Whooping Cough | Pertussis | Pertussis Vaccine | Symptoms
|A girl coughing|
Symptoms of Whooping cough
Discussion about whooping cough. Whooping cough is a dangerous disease, also discuss the causes, symptoms, and treatment of whooping cough. What is Pertussis?
Whooping cough is a respiratory disease caused by a bacteria called Bordetella Pertussis. Very contagious for people who find themselves not immunized, whooping cough might be critical in infants and frail people. The therapy is based on taking antibiotics. Vaccination can defend you from pertussis, however, it requires many reminders as a way to be correctly protected.
What is pertussis?
Whooping cough is a highly contagious respiratory infectious disease. It is because of Bordetella pertussis (Bacillus Bordet and Gengou), a bacterium that incorporates dioxygen. The germ multiplies on the ciliated respiratory epithelium (floor layer at the level of the mucosa) of the trachea and the bronchi. It diffuses several particular toxins that cause the disease. Inserm1 estimates that each year 300,000 children die from this disease and 40 million are affected worldwide. Whooping cough is also showing an upsurge in certain developed countries such as England, Australia, the United States, and France.
Note: in infants, whooping cough can be very critical, even fatal, and complications (pneumonia, seizures …) are possible in very children.
Contamination and incubation time
Contamination takes place by interhuman air (projection of droplets of saliva during coughing), basically within the catarrhal part of the disease throughout which the medical indicators should not but attribute. The danger of contagion decreases rapidly during the paroxysmal phase but can last for 3 weeks. The source of contamination is mainly constituted by a preschool or school-age children, and also by adults and elderly subjects whose symptoms are often poorly identified. The attack rate is 70-80% if the contact is close.
The incubation can last between 7 days and 3 weeks. Generally, it is around 10 days.
CAN WE HAVE WHOOPING COUGH SEVERAL TIMES?
Immunity is not definitive after the disease and it is possible to contract it several times in your life, hence the importance of making vaccination reminders according to the recommendations. The incidence of pertussis in early childhood has significantly decreased thanks to the systematic and not compulsory vaccination of infants.
THE INCUBATION PHASE
This is the phase of the disease during which the clinical signs are not yet characteristic. It lasts 1 to 2 weeks. There are non-specific signs of upper airway infection:
The cough, rebellious, gradually becomes spasmodic, emetic (giving nausea or vomiting), increases at night.
THE PAROXYSTIC PHASE
This period lasts 2 to 4 weeks. There are spontaneous coughing fits. Between the fifths, the clinical examination is normal. There is no fever.
WHAT IS A QUINTE DE TOUX?
Typically, the fifth is defined as the succession of shakes of expiratory cough (5 to 20, more and more carefully spaced), resulting in apnea of a few seconds in forced expiration (cyanosis), followed by a long inspiration. The “resumption” – noisy – prelude to a new succession of exhalation shakes. The cycle repeats 5 to 15 times and ends with mucous expectoration leading to vomiting. We note 15 to 30 fifths per 24 hours.
THE DECLINE PHASE
Then begins the decline phase, which lasts three to four weeks. The fifths are less and less frequent and less intense. Sputum becomes easier and mucopurulent. We often note for several months the transient reappearance of coughing Quintus with noisy resumption because of nonspecific respiratory infections.
Additional diagnosis, examinations and analyzes
The analysis is based mostly on three criteria: the character of the cough, the course of the disease, and the identification of contaminators. It is done via the following exams:
Isolation in 5 days of the bacteria on special Bordetelles special media (Bordet-Gengou or Regan Lowe). Nasopharyngeal suction is the best method. Culture must be undertaken within the first 3 weeks of illness. Its sensitivity is 50 to 60% at the start of the disease and decreases very quickly on antibiotics;
An X-ray pulmonary: there are alterations parallel to the depth of the paroxysmal part, harm to the respiratory tract sometimes localized ventilation disorders;
Bacteriology: it allows identification of the germ or detection of its genetic material by PCR (Polymerase Chain Reaction) in respiratory secretions (direct examination or immunofluorescence on the aspiration of the nostril and throat). It is the one organic examination to diagnose whooping cough reimbursed in France.
Serology makes it potential to increase the analysis of certainty if the tradition is defective. Always examine two sera taken Three or four weeks aside to verify the illness as a result of anti-pertussis antibodies are comparatively late, particularly in small infants. Several strategies exist:
Agglutination (the physique’s particular protection response, characterized by the gathering in small clusters of crimson blood cells, microorganisms, or different components, within the presence of the corresponding antibody) is insensitive and meaningless in younger folks infants. This approach is bare of curiosity for the detection of anti-agglutinogen antibodies linked to vaccination with complete vaccines;
The ELISA method is more sensitive and particular however requires samples spaced 2 to three weeks aside
There are several kinds of issues from pertussis:
Mechanical issues associated to the depth of the cough and intra-thoracic expiratory hyper pressure: ulceration of the tongue brake, nasal and subconjunctival hemorrhages, rectal prolapse, hernias, mediastinal and cervical emphysema, pneumothorax, and so on .;
Undernutrition, malnutrition, dehydration, through the repetition of vomiting and eating difficulties;
Infectious complications: suppurative otitis, bronchopulmonary infections, acute purulent bronchitis, atelectasis, bronchopneumonia, pleurisy;
Neurological complications particularly in young children: convulsions (2.7%) mainly by anoxia or hyperthermia, intracranial hemorrhages, neurological sequelae secondary to phases of cerebral anoxia (0.7%). Pertussis encephalitis occurs after 2 or three weeks and has an extreme prognosis.
Differential diagnosis of pertussis
There may be other causes of rebellious cough, the main symptom of whooping cough, which should not be confused with this respiratory illness:
|World Map of whooping cough|
A particular and serious form: the pertussis of the infant
“From 1996 to 2012, approximately 10,000 cases of pertussis occurred in babies under 6 months of age in France, 18% of whom were admitted to the intensive care unit. Pertussis remains one of the leading causes of death from a bacterial infection in infants less than 3 months old, “says the Vaccination infoservice2 site.
From the neonatal period and in an unvaccinated child, the risk of contamination by the environment, siblings, or parents with unusual and unidentified pertussis is high. There is no maternal-fetal immune protection.
THE FACTORS OF GRAVITY OF THE INFANT WHOOPING COUGH
Several factors can make baby’s pertussis worse:
- Age less than 4 months;
- Eating difficulties and incoercible vomiting;
- Consciousness, convulsions;
- Swelling of the abdomen;
- Vasomotor disorders of the extremities, mottling;
- Tachycardia (fast heartbeat)> 200 / min;
- Freediving apnea (breathing pause), persistent cyanosis between fifths;
- Leukocytosis> 50,000 / mm 3;
- Hyperplaquettose> 500,000 / ul;
- Hyponatremia (low blood sodium) <130 mM / L, hypoglycemia.
- Pertussis treatments
Antibiotic therapy: despite the germ’s sensitivity to many antibiotics (macrolides, tetracyclines, chloramphenicol), antibiotic therapy does not modify the course of the disease. Josamycin 50 mg/kg per day for 14 days causes germ eradication. Humidifiers, antitussives, sedatives, are ineffective and contraindicated in young children;
Corticosteroids: (hydrocortisone, betamethasone) and salbutamol, even prescribed late, cut back the depth of fifths: they are not in common use however useful in severe forms;
Ensure good hydration and nutrition;
Ensure an adequate, fractionated food intake; if necessary energy supplements.
Promote bronchial evacuation and good pulmonary ventilation: respiratory physiotherapy if it is well supported.
Isolation and surveillance.
Preventive treatment helps prevent the onset, unfold, or worsening of the illness. It is essential in the presence of a newborn or infant who has come into contact with a parent affected by pertussis. It consists of isolation and antibiotic prophylaxis for 14 days.
The pertussis vaccine is useful from the age of 2 months. The vaccination schedule consists of 3 injections at 2, 4, and 11 months, with a pertussis vaccine associated with the vaccines against tetanus, diphtheria, poliomyelitis, Haemophilus B, and hepatitis B.
Also, recalls are recommended at the age of 6, between 11 and 13, and then at 25. Finally, the vaccine is recommended for all adults who have not been vaccinated against pertussis for 10 years, in combination with tetanus, diphtheria, and polio vaccines.
Video Courtesy: Mayo Clinic