Pertussis or Whooping Cough in children

1. Pertussis
Whooping Cough
Epidemiology, Etiology
Clinical Features, Complications, Management
Prognosis and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. (God speaking to Prophet Muhammad (PBUH)
And, in fact, You have a great moral character
Al Quran surah Qalam 68:5

3. Case scenario
• A four year old child presents with cough for the last 20
days. Mother says cough comes in bouts many times and
the child is exhausted. Vomiting frequently occurs following
cough. Child has lost weight.
• Child’s vaccinations were incomplete.
• Similar disease has been present in other children of the
family.
• On examination, child temperature is 99 F. No abnormal
finding is detected on chest examination
• What is your diagnosis ?

4. Causes of Persistent Cough in Children
• Allergic rhinitis
• Asthma
• Chronic bronchitis
• Whooping Cough
• Tuberculosis
• Foreign body bronchus
• GERD
• Cystic fibrosis
• Immunodeficiency
• Ciliary dyskinesia
• Habit cough

5. Pertussis
WHOOPING COUGH

6. Epidemiology
• Highly contagious
• Can affect all ages
• Spreads from clinical or subclinical Patients to
unvaccinated susceptible children and adults
• Transmission – DROPLET infection
• INCUBATION PERIOD - 3 – 12 days

7. Etiology and Pathogenesis
• Caused by Bordetella pertussis (G –ve small bacilli)
• Toxins produce local damage to respiratory mucosa
• Produces exudative inflammation, with predominantly
lymphocytic infiltration
• Necrosis of respiratory epithelium with obstruction of
bronchioles

8. Etiology and Pathogenesis

9. Clinical Features

10. Pertussis (Whooping Cough)
• Usually lasts 6 weeks or more
• Clinical features may be divided in 3 stages
• Catarrhal stage
• Paroxysmal stage
• Convalescent stage
• Distinct stages may not be seen in younger children

11. Catarrhal stage
• Lasts for 1 - 2 weeks
• Low to moderate fever
• Malaise
• Runny nose
• Red eyes, lacrimation
• Cough

12. Paroxysmal stage
• Lasts for 2 – 4 weeks
• Dry cough coming in bouts every few hours
• Each paroxysm lasting 1 - 2 minutes
• Paroxysm of cough followed by one of the following:
– Vomiting
– Inspiratory whoop
– Apnea
– Seizures (due to hypoxia)
• Sub-conjunctival hemorrhage and ecchymosis around
eyes can occur

13. Convalescent stage
• After about 1 - 2 weeks
• Bouts of coughing decrease
• Symptoms gradually subside
• Child recovers in 1 - 2 weeks

14. Pertussis (Whooping Cough)
clinical diagnosis
• COUGH lasting for more than 2 weeks
• Bouts of cough
• Presence of one of the following
– Vomiting
– Inspiratory whoop
– apnea

15. DIAGNOSIS
• COUGH lasting for more than 2 weeks
• Bouts of cough
• Presence of any of the following with cough –
– Vomiting
– Inspiratory whoop
– apnea
• Sub-conjunctival hemorrhage and ecchymosis around
eyes

16. Investigations
• CBC - Absolute lymphocytosis
– TLC 15000 - 50000
– Polys – 30 %
– Lymphos – 70 %
• X-ray Chest – peri-hilar infiltrates
• Microbiological diagnosis - Culture of Nasopharyngeal
swab / Respiratory secretions

17. COMPLICATIONS
• Hemorrhagic manifestations (increased venous pressure)
– Epistaxis
– Petechiae on face
– Sub-conjunctival hemorrhage
– Periorbital ecchymosis
– Intracranial hemorrhage
• Lung complications
– Bronchopneumonia
– Atelectasis / collapse
– Pneumothorax
– Bronchiectasis
• Apnea (in infants)
• Malnutrition

18. MANAGEMENT
• Supportive management –
• Hydration - extra fluids
• Nutrition – small frequent feeds
• Symptomatic management –
• Bronchodilators ?
• Cough suppressants ?
• Specific management – Macrolide Antibiotics
– Erythromycin OR Clarithromycin OR Azithromycin
• Hospitalization (for infants)

19. Prognosis
• Child remains sick for weeks
• Death can occur in infants

20. PREVENTION
• Pertussis vaccine (DPT, Penta)
– (killed whole-cell bacteria)
– Causes local pain and fever
• Acellular pertussis vaccine (DTaP)
– (inactivated pertussis toxin)
– Reduced adverse effects

21. Vaccination schedule
• Given as DTP vaccine / DTaP
• Three doses - 6, 10, 14 weeks
• Booster doses at 18 months and 5 years

22. Thank You