Pertussis Disease

DESCRIPTION

Pertussis or whooping cough is a highly communicable, respiratory bacterial infection. Characteristically, it produces a paroxysmal spasmodic cough, ending in prolonged high-pitched inspiratory whoop or crow. Transmission is by direct contact and patients are contagious for 3 weeks. Incubation period averages 7 to 14 days (maximum 3 weeks). Usual course - acute, but protracted (lasts 4-12 weeks after catarrhal period).

System(s) affected: Pulmonary
Genetics: N/A
Incidence/Prevalence in USA:
- 1,740 cases per 100,000 people
- Annual average cases – 3,500, with 10 deaths
- Increasing as immunization rates decline
Predominant age: 3 months-6 years (infants comprise about half of the cases)
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

Cough paroxysms
Staccato cough
Mild fever
Rhinorrhea
Anorexia
“Whoop” cough
Apnea, episodic
Posttussive inspiratory gasp
Posttussive emesis

CAUSES

Bordetella pertussis. Bordetella parapertussis and Bordetella bronchiseptica produce a similar, but milder clinical illness.

RISK FACTORS

Unimmunized children
Contact with an infected person
Epidemic exposure
Pregnancy

LABORATORY

ELISA: IgA against Bordetella pertussis
WBC: elevated (15,000–60,000) with marked lymphocytosis
Bordetella pertussis on Bordet–Gengou culture medium

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Focal emphysema
Mucopurulent exudate
Patchy ulceration of respiratory epithelium

SPECIAL TESTS

N/A

IMAGING

Chest x-ray - focal atelectasis, peribronchial cuffing, emphysema

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Hospitalization for seriously ill infants. Outpatient for milder cases.

GENERAL MEASURES

General supportive, skilled nursing care
Isolation and quarantine for 4 weeks; or 1 week after erythromycin is started
Parenteral fluid therapy if needed
Oxygen
Careful observation for apnea in young infants, and avoidance of stimuli that trigger paroxysms
Mechanical ventilation
Nutritional support – may require tube feedings in infants

SURGICAL MEASURES

N/A

ACTIVITY

Rest during active phase in quiet environment

DIET

Encourage extra fluids. May need to provide small frequent meals to assure adequate nutrition.

PATIENT EDUCATION

For patient education materials favorably reviewed on this topic, contact: American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927, (800)433-9016

PREVENTION/AVOIDANCE

Isolate infected persons until treated with erythromycin for 5 days
Active immunization for all infants, usually combined with diphtheria and tetanus toxoids (DPT). Immunization or booster is not recommended after age 6 years.
Erythromycin for susceptible children (under 2 months or unvaccinated) if they are exposed to an infected person during the contagious period

POSSIBLE COMPLICATIONS

Can infect up to 90% of household members who are not immune
Death in infants
Pneumonia
Hypoxic encephalopathy
Coma
Otitis media
Tuberculosis activation
Epistaxis
Hernia
Re-induction of paroxysmal coughing (for several months), especially with upper respiratory infections
Convulsions
Cerebral hemorrhage
Neurologic disorders
Weight loss
Hemoptysis
Atelectasis

EXPECTED COURSE AND PROGNOSIS

Complete recovery

ASSOCIATED CONDITIONS

Otitis media
Bronchopneumonia
Failure to thrive

AGE-RELATED FACTORS

Pediatric: Most serious and highest mortality in infants less than 6 months of age (death usually due to complications)
Geriatric: May be more serious in this age group
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Do not use cough suppressants
Reporting of selected adverse reactions with certain vaccines is required by the National Childhood Vaccine Injury Act of 1986. Toll-free information number: (800) 822-7967.

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.