Page 65 - Learnwell EVS
P. 65
oping cough (pertussis)
Whooping cough (pertussis)
W h ooping coug h is a h ig h ly contag ious bacterial infection of th e low er respiratory
tract, of prolong ed d uration, d ue to Bordetella pertussis.
B. pertussis is transm itted th roug h inh alation of d roplets spread by infected ind iv id uals
(coug h ing , sneezing ).
T h e m ajority of cases arise in non-v accinated or incom pletely v accinated ind iv id uals.
W h ooping coug h affects all ag e g roups. Sig ns and sym ptom s are usually m inor in
ad olescents and ad ults. A s a result th e infection m ay be ig nored , th us contributing to
th e spread of B. pertussis and infection in infants and young ch ild ren, in w h om th e
illness is sev ere.
Clinical features
A fter an incubation period of 7 to 1 0 d ays, th e illness ev olv es in 3 ph ases:
– C atarrh al ph ase ( 1 to 2 w eeks) : coryza and coug h . A t th is stag e, th e illness is
ind isting uish able from a m inor upper respiratory infection.
– P aroxysm al ph ase (1 to 6 w eeks):
• T ypical presentation: coug h of at least 2 w eeks d uration, occurring in ch aracteristic
bouts (paroxysm s), follow ed by a laboured inspiration causing a d istinctiv e sound
(w h oop), or v om iting . F ev er is absent or m od erate, and th e clinical exam is norm al
betw een coug h ing bouts; h ow ev er, th e patient becom es m ore and m ore fatig ued .
• A typical presentations:
- Infants und er 6 m onth s: paroxysm s are poorly tolerated , w ith apnoea, cyanosis;
coug h ing bouts and w h oop m ay be absent.
- A d ults: prolong ed coug h , often w ith out oth er sym ptom s.
• C om plications:
- M ajor: in infants, second ary bacterial pneum onia ( new - onset fev er is an
ind icator); m alnutrition and d eh yd ration trig g ered by poor feed ing d ue to coug h
and v om iting ; rarely, seizures, enceph alopath y; sud d en d eath .
- M inor: subconjunctiv al h aem orrh ag e, petech iae, h ernias, rectal prolapse
– C onv alescent ph ase: sym ptom s g rad ually resolv e ov er w eeks or m onth s.
Management and treatment
Suspect cases
– R outinely h ospitalise infants less th an 3 m onth s, as w ell as ch ild ren w ith sev ere cases.
I nfants und er 3 m onth s m ust be m onitored 2 4 h ours per d ay d ue to th e risk of
apnoea.
– W h en ch ild ren are treated as outpatients, ed ucate th e parents about sig ns th at sh ould
lead to re- consultation ( fev er, d eterioration in g eneral cond ition, d eh yd ration,
m alutrition, apnoea, cyanosis).
– R espiratory isolation (until th e patient h as receiv ed 5 d ays of antibiotic treatm ent):
• at h om e: av oid contact w ith non-v accinated or incom pletely v accinated infants;
• in cong reg ate setting s: exclusion of suspect cases;
• in h ospital: sing le room or g rouping tog eth er of cases aw ay from oth er patients
(coh orting ).
60
Whooping cough (pertussis)
W h ooping coug h is a h ig h ly contag ious bacterial infection of th e low er respiratory
tract, of prolong ed d uration, d ue to Bordetella pertussis.
B. pertussis is transm itted th roug h inh alation of d roplets spread by infected ind iv id uals
(coug h ing , sneezing ).
T h e m ajority of cases arise in non-v accinated or incom pletely v accinated ind iv id uals.
W h ooping coug h affects all ag e g roups. Sig ns and sym ptom s are usually m inor in
ad olescents and ad ults. A s a result th e infection m ay be ig nored , th us contributing to
th e spread of B. pertussis and infection in infants and young ch ild ren, in w h om th e
illness is sev ere.
Clinical features
A fter an incubation period of 7 to 1 0 d ays, th e illness ev olv es in 3 ph ases:
– C atarrh al ph ase ( 1 to 2 w eeks) : coryza and coug h . A t th is stag e, th e illness is
ind isting uish able from a m inor upper respiratory infection.
– P aroxysm al ph ase (1 to 6 w eeks):
• T ypical presentation: coug h of at least 2 w eeks d uration, occurring in ch aracteristic
bouts (paroxysm s), follow ed by a laboured inspiration causing a d istinctiv e sound
(w h oop), or v om iting . F ev er is absent or m od erate, and th e clinical exam is norm al
betw een coug h ing bouts; h ow ev er, th e patient becom es m ore and m ore fatig ued .
• A typical presentations:
- Infants und er 6 m onth s: paroxysm s are poorly tolerated , w ith apnoea, cyanosis;
coug h ing bouts and w h oop m ay be absent.
- A d ults: prolong ed coug h , often w ith out oth er sym ptom s.
• C om plications:
- M ajor: in infants, second ary bacterial pneum onia ( new - onset fev er is an
ind icator); m alnutrition and d eh yd ration trig g ered by poor feed ing d ue to coug h
and v om iting ; rarely, seizures, enceph alopath y; sud d en d eath .
- M inor: subconjunctiv al h aem orrh ag e, petech iae, h ernias, rectal prolapse
– C onv alescent ph ase: sym ptom s g rad ually resolv e ov er w eeks or m onth s.
Management and treatment
Suspect cases
– R outinely h ospitalise infants less th an 3 m onth s, as w ell as ch ild ren w ith sev ere cases.
I nfants und er 3 m onth s m ust be m onitored 2 4 h ours per d ay d ue to th e risk of
apnoea.
– W h en ch ild ren are treated as outpatients, ed ucate th e parents about sig ns th at sh ould
lead to re- consultation ( fev er, d eterioration in g eneral cond ition, d eh yd ration,
m alutrition, apnoea, cyanosis).
– R espiratory isolation (until th e patient h as receiv ed 5 d ays of antibiotic treatm ent):
• at h om e: av oid contact w ith non-v accinated or incom pletely v accinated infants;
• in cong reg ate setting s: exclusion of suspect cases;
• in h ospital: sing le room or g rouping tog eth er of cases aw ay from oth er patients
(coh orting ).
60
