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Dictionary The Respiratory System

Whooping cough

Synonyms :  Pertussis

Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs,

    Whooping cough is an acute, highly infectious disease caused by gram-negative bacteria Bordetella pertussis, which spread by droplets. Clinical diagnosis in the early and most infectious stage is virtually impossible so that epidemics occur. Whooping cough occurs at all ages but approximately 90% of cases are children under 5 years of age, and 40% are under 6 months of age. Children usually acquire the disease from asymptomatic family contacts. Adults who have mild respiratory illness, not recognised as pertussis, frequently are the source of infection. The incubation period is 7-14 days. B. pertussis invades the mucosa of the nasopharynx, trachea, bronchi and bronchioles.

Clinical features:  < BACK TO TOP >

           The disease develops through three distinct stages.

           The first stage is a highly infectious upper respiratory catarrh that begins insidiously and lasts about 1 week during which conjunctivitis (lacrimation), rhinitis (runny nose, sneezing) and an unproductive troublesome cough are present. Fever is rare.

           The distinctive paroxysmal stage follows and is characterised by severe bouts of coughing.

           The number of such paroxysms in 24 hours varies from an occasional attack to 40 to 50 and they are more severe at night.

           Each paroxysm consists of a succession of short sharp coughs (5-15) ending in a deep inspiration during which the characteristic whoop may be heard.

           It may be absent in older children and in adults because the air passages are much wider.

           Coughing is accompanied by cyanosis, sweating and exhaustion, and frequently copious amounts if viscid sputum may be expelled.

           The last paroxysm of a series frequently ends with vomiting.

           The paroxysmal stage lasts from one to several weeks and is followed by the stage of convalescence during which the cough becomes less frequent and the sputum less tenacious.

    Complications:

           Bronchopneumonia, resorption atelectasis (mucous plug obstruction of a bronchiole), bronchiectasis, conjunctival haemorrhage, haemorrhage in the brain, oedema of the brain (probably due to hypoxia).

Diagnosis:  < BACK TO TOP >

           It is very difficult in the catarrhal stage when the disease is most infectious, but it is easier in the paroxysmal stage when the whoop has developed.

           Bordetella pertussis can be isolated from the posterior wall of the nasopharynx in 90% of cases.

           Specific fluorescent antibody testing of nasopharyngeal smears accurately diagnoses pertussis but is not as sensitive as culture.

           Examination of the blood shows marked leukocytosis (15-20 x 109/L) with 70-80% lymphocytes (sometimes this lymphocytosis is not seen in mild cases).

Management  < BACK TO TOP >

           Pertussis is serious in children younger than 2 with the mortality rate of around 1-2% (deaths are caused by complications).

           Isolation is necessary for at least 4 weeks from disease onset or until symptoms have subsided.

           Erythromycin may reduce the severity of the infection if given during the catarrhal stage (it is not very effective if given in paroxysmal stage); ampicillin may be used for erythromycin-intolerant patients.

           A cough suppressant may be helpful in controlling the severity of paroxysms; oxygen may be administered if cyanosis develops.

           Skilled nursing to maintain nutrition, especially in infants and young children, is necessary. 

    Prevention:

           A vaccine is available in form of ‘triple antigen?/i> together with diphtheria and tetanus (DTP) and is given at age of 2, 4 and 6 months.

           Acellular pertussis vaccines cause less fever and fewer local and systemic reactions.

           Active immunisation can very rarely (one in over 300,000 doses) cause fits or neurological damage which has led to a decrease in the number of children who are immunised against the disease.

Prognosis  < BACK TO TOP >

    -

Nutrition < BACK TO TOP >

Nutrition that alleviate or prevent Whooping cough :-
C

Herbs < BACK TO TOP >

Herbs that alleviate or prevent Whooping cough :-
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(source : -)

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