WHOOPING COUGH AND

DIPHTHERIA
i.sing`ombe
 WHOOPING COUGH
• Definition – it is a specific contagious (infectious) disease
caused by bordetella pertussis which results in fits of
coughing that usually end in prolonged, high pitched
deeply indrawn breath (whoop).
• The disease is caused by bacteria which grow on the
epithelial trachea and bronchus and causes inflammation
of mucous membrane and thick mucous is produced
which the child wants always to get rid of by cough
• Also the bacteria produces an endotoxin which is said to
sensitize nerve endings in the respiratory tract and also
has possible toxic effects on the CNS.
 Cont`
• The cough is a characteristic of the disease and is very
dangerous in babies and the mortality rate is high
• Cause – Bordetella Pertusis
• Transmission – airborne or droplets
• Incubation Period – 7 – 10 days
• Duration of infectivity is from 2 days before onset of cough
until 3 weeks after
• There is no protection through antibodies from the mother.
• Attack usually provide lasting immunity but a second attack
can occur.
 Cont`
• Pathophysiology – symptoms begin on the average 7 –
10 days after exposure to the Pertussis bacteria
• The bacteria invade the lining of the throat and trachea
causing the secretion of mucus
• At first the mucous is thin and changes to thick and sticky
later
• Three stages;
• catarrhal stage (signs of coryza)
• Paroxysmal stage (severe coughing fits)
• and convalescent stage (recovery stage)
 Cont`
• Signs and Symptoms
• Onset is characterized by catarrhal stage lasting for 7 –
14 days in which the child has;
• Coryza, cough, slight pyrexia and highly infectious
• Later the cough gradually becomes more severe
assuming the paroxysmal characteristic
• A prolonged series of violent inspiration during which
the child`s face becomes cyanotic and is followed by a
sudden in drawing of the breath which produces a
typical `Whoop’
 Cont`
• Very often paroxysmal of cough end in
vomiting
• Eyes are bulging, tongue protrudes and
paroxysms may continue until the thick
mucous plug is dislodged
• The paroxysms are usually worse in the night
• In mild cases or babies who are immunized a
typical whoop may be missing
 Cont`
• Clinical picture
• Catarrhal stage/pre-paroxysmal stage
• Lasts 7 -10 days
• Cough, coryza
• Slight fever, irritability
• Restless and red eyes
• Paroxysmal Stage – lasts 2 – 4 weeks
• The cough is intensive and more frequent especially at night
• In a few patients a characteristic whoop develops which consist
of;
a. Long inspiration
 Cont`s
b. A series of 10 – 20 short expiratory coughs
occurring one after the other without an intervening
inspiration and the child becomes cyanosed
c. Long noise inspiration/whoop which is produced
by air being drawn into a partially closed vocal cords
• Vomiting of food or mucous occurs at the end of a
whoop
• A whoop is precipitated by loud noise or bright
light
 Cont`
• Convalescent stage
• It takes about 2 – 3 weeks
• All signs and symptoms subside and the child
feels better
• Temperature is normal, paroxysms of cough
become less severe and soon disappear
• The child starts gaining weight
• New infections e.g. cold can make the condition
worse during this stage
 Cont`
• Investigations
• WBC will raised
• ESR will be raised
• Throat and nasal swab for culture to isolate
the bacteria
• Signs and symptoms will reveal the disease
 Cont`
• Treatment
• In most health children recover from pertussis without treatment
• Erythromycin 40mg/kg QID * 7 days or Penicillins or
Chloramphenicol
• Increase fluid intake
• High calorie diet
• Oxygen therapy
• Antispasmodic Drugs –
• Sedatives – phenobarbitone - dose – 2mg/kg
- Side effects – sedation, ataxia
- No heavy sedation
 Cont`
• Prevention
• DPT vaccination to children aged 6 weeks, three
doses
• Good Nutrition
• Prognosis
• Half of the deaths occur in children below 1 year
and the condition is more serious among children
of the poor and those suffering from malnutrition
 Cont`
• Complications
• Broncho-pneumonia
• Otitis media
• Cerebral anoxia, epilepsy, hemiplegia, mental retardation
• Convulsions
• Hernia
• Rectal prolapse
• Epistaxis or bleeding in the conjunctiva occur during
paroxysmal stage
Thank you
 DIPHTHERIA
• Definition – it is an acute infectious disease caused by
corynabacterium diphtheria or klebs, loeffler bacilus
characterized by;
• Formation of exudate or pseudo-membrane at the sight
of infection
• Constitutional symptoms
• Exotoxins are produced by the bacteria
• Characteristic of the Bacilli
• Gram positive, non motile, non sporulation, rod shaped
and aerobic bacteria
 Cont`
• Transmission – droplets, fecal oral and direct
contact
• It spreads by droplet infection, coughing,
sneezing, talking
• It can also spread by direct contact with a
person with the disease or by the carrier
• Incubation period – 1 – 6 days
 Cont`
• Pathophysiology
• The clinical manifestation depends on the sight of infection,
immune status of the patient, whether the toxins have reached
the blood
• The organism on the entry into the membrane of the respiratory
tract will stay dormant for 2 – 4 days
• Then it stays to produce toxins which will be absorbed in the cell
membrane
• It penetrates the cell and hinders the protein synthesis resulting
in necrosis and death of the cell
• It is associated with inflammation of surrounding cells forming a
diphtheria membrane which is grey in colour and becomes dark.
 Cont`
• The membrane is very adhesive and on
separation it causes bleeding as the result of
edema and the spread of the membrane, there
is respiratory embarrassment
• The toxins will reach the blood stream and
affect other organs e.g. on the kidneys it
causes acute tubular necrosis, on the heart it
causes myocarditis and on the nerves it causes
neuritis between 10 – 37th week
 Cont`
• Signs and Symptoms
• Nasal Diphtheria
• It resembles common cold, nasal discharge which gradually
becomes mucous purulent with foul odour, excoriation of
nostrils and upper lip.
• There is a diphtheria membrane on the upper nasal septum
• This type is relatively mild and occurrs mostly in infants
• Tonsilar and Pharyngeal Diphtheria
• This form or type is more severe.
• There is very poor appetite, malaise, headache, fever and
sore throat
 Cont`
• The child looks ill and toxic after 1 -2 days.
• There is a greyish membrane formed from the tonsils which may go
beyond the tonsils and pharynx
• There is foul smell from the mouth and glands in the neck enlarge and
resemble bulls neck.
• In 7 – 10 days the membrane peels off

• Laryngeal Diphtheria
• The involves the larynx with or without extension to the trachea or
bronchi
• Mechanical obstruction and swelling of the larynx will give rise to noise
breathing, stridor, hoarseness and dry cough
• There is difficult in breathing and later there will be cyanosis and death
may occur due to inability to breath enough air unless the obstruction
is relieved
 Cont`
• Non- Respiratory Infection
• It includes skin lesions, ulcers, umbilical/vulva infection.
• A membrane forms on a skin lesion

• Diagnosis
• History from the patient
• Culture of the throat swab
• Clinical presentation e.g. enlarged tonsils
• ECG if myocarditis is present
• Lumbar puncture – CSF exam, if any signs of neuritis
• Urinalysis to rule out renal failure
 Cont`
• Treatment
• Complete bed rest is essential to prevent heart
complications
• Aspirin and Panado given for fever and headache
• Adequate fluids and diet. Take care when giving
• Procaine Penicillin given immediately when the
diagnosis is made to prevent complications
- Dose – 50mg/kg daily * 10 days
- Side effects – hypersensitivity reaction, fever,
joint pains
 Cont`
• Or Erythromycin
- Dose - 40mg/kg QID * 7 – 10 days
- Side effects – abdominal discomfort, diarrhea, vomiting
• Diphtheria Antitoxin
- Dose – 10 000 – 30 000 iu in mild to moderate cases and
40 000 – 80 000 IU in severe cases
- Route - IV slowly
- Side effects – urticaria, hypotension, dyspnoea, serum
sickness
 Cont`
• Digoxin
- Indication - diphtheria myocarditis
- Dose –
- Side effects – diarrhea, headache, blurred vision
• Prednisolone
- Indication - myocarditis
- Dose - 1mg/kg in divided doses
- Side effects – hypersensitivity reactions
• Tracheostomy may be performed if there is
laryngeal obstruction
 Cont`
• Prevention
• Isolation of cases
• Immunization of the child

• Complications
• Diphtheria myocarditis leading to heart failure
• Nerve paralysis – the soft palate may get paralyzed resulting
in difficult in swallowing, nasal voice and regurgitation of
fluids through the nose
• Blurring of vision and squint
• Respiratory obstruction, neuritis and nephritis