manifestations, additional diagnostic tests and therapeutic interventions. Results: We included 78 children in the study, 60% were male and mean age was 8.5 months. Fifty-three percent of children required hospitalization and the average duration of that was 7 days. Proof therapy with salbutamol was performed at 59% of children, and was continued in 32.4% of those treated at home and in 56.1% of those hospitalized. Systemic antibiotics were prescribed in 19.2% of children. Along hospitalization 95% of children required supplemental oxygen. Nasopharyngeal suction was performed in 56%, and 61% of the children needed intravenous hydration. Chest physiotherapy was performed in 22% of hospitalized children. Chest X-ray was performed in 38.5%, blood count and PCR in 28.2% and blood culture in 17.9% of children. In viral diagnostic testing at least one virus was detected in 78.7% and concomitant infection with two viruses was detected in 23% of children. The RSV was identified in 69.3% and BoVh in 22.7% of children. In 88% of children with positive samples for BoVh it has been detected simultaneously RSV infection. Children with concomitant infection with RSV and BoVh required more often hospitalization compared with children infected with RSV alone (80% vs 60%). Conclusions: Given the current evidence regarding the diagnostic approach and treatment of bronchiolitis there were found two issues that are likely to be optimized: the reduction of salbutamol prescription and the use of complementary tests of diagnosis. These results confirm RSV as the primary etiologic agent of bronchiolitis, and highlight the BoVh as a virus often associated with this disease, also showing a high rate of co-detection with RSV. Given the limitations of the study it wasn’t possible to associate the co-infection with RSV and BoVh with a greater severity of illness, compared to infection by RSV alone.
Backgroud: The bronchiolitis is the most common lower tract respiratory infection in children under two years and is a major cause of hospitalization during the winter months. It´s the result of infection and inflammation of the distal airways respiratory mucosa the by a variety of seasonal virus, and Respiratory Syncytial Virus is the etiologic agent most frequently implicated. The diagnosis is based on typical clinical history and physical examination. Treatment is essentially supportive however, therapeutics not sufficiently supported by scientific evidence remain being used. Despite being a common disease there is little consensus about the best diagnostic and therapeutic approach. Objectives: The main objective of this study was to analyze therapeutic and diagnostic approaches of children with bronchiolitis. The secondary objective was to determine the frequency of various viral pathogens isolated and analyze the severity of the disease according to these. Methodology: We conducted a prospective descriptive study in children with bronchiolitis, with the age below 24 months, which have been taken at Pediatric Emergency Service of Hospital of Cova da Beira, between 1 November 2008 and 31 March 2009. It has been registrated information related to demographics, clinical manifestations, additional diagnostic tests and therapeutic interventions. Results: We included 78 children in the study, 60% were male and mean age was 8.5 months. Fifty-three percent of children required hospitalization and the average duration of that was 7 days. Proof therapy with salbutamol was performed at 59% of children, and was continued in 32.4% of those treated at home and in 56.1% of those hospitalized. Systemic antibiotics were prescribed in 19.2% of children. Along hospitalization 95% of children required supplemental oxygen. Nasopharyngeal suction was performed in 56%, and 61% of the children needed intravenous hydration. Chest physiotherapy was performed in 22% of hospitalized children. Chest X-ray was performed in 38.5%, blood count and PCR in 28.2% and blood culture in 17.9% of children. In viral diagnostic testing at least one virus was detected in 78.7% and concomitant infection with two viruses was detected in 23% of children. The RSV was identified in 69.3% and BoVh in 22.7% of children. In 88% of children with positive samples for BoVh it has been detected simultaneously RSV infection. Children with concomitant infection with RSV and BoVh required more often hospitalization compared with children infected with RSV alone (80% vs 60%). Conclusions: Given the current evidence regarding the diagnostic approach and treatment of bronchiolitis there were found two issues that are likely to be optimized: the reduction of salbutamol prescription and the use of complementary tests of diagnosis. These results confirm RSV as the primary etiologic agent of bronchiolitis, and highlight the BoVh as a virus often associated with this disease, also showing a high rate of co-detection with RSV. Given the limitations of the study it wasn’t possible to associate the co-infection with RSV and BoVh with a greater severity of illness, compared to infection by RSV alone.
Description
Keywords
Bronquite Bronquiolite - Crianças Bronquiolite - Crianças - Diagnóstico Bronquiolite - Crianças - Terapêutica Vírus sincicial respiratório Bocavírus humano
Citation
Publisher
Universidade da Beira Interior