CHILD PERTUSSIS

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Pertussis is most severe in young infants who have not yet been immunized. After an incubation period of 7–10 days, the child has fever, usually with a cough and nasal discharge that are clinically indistinguishable from the common cough and cold. In the second week, there is paroxysmal coughing that can be recognized as pertussis. The episodes of coughing can continue for 3 months or longer. The child is infectious for up to 3 weeks after the onset of bouts of whooping cough.

Diagnosis

Suspect pertussis if a child has had a severe cough for more than 2 weeks, especially if the disease is known to be occurring locally.

Diagnostic signs are:

  • Paroxysmal coughing followed by a whoop when breathing in, often with vomiting
  • Subconjunctival haemorrhages
  • Child not vaccinated against pertussis
  • Young infants may not whoop; instead, the cough may be followed by suspension of breathing (apnoea) or cyanosis, or apnoea may occur without coughing.
  • Also examine the child for signs of pneumonia, and ask about convulsions.

Treatment evaluation

  • Treat mild cases in children aged ≥ 6 months at home with supportive care
  • Admit infants aged < 6 months to hospital
  • Admit any child with pneumonia, convulsions, dehydration, severe malnutrition or prolonged apnoea or cyanosis after coughing

Pharmacological treatment

Antibiotics

Erythromycin oral

 (12.5 mg/kg four times a day) for 10 days.

Note: This does not shorten the illness but reduces the period of infectiousness.

OR

Azithromycin

10 mg/kg (maximum, 500 mg) on the first day, then 5 mg/kg (maximum, 250 mg) once a day for 4 days.

 

Oxygen

  • Give oxygen to children who have spells of apnoea or cyanosis, severe paroxysms of coughing or low oxygen saturation ≤ 90% on a pulse oximeter.

Supportive treatment

  • Avoid, as far as possible, any procedure that could trigger coughing, such as application of suction, throat examination or use of a nasogastric tube (unless the child cannot drink).
  • Do not give cough suppressants, sedatives, mucolytic agents or antihistamines.
  • If the child has fever (≥ 39 °C, ≥ 2 °F) that appears to be causing distress, give paracetamol.
  • Encourage breastfeeding or oral fluids
  • If there is severe respiratory distress and maintenance fluids cannot be given through a nasogastric tube because of persistent vomiting, give IV fluids to avoid the risk of aspiration and avoid triggering coughing.
  • Ensure adequate nutrition by giving small, frequent feeds. If there is continued weight loss despite these measures, feed the child by nasogastric tube.

Complications

Pneumonia

  • This is the commonest complication of pertussis and is caused by secondary bacterial infection or inhalation of vomit. Signs suggesting pneumonia include fast breathing between coughing episodes, fever and the rapid onset of respiratory distress.

Convulsions

  • These may result from anoxia associated with an apnoeic or cyanotic episode or toxin-mediated encephalopathy. If a convulsion does not stop within 2 min, give diazepam, following the guidelines.

Malnutrition

  • Children with pertussis may become malnourished as a result of reduced food intake and frequent vomiting. Prevent malnutrition by ensuring adequate feeding

Haemorrhage and hernias

  • Subconjunctival haemorrhage and epistaxis are common during pertussis. No specific treatment is needed.
  • Umbilical or inguinal hernias may be caused by violent coughing. Do not treat them unless there are signs of bowel obstruction, but refer the child for surgical evaluation after the acute phase.

Public health measures

  • Give DPT vaccine to any child in the family who is not fully immunized and to the child with pertussis.
  • Give a DPT booster to previously vaccinated children.
  • Give erythromycin estolate (12.5 mg/kg four times a day) for 10 days to any infant in the family who is < 6 months old and has fever or other signs of a respiratory infection.