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Detailed information of PERTUSSIS (WHOOPING COUGH)
PERTUSSIS (WHOOPING COUGH)
DEFINITION:
An acute bacterial infection of the lower respiratory tract
characterized by a paroxysmal cough.
EPIDEMIOLOGY:
- prevalence: 10/100,000
- age of onset:
- all, but 50% before 2 years and 35% before 6 months of age
- risk factors:
- endemic and epidemic every 2-4 years
- non-immunized children
- history of contact
PATHOGENESIS:
- Bordetella pertussis (gram negative bacilli)
2. Pathogenesis
- spread: airborne droplet
- incubation period: 6 to 20 days and usually 7-10 days
- infectivity: 1 week before the onset of the paroxysmal cough
and 3 weeks after (maximal in Catarrhal Stage)
- duration of illness: 6-10 weeks in uncomplicated cases
- a whooping cough syndrome may also be caused by:
- Bordetella parapertussis - adenoviruses 1,2, & 5
- Bordetella bronchiseptica - CMV
- Chlamydia trachomatis
CLINICAL FEATURES:
- lasts 7-10 days
- prodrome of mild upper respiratory tract symptoms:
- anorexia and listlessness
- cough - hacking and nocturnal
- coryza and rhinorrhea
- inflammed mucous membranes
- insidious and most contagious stage
2. Paroxysmal Stage
- lasts a mean of 10-14 days but can last up to 6-10 weeks
- paroxysmal cough
- characterized by 5-15 rapid coughs followed by a
characteristic inspiratory whoop, a few normal breaths and
then more of the same (chronic cough)
- paroxysms initially occur at night and then become more
frequent during the day (5-50 episodes per day)
- the face may become suffused or cyanotic during an episode
- paroxysms of coughing often end in vomiting
- may be associated with copious amounts of viscid fluid
leading to aspiration and vomiting
- fever absent or minimal
3. Convalescent Stage
- lasts 2-4 weeks and sometimes months
- paroxysmal cough
- not as frequent or severe as in the paroxysmal stage
- symptoms gradually wane but may last for 6 months
- with each URI for up to a year after the acute infection,
many children will develop a pertussis-like cough
4. Atypical Manifestations
- less than 6 months of age
- may present with apnea with no inspiratory whoop
2. Older Children and Adults
- persistent cough and no inspiratory whoop
- disease in older children and those vaccinated is often
milder
5. Complications*
- seizures (+/- intracranial bleeds)
- encephalopathy (seizures and mental retardation)
2. Respiratory
- apnea, cyanosis,
- pneumonia (aspiration, atelectasis, consolidation)
3. Gastrointestinal
4. Others
- inguinal hernia
- nose bleeds
- subconjunctival hemorrhages
- secondary bacterial infections (otitis media, sinusitis)
5. Death
- increased mortality in those less than 2 years of age
- case-fatality rate is 0.5% in those less than 6 months
INVESTIGATIONS
- culture is positive in only 80% of cases
- most frequently positive in the catarrhal or early
paroxysmal stages and rarely found after the 4th week of
illness
- rapid direct immunofluorescence testing has variable
sensitivity and specificity
2. Imaging Studies
3. Serum
- CBC - lymphocytosis a nonspecific finding
MANAGEMENT:
- aim is to prevent spread of infection to other family
members as the effect on the severity and duration of the
illness is minor
- all family members with children under the age of 7 should
also be treated
- 40-50 mg/kg/d po qid (max. 2gm/d) x 14 days
2. Trimethoprim-Sulfamethoxazole (Septra)
- 2.5 cc po bid (less than 2 years)
- 2.5-5.0 cc po bid (2-5 years)
- 5-10 cc po bid (6-12 years)
2. Hospitalization
- for supportive care for those with severe illness and
complications, i.e., apnea moniter, feeding difficulties,
oxygen, periodic gentle nasal suctioning, hydration
- should be placed in respiratory isolation for 5 days after
initiation of antibiotic therapy
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Pediatric Database - PERTUSSIS (WHOOPING COUGH)
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