Petussis in children, diagnosis, symptoms ,vaccination and treatment.

1. (Whooping cough)
By; Dr Yusuf Imran
Dept. of Pediatrics
J.N Medical College
AMU (INDIA)

2.  Pertussis is an acute respiratory tract infection
caused by Bordetella pertussis
 Characterized by intense spasmodic cough
"whoop.“
 Sydenham first used the term pertussis (intense
cough) in 1670
 worldwide prevalence is decreased by active
immunization

3.  Continues to be public health concern even in
countries with high immunization coverage
 About 1.29 lac cases were reported to WHO
globally, in 2010
 In India ,marked decline in incidence occurred
after launch of UIP ( 1.63 lac cases in 1987 vs
only 39,091 cases in 2011; 76% decrease)

4.  DROPLETS
 Highly contagious,almost 100% in susceptible
host(under fives)
Undiagnosed adults may be a source when source
is not obvious
Do not survive in dust for too long

5.  Bordetella pertussis is the sole cause of epidemic pertussis
and usual cause of sporadic pertussis
 B. parapertussis is an occasional cause ( fewer than 5% of
cases )
 These two are exclusive human pathogen (and for some
primates)
 B. bronchiseptica is common animal pathogen
 Pertussoid syndrome : protracted coughing can also be
caused by Mycoplasma, parainfluenza or influenza viruses,
enteroviruses, RSV & adenoviruses.

6. A E R O S O L A C Q U I S I T I O N O F B
P E R T U S S I S
A T T A C H T O R E S P I R A T O R Y E P I T H .
C E L L S W I T H S U R F A C E
F I L A M E N T O U S H E M A G G L U T I N I N
( F H A ) , F I M B R I A E ( T Y P E S 2 A N D 3 ) &
P E R T A C T I N
P R O D U C E T R A C H E A L C Y T O T O X I N ,
A D E N Y L A T E C Y C L A S E A N D
P E R T U S S I S T O X I N ( P T ) W H I C H
D A M A G E L O C A L E P I T H E L I U M &
E X E R T V A R I O U S B I O L O G I C
A C T I V I T I E S

7. Classically pertussis is divided into :
 catarrhal stage- begins after an incubation period
of 3-12 days with symptoms of congestion,
rhinorrhea , low-grade fever, sneezing,
lacrimation, and conjunctivitis (last 1-2wks)
 Paroxysmal stage- dry, intermittent, irritative
cough characterized by whoop(forceful inspiratory
gasp) infrequently occurs in infants <3 mo .Post-
tussive emesis is common (lasts for 2-6 wks )
 convalescent stage- no. & severity of episodes
decreases over next 1-4 weeks

8. Goals of therapy :
 Supportive- give oxygen if cyanosed, proper
nutrition, rest, hydration & avoid stimulation
 salbutamol (albuterol) – nebulization may alleviate
symptom(cough suppressants are contraindicated)
 Antimicrobial Agents –
1)Erythromycin (40-50 mg/kg/24 hr divided qid)
for 14 days is standard treatment
2)Clarithromycin , azithromycin & co-
trimoxazole are useful alternatives

9.  Patients placed in respiratory isolation for ≥5d
 Chemoprophylaxis: Erythromycin for 14 days should
be given to all household and other close contacts
 Close contacts <7 yr of age who have received less than
four doses of pertussis vaccines should have
vaccination initiated or continued
 Prevention : Universal immunization of children <7 yr
of age , beginning in infancy, is central to the control of
pertussis
 Combination acellular pertussis (DTaP) vaccines are
preferred over those containing whole-cell pertussis
(DTP) vaccines because of fewer adverse reactions

11. The principal complications of pertussis are
 Respiratory complications eg a) bronchieactasis
b) secondary infections ( otitis media,pneumonia)
c) atelectasis ,emphysema &pneumothorax
 Sequelae of forceful coughing :(raised pressure)
- conjunctival and scleral hemorrhages
- petechiae on the upper body, epistaxis
- hemorrhage in the CNS and retina

12. -umbilical and inguinal hernias
-rectal prolapse
 Neurological complications :
-seizures( several reasons)
-encephalopathy
 Malnutrition due to persistent vomiting &
reduced appetite
 Flare up of tuberculosis(decrease CMI)

13.  Those <2 mo of age have the highest reported rates of
pertussis-associated complications like-
 apnea
 pneumonia(25%)
 seizures (4%)
 encephalopathy (1%)
 and death (1%)
and so hospitalized in 82% case
 Apnea, cyanosis, and secondary bacterial pneumonia
are events precipitating intubation and ventilation
 The need for intensive care and artificial ventilation is
usually limited to infants <3 months