pertussis
TRANSCRIPT
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Dr Rai Muhammad Asghar Professor of Paediatrics
RGH Rawalpindi
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PERTUSSIS
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Pertussis
(Whooping Cough)
* Pertussis : Intense Cough
* Highly Infectious disease
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Etiology:
* Bordetella Pertussis
* B.Parapertussis
* B. Bronchiseptica
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Epidemiology:* World wide
* 1922-1948--- leading causes of death
* Endemic---Epidemic cycles
* Extremely contagious-attack rate 100%
* Immunity is never complete
* Protection begins to wane in 3-5 yrs after vaccination
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* Unmeasurable after 12 yrs
* Adolescents & adults are major Reservoir
* Age : 1-5 yrs
* Incubation period : 7-10 days
* Infectivity : first 4 weeks
* Transmission by droplet
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Pathophysiology:* B. Pertussis produces many biologically active substances
* Inflammation of respiratory mucosa
* Patchy necrosis
* Tenacious mucopurulant exudate
* Bronchiolar obstruction : Atelectasis, Bronchiectasis
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Clinical Features:
* Pertussis is a 6 weeks disease * CATARRHAL STAGE (1-2 WKS)* Nonspecific features* Congestion, Rhinorrhoea* Sneezing* Lacrimation, Conjunctival redness* Low grade fever, mild cough
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Paroxysmal Stage ( 2-4 wks)* Cough is first dry & intermittent* Inexorable paroxysm * Machine-gun burst of uninterrupted cough* Series of coughing in single expiration* Eyes bulging—watering* Chin & Chest held forward* Tongue protruding maximally
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* Face-Red-Blue
* Whoop at the end of paroxysm
* Post tussive emesis
* Number & Severity of Paroxysm progress over days to weeks
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Infants < 3 months* No classical stages* well appearing infants begins to choke * Gasp & flail extremities * Reddend face * Cough may not be prominent * Woop infrequent
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* Immunized children have fore-shortening of all stages
* Adults have no distinct stages
* Number & severity of paroxysm progress & remain at that plateau
* Physical examination is unremarkable
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Convalescent Stage ( 1-2 wks)
* Episodes of cough becomes less frequent
* Less severe
* Paroxysms of whooping disappear
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Diagnosis:
*Clinical DiagnosisParoxysmal stage
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* Suspect if predominant complaint is cough especially following are absent
- Fever- Malaise, Myalgias - Rash- Sore throat- Hoarseness- Tachypnea- Wheeze- Crepitations/ Rales
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Investigations:
1. Blood Count Absolute Lymphocytosis
(15,000-100,000 cells/mm3)
2. Flourescent antibody staining
3. Cultures:Nasopharyngeal aspirate
4. X-Ray chest
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Complications:
1. Respiratory
2. Sequelae of forceful cough
3. CNS
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1.Respiratory
- Apnea- Bronchopneumonia- Atelectasis- Bronchiectasis- Emphysema—Interstitial / Subcutaneous- Otitis media - Reactivation of quiescent tuberculosis
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2. Sequelae of forceful cough
- Epistaxis, sub-conjunctival hemorrhage
- Intracranial Bleeding
- Rectal prolapse, umbilical hernias
- Dehydration, Malnutrition
- Tetany
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3. CNS
- Convulsions…..Hypoxemia, Hemorrhage
- Encephalopathy
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Treatment: Specific
* Erythromycin 40-50 mg/kg/day for 14 d
* Clarithromycin 15 mg/kg for 7 d
*Azithromycin 10 mg/kg for 5 d
* Ineffective if given in paroxysmal stage
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General Measures* Young infants should be hospitalized
* Adequate hydration, Nutrition
* Oxygen
* Gentle suction
* Cough syrup have no role
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Prevention:* Pertussis vaccine is part of DPT vaccine
* All household contacts should get Erythromycin for 14 days
* Close contacts < 7 yr should get booster
* If documented pertussis infection exempt from routine pertussis vaccination
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Thank You