PAEDIATRIC PACKAGES

Pediatric Packages (Asthma, Viral Fever, Bronchitis and so on) depend on patient case. Call us to get more information

 Viral fever introduction

        Viral fever refers to a broad spectrum of conditions where viral infections are associated with elevations of body temperature. The term encompasses a wide variety of viral infections, some of which can be clearly identified by their symptoms and signs. These viral infections may show generalised symptoms, but may target specific organs.

        Headaches, body aches and a skin rash characterise most of these viral fevers. They may affect any age group, and are seen world-wide. They require only symptomatic treatment. Some are highly contagious. Most of them are not dangerous and self-limited, but some can progress rapidly leading to death.

                  Cause and Pathogenesis

        Most viral infections are spread by inhalation of aerosolised particles, by intake of contaminated water or food, or by direct contact. Infection then spreads locally and thereafter into the blood stream or lymph channels. Some of the viral infections can be transmitted sexually or by direct inoculation into the blood stream.

        The duration of the primary infection may vary from days to several weeks. Manifestation of the disease clinically is usually a consequence of the virus multiplying at a specific site. Even though the fever comes down, in some infections the virus continues to multiply and cause persistent infection.

                  Symptoms and Signs

        Once the virus enters the body, there is an incubation period when the virus multiplies to a level high enough to cause infection. This is followed by a prodromal phase of fatigue, malaise and body and muscle aches that may lead to the onset of fever. The fever may be low grade or high grade and remittent. Inflammation of the pharynx, a running nose, nasal congestion, headache, redness of the eyes, cough, muscle and joint pains and a skin rash could be present.

         The fatigue and body pain could be disproportionate to the level of fever, and lymph glands may swell up. The illness is usually self-limited but the fatigue and cough may persist for a few weeks. Sometimes pneumonia, vomiting and diarrhoea, jaundice or arthritis (joint swelling) may complicate the initial viral fever. Some viral fevers are spread by insects, for example, arbovirus, can cause a bleeding tendency, which results in bleeding from the skin and several other internal organs and can be fatal.

                 Investigations and Diagnosis

          The diagnosis and management of viral fevers is based more on the clinical presentation than by laboratory investigations. Since these infections are commonly self-limited, investigations are unnecessary. The diagnosis is made by the typical history of fever with severe muscle and joint pains. Skin rash and lymph gland swellings have to be specifically looked for.

        Laboratory investigations are undertaken to rule out other bacterial infections rather than to confirm viral fever. Blood tests will not show any increase in the white blood cells, which typically occurs with bacterial infections. The numbers of lymphocytes may be increased. The Erythrocyte Sedimentation Rate (ESR) is not elevated. Confirmation is by culture of virus from the relevant specimens such as nasal swabs, and skin rash or by increase in antibody levels in serial blood samples.

                     Treatment and Prognosis

         Treatment of viral fever is purely symptomatic with antipyretic and analgesic drugs. Bed rest and adequate fluid intake is advised. Nasal decongestants may be beneficial. Specific antiviral therapy is not routinely recommended. Steroids are not advised as it may lead to bacterial super-infection. Only in cases of super-infection do antibiotics need to be prescribed. It is important that antibiotics are NOT routinely used for prophylaxis.

         Complications of viral infections like pneumonia (viral or super-infection by bacteria) need to be addressed specifically by clearance of respiratory secretions and utilising ventilator assistance if hypoxia is severe. Symptoms of gastroenteritis should be managed with anti-motility agents. Most viral fevers recover completely in a week although fatigue may persist for a few weeks.

                       Prevention

           Viral fevers are difficult to prevent. They occur as epidemics of infection depending on their mode of spread. Vaccines have been tried targeting the respiratory and gastrointestinal viruses with little success due to several sub-groups of viruses with different forms of antigenicity, all of which cannot be covered with a single vaccine. Fortunately since most infections are mild and self-limited, we can be assured of a full recovery.

                                           Asthma

                   Introduction
            Asthma is a disease of the airways. It is characterised by increased sensitivity of the airways to a number of stimuli-producing spasm of airways; it is also caused by constriction. This ailment causes a pronounced narrowing of the airways, which may be relieved either spontaneously or after treatment. Asthma can occur at all ages. However in 50% of the cases it occurs before the age of ten. Asthma may be triggered by exposure to specific allergens and/or external stimuli, in which case it is classified as allergic asthma. Cases of asthma where there is no specific allergen or stimuli implicated, are called idiosyncratic asthma. Asthmatics may have a strong personal or family history of allergies. Asthma is thought to affect close to 3% of the population in most countries. Asthma is an episodic disease that alternates with long periods of normalcy.

                        Cause and Pathogenesis
           Extrinsic or allergic asthma is triggered by a variety of allergens such as dust, smoke, pet dander, chemicals, and certain foodstuffs. Underlying respiratory infections, emotional stress, and fatigue can also act as triggers. Viral infections of the respiratory tract may provoke severe asthma. A number of drugs such as aspirin and beta blockers also act as causes. Quite often more than one factor may be responsible for triggering an episode. The exact mechanism by which the increased reactivity of the airway begins is not clear but the progress of the ailment in its subsequent stages has been well studied. The inflammatory reaction that occurs is mediated by certain cells such as the eosinophils, mast cells, and lymphocytes, as well as by certain chemical mediators such as Prostaglandins and Leukotrienes.The inflammation that occurs leads to an exudation of inflammatory material and leads to narrowing and blockage of the airway, producing the typical symptoms of the disease. Air also gets trapped within the airways producing a hyper-inflated chest. The severity of the obstruction is not uniform and different parts of the airway may be affected in varying degrees. 
                      Symptoms and Signs

          The three typical symptoms of asthma are:
• Breathlessness (dyspnoea)
• Cough
• Wheezing
         Usually all three symptoms may be evident during an acute attack. The accessory muscles of respiration may be active. The presence of a pulsus paradoxus (a type of pulse) and the presence of significant activity of the accessory muscles of respiration, indicate that the episode is severe. The patients may complain of a feeling of tightness in the chest - often at the start of an episode. During an episode the patient may lean forward and breathe long and hard. In severe cases the wheeze may appear to reduce and the patient may become cyanosed with severe fatigue and narrow, shallow respirations. A silent chest in a severe episode of asthma is often an ominous sign. Severe cases may lead to status asthmaticus (a form of treated but uncontrolled severe asthma) and eventually respiratory failure. 
                      Investigations and Diagnosis
          A typical feature of an asthma attack is its reversibility. Administering a bronchodilator and estimating the improvement in the patient's expiratory volume during the first second of expiration (FEV1), is a simple and effective method of diagnosis. During an acute attack, an examination of the arterial blood gases would indicate the severity of the episode. A chest X-Ray may be necessary to indicate a hyperventilated chest. It also helps differentiate from other causes of breathlessness such as cardiac failure. The sputum could be thick and viscous and may indicate eosinophils and what are called Charcot-Leyden crystals. The effectiveness of therapy is monitored by assessing the PEFR (Peak Expiratory Flow Rate). Estimation of blood and sputum eosinophil counts (elevated), and raised levels of serum Immunoglobin-E, are often useful supportive evidence but are not specific. A Pulmonary Function Testing may indicate an obstructive pattern of airway disease. 
                    Treatment and Prognosis
       A variety of drugs are used in the treatment of asthma. These include the Beta-agonists, the Methylxanthines, and Corticosteroids. Drugs such as Salbutamol, Terbutaline and Salmetrol (long acting) belong to the group of adrenergic stimulants; while Theophylline and its various salts belong to the family of Methylxanthines. Anticholinergic drugs are also useful in treating acute episodes but are not used as often. Steroids reduce the inflammation within the airways in asthma and are highly effective. The drugs may be administered either by inhalation, orally, or by injections. Treatment has to continue until the episode has completely resolved; after that many patients may require a small dose of bronchodilator, usually administered by an inhaler for a prolonged period.
        Mast cell stabilizing agents such as Cromolyn Sodium and Nedocromil sodium help restrict the degranulation of mast cells, and prevent the release of the mediators of inflammation. Thus they are more useful when given as prophylactics rather than during the acute episode. Oxygen may need to be given during severe attacks; severe attacks may warrant antibiotics. Desensitization or immunotherapy with extracts of the suspected allergens, has been tried and may become widely acceptable in the future. The prognosis of asthma remains good with as many as 60%-80% of those who have the disease being able to lead normal lives without any significant disruptions. But between 10%-20% of patients continue to have severe attacks throughout their lives. Fortunately asthma is not a progressive disease. The mortality rate among asthma patients is low though it has been on the rise of late. 

                              What Is Bronchitis?
             Bronchitis (pronounced: brahn-kite-uss) is an inflammation of the lining of the bronchial tubes, the airways that connect the trachea (windpipe) to the lungs. This delicate, mucus-producing lining covers and protects the respiratory system, the organs and tissues involved in breathing. When a person has bronchitis, it may be harder for air to pass in and out of the lungs than it normally would, the tissues become irritated and more mucus is produced. The most common symptom of bronchitis is a cough.
           When you breathe in (inhale), small, bristly hairs near the openings of your nostrils filter out dust, pollen, and other airborne particles. Bits that slip through become attached to the mucus membrane, which has tiny, hair-like structures called cilia on its surface. But sometimes germs get through the cilia and other defense systems in the respiratory tract and can cause illness.
          Bronchitis can be acute or chronic. An acute medical condition comes on quickly and can cause severe symptoms, but it lasts only a short time (no longer than a few weeks). Acute bronchitis is most often caused by one of a number of viruses that can infect the respiratory tract and attack the bronchial tubes. Infection by certain bacteria can also cause acute bronchitis. Most people have acute bronchitis at some point in their lives.
         Chronic bronchitis, on the other hand, can be mild to severe and is longer lasting — from several months to years. With chronic bronchitis, the bronchial tubes continue to be inflamed (red and swollen), irritated, and produce excessive mucus over time. The most common cause of chronic bronchitis is smoking.
          People who have chronic bronchitis are more susceptible to bacterial infections of the airway and lungs, like pneumonia. (In some people with chronic bronchitis, the airway becomes permanently infected with bacteria.) Pneumonia is more common among smokers and people who are exposed to secondhand smoke.
What Are the Signs and Symptoms?
         Acute bronchitis often starts with a dry, annoying cough that is triggered by the inflammation of the lining of the bronchial tubes. Other symptoms may include:
                             • cough that may bring up thick white, yellow, or greenish mucus
                             • headache
                             • generally feeling ill
                             • chills
                             • fever (usually mild)
                             • shortness of breath
                             • soreness or a feeling of tightness in the chest
                             • wheezing (a whistling or hissing sound with breathing)
             Chronic bronchitis is most common in smokers, although people who have repeated episodes of acute bronchitis sometimes develop the chronic condition. Except for chills and fever, a person with chronic bronchitis has a chronic productive cough and most of the symptoms of acute bronchitis, such as shortness of breath and chest tightness, on most days of the month, for months or years.
              A person with chronic bronchitis often takes longer than usual to recover from colds and other common respiratory illnesses. Wheezing, shortness of breath, and cough may become a part of daily life. Breathing can become increasingly difficult.
In people with asthma, bouts of bronchitis may come on suddenly and trigger episodes in which they have chest tightness, shortness of breath, wheezing, and difficulty exhaling (breathing out). In a severe episode of asthmatic bronchitis, the airways can become so narrowed and clogged that breathing is very difficult.
                        What Causes Bronchitis?
             Acute bronchitis is usually caused by viruses, and it may occur together with or following a cold or other respiratory infection. Germs such as viruses can be spread from person to person by coughing. They can also be spread if you touch your mouth, nose, or eyes after coming into contact with respiratory fluids from an infected person.
Smoking (even for a brief time) and being around tobacco smoke, chemical fumes, and other air pollutants for long periods of time puts a person at risk for developing chronic bronchitis.
            Some people who seem to have repeated bouts of bronchitis — with coughing, wheezing, and shortness of breath — may actually have asthma.
                        What Do Doctors Do?
            If a doctor thinks you may have bronchitis, he or she will examine you and listen to your chest with a stethoscope for signs of wheezing and congestion.
            In addition to this physical examination, the doctor will ask you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues (including whether you smoke). This is called the medical history. Your doctor may order a chest X-ray to rule out a condition like pneumonia, and may sometimes order a breathing test (called spirometry) to rule out asthma.
            Because acute bronchitis is most often caused by a virus, the doctor may not prescribe an antibiotic (antibiotics only work against bacteria, not viruses).
            The doctor will recommend that you drink lots of fluids, get plenty of rest, and may suggest using an over-the-counter or prescription cough medicine to relieve your symptoms as you recover.
In some cases, the doctor may prescribe a bronchodilator (pronounced: bron-ko-dy-lay-ter) or other medication typically used to treat asthma. These medications are often given through inhalers or nebulizer machines and help to relax and open the bronchial tubes and clear mucus so it's easier to breathe.
            If you have chronic bronchitis, the goal is to reduce your exposure to whatever is irritating your bronchial tubes. For people who smoke, that means quitting!
            If you have bronchitis and don't smoke, try to avoid exposure to secondhand smoke.
                      Smoking and Bronchitis
           Tobacco smoke is the cause of more than 80% of all cases of chronic bronchitis. People who smoke also have a much harder time recovering from acute bronchitis and other respiratory infections.
Smoking causes lung damage in many ways. For example, it can cause temporary paralysis of the cilia and over time kills the ciliate airway lining cells completely. Eventually, the airway lining stops clearing smoking-related debris, irritants, and excess mucus from the lungs altogether. When this happens, a smoker's lungs become even more vulnerable to infection. Over time, harmful substances in tobacco smoke permanently damage the airways, increasing the risk for emphysema, cancer, and other serious lung diseases. Smoking also causes the mucus-producing glands to enlarge and make more mucus. Along with the toxic particles and chemicals in smoke, this causes a smoker to have a chronic cough.
                    Prevention
           What's the best way to avoid getting bronchitis? Washing your hands often helps to prevent the spread of many of the germs that cause the condition — especially during cold and flu season.
If you don't smoke, don't ever start smoking — and if you do smoke, try to quit or cut down. Try to avoid being around smokers because even secondhand smoke can make you more susceptible to viral infections and increase congestion in your airway. Also, be sure to get plenty of rest and eat right so that your body can fight off any illnesses that you come in contact with.