Pertussis a serious medical condition

We know it as whooping cough. The medical term is pertussis. This is a very serious infection of the upper respiratory system and can be fatal in babies. Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep “whooping” sound is often heard when the patient tries to take a breath.

 

Causes, incidence and risk factors

Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussis bacteria. It is a serious disease that can cause permanent disability in infants, and even death.

When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person. The infection usually lasts six weeks. Whooping cough can affect people of any age. Before vaccines were widely available, the disease was most common in infants and young children. Now that most children are immunised before entering school, the higher percentage of cases is seen among adolescents and adults.

 

Symptoms

Initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria. Severe episodes of coughing start about ten to 12 days later. In children, the coughing often ends with a “whoop” noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults. Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common.

 

Other pertussis symptoms include:

Runny nose

Slight fever (102 °F or lower)

Diarrhoea

 

Signs & tests

The initial diagnosis is usually based on the symptoms. However, when the symptoms are not obvious, pertussis may be difficult to diagnose. In very young infants, the symptoms may be caused by pneumonia instead.

To know for sure, the healthcare provider may take a sample of mucus from the nasal secretions and send it to a lab, which tests it for pertussis. While this can offer an accurate diagnosis, the test takes some time, and treatment is usually started before the results are ready. Some patients may have a complete blood count that shows large numbers of lymphocytes.

 

Treatment

If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren’t very effective. However, the medicines can help reduce the patient’s ability to spread the disease to others. Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalised.

An oxygen tent with high humidity may be used. Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids. Sedatives may be prescribed for young children.

Cough mixtures, expectorants and suppressants are usually not helpful and should not be used.

 

Prevention

DTaP vaccination, one of the recommended childhood immunisations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are usually given to children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. The DTap vaccine should be given around age 11 or 12, and every ten years thereafter. During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case. Many health care organisations strongly recommend that adults up to the age of 65 years receive the adult form of the vaccine against pertussis. —www.ncbi.nlm.nih.gov