Pertussis (whoopingcough)

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Symptoms And Treatment of Cough Disease:

Pertussis is highly infectious disease caused by Bordetella pertussis. It is spread by the droplet infection. Patients get a spasmodic cough, ending with a typical whoop (high pitch crowing on inspiration) and occasionally vomiting.

Young infants are more susceptible. It is seen more in children from six months to four years of age.

Incubation Period

Incubation period is from 7 to 14 days.
The disease is divided in to three stages as follows:
The catarrhal stage: The catarrhal stage starts with cold, fever, anorexia and uneasiness. Severe cough begins during the night and later during the day. The cough lasts for four to six weeks. Severe cough at night, chocking and vomiting makes the patients red and tired.
Paroxysmal stage: The bronchitic cough becomes more severe and rapid, about 10 to 15 times during the 24 hours. The patients get rapid and deep inspirations with the whoop. There may be cyanosis, gagging and chocking due to tenacious mucus. In severe cases, convulsions and exhaustion may be seen. Haemorrhage in sub conjunctiva and puffiness of the eyelids may occur.

Convalescence:

The paroxysm of cough is reduced by six to eight weeks and then the convalescence starts.
Recurrence of pertussis may occur within one year, if children develop a relapse of the whooping cough.

Investigations:

Clinically, a typical paroxysmal cough with a whoop is observed.
White blood cells may be low in the early stage, but later it increases up to 20,000 to 30,000/cmm with high lymphocyte count.
E.S.R. may be high.
The chest x-ray may reveal.
Patchy area of segmental atelectas, emphysema or pneumothorax.
Nasopharyngeal swab is tested for bacteriology.

Complications:

Pneumothorax
Surgical emphysema
Bronchiectasis
Otitis media
Convulsions
Intracranialhaemorrhage
Prolapse of the rectum
Hernia

Treatment

Antispasmodic and sedative cough mixture may be prescribed to relieve the cough and provide rest.
Antibiotics may be prescribed to treat the infection.

Management:

Patient should be isolated in a well ventilated room.
The bed rest is necessary until the fever subsides.
The respirations should be maintained. Sometimes suction may be required to remove severe secretions. Administration of oxygen helps to relieve cyanosis.
The chilling should be avoided.
Nutrition: The feeling also can stimulate the cough and vomiting. As a result, children refuses to eat and become dehydrated and malnourished. Patients should be given small feeds every hour. In case of severe vomiting. Mydrindon may be prescribed and can be given 10-15 minutes prior to feedings. The fluids, such as, water and milk should be given in adequate amount to liquefy the sputum and mucus.
Patients should be observed for convulsions. Care should be provided during and after the convulsions, to prevent injury and tongue bite.
During the spasm, the patients should be held in head down position, patting the back until the spasm subsides. This helps to prevent aspiration of the secretions.

Prevention:

Active immunization, D.P.T. vaccine should be given as explained in the immunization schedule.
Passive immunization, Gamma globulin may be given.
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