Частые ОРЗ у детей. Системный подход. Статья февраль 2009 (англ.)

[Наталья П.]

Pediatric Clinics of North America, Volume 56, Issue 1, February 2009
пдф 347 кб

System Based Approach
Recurrent Respiratory Infections
Andrew Bush MBBS (Hons), MA, MD, FRCP, FRCPCH,

Imperial School of Medicine at National Heart and Lung Institute, London, UK
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK


Available online 8 January 2009.

The child who has recurrent infections poses one of the most difficult diagnostic challenges in pediatrics. The clinician faces a two-fold challenge in determining first whether the child is normal or has a serious disease, and then, in the latter case, how to confirm or exclude the diagnosis with the minimum number of the least invasive tests. It is hoped that, in the absence of good-quality evidence for most clinical scenarios, the experience-based approach described in this article may prove a useful guide to the clinician.

Keywords: Pneumonia; Croup; Otitis media; Immunodeficiency; Cystic fibrosis; Primary ciliary dyskinesia; Human immunodeficiency virus; Gastro-esophageal reflux

Article Outline

Clinical scenarios: upper airway
Recurrent Viral Colds
Recommendations
Rhinitis
Recommendations
Recurrent Tonsillitis and Pharyngitis
Recommendations
Sinusitis
Recommendations
Recurrent Acute and Chronic Otitis Media with Effusion
Recommendations
Croup and other Causes of Acute Upper Airway Obstruction
Recommendations
Further investigations in upper airway obstruction
Recommendations for further investigations

Clinical scenarios: lower airway
Chronic, Usually Productive Cough
Recommendations
Recurrent Wheezing Lower Respiratory Tract Infection
Airway sounds that are not true wheeze
Episodic (viral) wheeze
Multi-trigger wheeze
Recommendations
Recurrent Radiologic Shadowing
Recurrent radiologic shadowing in the same place
Recommendations
Other recurrent focal abnormalities in a single site
Recommendations
Recurrent multifocal radiologic shadowing
Recommendations

Diagnosing specific conditions presenting as chronic or recurrent acute on chronic productive cough
Cystic Fibrosis
Recommendations
Primary Ciliary Dyskinesia
Recommendations
Idiopathic Bronchiectasis
Recommendations
The Special Problems of Congenital and Acquired Immunodeficiency
Tuberculosis

Summary
References