I. Definition: Recurrent whistle infections refer to the frequent occurrence of upper and lower whistle infections within one year, beyond the normal range. As children are in the process of growth and development, the respiratory system and immune system is not yet well developed to resist the invasion of pathogens, the ability to resist disease is weak, 5 to 6 (older children 3 to 4) times a year on the whistle infection is common, but too many times the upper and lower whistle infection is abnormal.
Second, determine the conditions.
(1) repeated upper whistle infections with an interval of at least 7 days between infections.
(2) If the number of upper whistle infections is not enough, the number of upper and lower whistle infections can be added together, and vice versa; but if the repeated infections are mainly in the lower whistle, it should be defined as repeated lower whistle infections.
(3) The number of determinations must be observed continuously for 1 year.
(4) Recurrent pneumonia means repeated pneumonia ≥ 2 times in 1 year, pneumonia must be confirmed by pulmonary signs and imaging, pneumonia signs and imaging changes should completely disappear during the diagnosis of two pneumonia.
Third, the etiology of recurrent upper whistle infection analysis and management principles
1, etiology: in general, recurrent upper whistle infections mainly in infants and preschool children, mostly related to improper care, the beginning of child care institutions, lack of exercise, relocation, passive inhalation of fumes, environmental pollution, micronutrient deficiencies or other nutrients with a poor mix of factors; some children with chronic nasopharyngeal lesions; very few children with temporary infant low gammaglobulin or secondary immune deficiency.
2.Management principles.
(1) search for causative factors and give appropriate treatment.
(2) Since most upper whistle infections are viral, antibacterial drugs should not be misused.
(3) attention to nutrition and dietary habits and guidance on strengthening physical fitness.
(4) Proper nursing care.
(5) Good hygiene and prevention of cross-infection.
(6) targeted immune modulation.
3, repeated lower whistle infection etiology analysis and management principles
(1) the etiology of recurrent tracheobronchitis: only confined to the preschool children with recurrent tracheobronchitis – bronchitis, mostly due to repeated upper whistle infections improperly treated, so that the disease spreads downward. A small number of children are associated with primary immune deficiency and airway malformations. Some children have chronic sinusitis-bronchitis syndrome.
Principles of management.
①Search for causative factors and treat accordingly.
Pay attention to the differentiation from bronchial asthma, wheezing bronchitis, recurrent spasmodic laryngitis, bronchiectasis, etc.
③Rational application of antibiotics.
④Symptomatic treatment is the same as recurrent pneumonia.
⑤ Targeted application of immunomodulators.
(6) Treat chronic sinusitis-bronchitis.
(2) Recurrent pneumonia For recurrent pneumonia, in addition to what causative microorganisms must be considered, it is more important to carefully search for the underlying lesions that cause recurrent pneumonia.
Etiology
(1) Primary immunodeficiency diseases: These include primary antibody deficiency diseases, cellular immunodeficiency diseases, combined immunodeficiency diseases, complement deficiency diseases, phagocytosis deficiency diseases, and other primary immunodeficiency diseases.
② Congenital abnormalities of lung parenchyma and pulmonary vascular development.
(③) Congenital abnormal airway development: such as tracheobronchial stenosis, tracheobronchial softening, and tracheobronchial bridges. These malformations often cause obstruction of airway secretions and recurrent pneumonia.
④Congenital heart malformations: various congenital heart diseases, especially the left-to-right shunt type, can cause recurrent pneumonia due to pulmonary stasis.
⑤ Primary ciliary dyskinesia: When the cilia are structurally or functionally impaired, pathogenic microorganisms are retained in the whistle tract due to impaired mucus clearance, which can easily lead to recurrent pneumonia or chronic pneumonia.
(6) Cystic fibrosis: In Western countries, cystic fibrosis is the most common cause of recurrent pneumonia in children.
(vii) Intra-airway obstruction or extra-tubular compression.
(viii) Bronchiectasis: limited or widespread bronchiectasis from various causes can lead to recurrent pneumonia due to impaired clearance of secretions.
⑨ Repeated aspiration: Children with swallowing dysfunction such as mental retardation, delayed cricopharyngeal muscle development, neuromuscular disease, and children with gastroesophageal reflux may have prolonged or recurrent pneumonia due to long-term repeated aspiration.
Differential diagnosis of recurrent pneumonia: diseases that need to be differentiated from recurrent pneumonia: tuberculosis, idiopathic pulmonary ferritinosis, asthma, occlusive bronchitis with mechanized pneumonia (BOOP), eosinophilic pneumonia, allergic alveolitis, etc.
Ancillary tests.
① Otolaryngological examination: certain congenital developmental abnormalities and acute and chronic foci of infection can be detected.
②Pathogenic microbial testing: combined multipathogenic testing should be performed to obtain hints of pathogenic microorganisms.
③Lung CT and airway and vascular reconstruction imaging: can suggest bronchial dilatation, airway narrowing (intraluminal obstruction and extraluminal compression), airway developmental malformations, lung developmental abnormalities, vascular compression, etc.
④Immune function assay: helps to detect primary and secondary immunodeficiency diseases.
⑤ Bronchoscopy (including rigid, fiberoptic and electronic bronchoscopy): it can diagnose foreign bodies, bronchial dilatation, intraluminal obstruction and extraluminal compression of the airway lumen, and abnormal airway development.
(6) Pulmonary function measurements: Ventilation function measurements and bronchial excitation tests and bronchodilatation tests, if necessary, can help identify allergic lower whistle disease; ventilation and diffusion function measurements can help identify certain interstitial lung disorders.
(7) Special tests: If primary ciliary dyskinesia is suspected, mucosal biopsies of the inspiratory tract (nose and bronchi) can be performed to observe cilia structure and function; if cystic fibrosis is suspected, sweat sodium chloride measurement and CFRT gene test can be performed; if recurrent aspiration is suspected, cricopharyngeal muscle function test or 24-hour pH measurement can be performed.