Pertussis (Whooping Cough)
exp date isn't null, but text field is
An acute bacterial respiratory infection characterised by an inspiratory whoop following paroxysmal cough. It is highly contagious with an incubation period of 7-10 days. It is a notifiable disease.
Cause
- Bordetella pertussis, spread by droplet infection
Clinical features
- Stage 1: Coryzal (catarrhal: 1-2 weeks)
- Most infectious stage
- Running nose, mild cough, slight fever
- Stage 2: Paroxysmal (1-6 weeks)
- More severe and frequent repetitive cough ending in a whoop, vomiting, conjuctival haemorrhage
- Fever may be present; patient becomes increasingly tired
- In infants <6 months: paroxyms lead to apnoea, cyanosis (coughing bouts and whoops may be absent)
- Stage 3: Convalescent
- Paroxysmal symptoms reduce over weeks or months
- Cough may persist
Complications may include
- Respiratory: pneumonia (new onset fever a symptom), atelectasis, emphysema, bronchiectasis, otitis media
- Nervous system: convulsions, coma, intracranial haemorrhage
- Others: malnutrition, dehydration, inguinal hernia, rectal prolapse
Differential diagnosis
- Chlamydial and bacterial respiratory tract infection
- Foreign body in the trachea
Investigations
- Clinical diagnosis
- Blood: complete blood count
- Chest X-ray
Management
Treatment
- Maintain nutrition and fluids
- Give oxygen and perform suction if the child is cyanotic
- For the unimmunised or partly immunised, give DPT (three doses) as per routine immunisation schedule
- Isolate the patient (avoid contact with other infants) until after 5 days of antibiotic treatment
- Treatment should be initiated within 3 weeks from onset of cough: Erythromycin 500 mg every 6 hours for 7 days
- Child: 10-15 mg/kg every 6 hours
Note: Cough mixtures, sedatives, mucolytics, and antihistamines are USELESS in pertussis and should NOT be given
Prevention
- Educate parents on the importance of following the routine childhood immunisation schedule
- Ensure good nutrition
- Avoid overcrowding
- Booster doses of vaccine in exposed infants