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Pertusis Lecture

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18 views13 pages

Pertusis Lecture

Uploaded by

DR MOHAMED HEALTH CHANNEL
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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PERTUSSIS=QIIX

DHEER

Dr.Ciise warsame
PERTUSSIS (WHOOPING COUGH)

Cough of 100 days

Whooping cough: whooping sound made when


gasping for air after a fit of coughing
INTRODUCTION

 A highly contagious acute bacterial infection caused by the


bacilli Bordetella pertussis
 Currently worldwide prevalence is diminished due to active
immunization(vaccine preventable disease)
 However it remains a public health problem among older
children and adults
 It continues to be an important respiratory disease afflicting
unvaccinated infants and previously vaccinated children and
adults (waning immunity)
EPIDEMIOLOGY

 Transmission: through the respiratory route in the form of


droplet infection
 Adolescents and adults are the reservoir.
 No animal or insect reservoir
 A highly communicable disease.
 SARS 80% among households contacts
 In the catarrhal stage and 2 weeks after the onset of cough
ETIOLOGY

 Bordetella pertussis – aerobic gram-negative


coccobacilli
 Produces toxins namely pertussis toxin,
filamentous hemagglutinin, hemolysin, adenylate
cyclase toxin, dermonecrotic toxin and tracheal
cytotoxin- responsible for clinical features (toxin
mediated disease) and the immunity
PATHOGENESIS
CLINICAL MANIFESTATIONS

 Incubation period: 7-10 days


 Infection lasts for 6 weeks – 10 weeks
 Stage I (catarrhal stage; 1-2 weeks): insidious onset of
coryza, sneezing, low grade fever and occasional cough
 Stage II (paroxysmal cough stage; 1-6 weeks): due to
difficulty in expelling the thick mucous form the
tracheobronchial tree
 At the end of paroxysm long inspiratory effort is followed by
a whoop
 In between episodes child look well. During episode of cough
the child may become cyanosed, followed by vomiting,
exhaustion and seizures
CLINICAL MANIFESTATIONS

 Cough increase for next 2-3 weeks and decreases over next 10
weeks
 Absence of whoop and/or post-tussive vomiting does not rule
out clinical diagnosis of pertussis
paroxysmal cough>2 weeks with or without whoop and/or
post-tussive vomiting is the hallmark feature of pertussis
 Stage III (convalecence stage): period of gradual recovery
even up to 6 months
COMPLICATIONS

1. Secondary pneumonia (1 in 5) and apneic spells (50%;


neonates and infant<6 months of age)
2. Neurological complications: seizures (1 in 100) and
encephalopathy (1 in 300) due to the toxin or hypoxia or
cerebral hemorrhage.
3. Differential diagnosis:
1. B. parapertussis, adenovirus, mycoplasma pneumonia, and
chlamydia trachomatis
2. Foreign body aspiration, endobronchial tuberculosis and
a mass pressing on the airway
DIAGNOSIS

1. Suspected on the basis of history and clinical examination


and is confirmed by culture, genomics or serology
2. Elevated WBC count with lymphocytosis. The absolute
lymphocyte count of ≥20,000 is highly suggestive
3. Culture: gold standard specially in the catarrhal stage. A
saline nasal swab or swab from the posterior pharynx is
preferred.
TREATMENT

1. Avoidance of irritants, smoke, noise and other cough


promoting factors
2. Antibiotics: effective only if started early in the course of
illness. Erythromycin (40-50 mg/kg/day 6 hrly orally for 2
weeks or Azithromycin 10 mg/kg for 5 days in children<6
months and for children>6 months 10 mg/kg on day 1,
followed by 5mg/kg from day2-5 or Clarithromycin 15
mg/kg 12 hrly for 7 days
3. Supplemental oxygen, hydration, cough mixtures and
bronchodilators (in individual cases)
PREVENTION

 All household contacts should be given erythromycin for 2


weeks
 Children <7 years of age not completed the four primary dose
should complete the same at the earliest
 Children <7 years of age completed primary vaccination but
not received the booster in the last 3 years have to be given a
single booster dose
 VACCINE
PREVENTION

VACCINE:
 DPT vaccine: 3 primary doses starting at 6 weeks of age

 1st booster at 16-18 months of age, 2nd booster at 5 years of

age
 At 10 years of age Tdap/Td followed by Td every 10 years

 Catch-up vaccination:

 Below 7 years: DPT at 0,1 and 6 months

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