Pertussis
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PERTUSSIS (Whooping cough)
What is Pertussis? Bordetella pertussis
• Pertussis , also known as
whooping
cough
•Caused by the bacterium Bordetella pertussis (or B. pertussis) •Highly contagious bacterial infection •Characterized by severe coughing spells that end in a "whooping" sound when the person breathes in
Pertusis is a devastating contagious disease of childhood, particularly infancy
Bordetella pertussis, gram (-), coccobacil, recovered by Bordet & Gengou (1906)
Epidemiology Pertusis is highly contagious, transmitted by intimate respiratory contact No effective transplacental immunity No seasonal variation
Signs & Symptoms of Pertussis
The first symptoms of pertussis are similar to those of a common cold runny nose sneezing mild cough low-grade fever
Elevated white blood cell count with a lymphocytosis Confirmed with laboratory testing
Incubation period : 7-13 days The initial symptom are nonspecific Fever is absent or low Mild coryza like symptoms, and a mild dry cough. The cough progresses in frequency & severity 2 weeks after onset, spells of paroxysmal coughing are recognized whoop, vomiting, cyanosis, the eyes roll back, the child may appear semiconscious (2-6 wks)
In convalescence the cough gradually disappear over a month or more Lethal complication bronchopneumonia and encephalopathy
Diagnosis Clinical picture of full-blown pertussis Culture of nasopharyngeal mucus by using transnasal swab during the catarrhal stage
Laboratory Tests for Pertussis
Gram Stain of Bordetella pertussis
Culture is “Gold Standard” PCR DFA Serological testing Lab tests may be negative for patients with pertussis Culture results may not be available for 710 days
Who gets pertussis?
Although pertussis can occur at any age, it's most severe in unimmunized children and in infants under 1 year of age
About 40% of all pertussis infections occur in children less than 1 year old, and only 15% occur in children over 15 years old
Half of all deaths from pertussis occur in infants under age 1, and serious complications are more common in this group
Child with Pertussis Child demonstrating the characteristic “whooping" cough of Pertussis. It is difficult for him to stop coughing and to get air. The "whooping" sound that follows the cough is typical and means that the child is trying to catch his breath before the next round of
Complications of Pertussis in infants
Infants with pertussis are at highest risk
59% hospitalization 12% Pneumonia 1% Seizures 0.2% Encephalopathy 0.7% Death
Complications Respiratory problems : atelectasis, bronchopneumonia, emphysema, pneumothorax (rare). 90% of deaths resulted from pulmonary complications Effects on CNS (most frequent in young infants) : anoxia and/or cerebral hemorrhage encephalopathy, convulsions, visual disturbances, paralyses. Permanent sequelae mental retardation and pareses Malnutrition
Minor complications : otitis media, epistaxis, petechiae, subconjunctival bleeding
Prognosis With good care the prognosis is excellent
Life-threatening complications of pertussis
Choking Pneumonia (occurs in about 10% of cases) Collapsed lung Seizures (happens about 2% of the time)
Inadequate oxygen supply to the brain
Potentially result in permanent epilepsy Patients breathing slows down or stops completely
Cerebral hemorrhage
Pertussis Duration
Pertussis can cause prolonged symptoms The child usually has 1 to 2 weeks of common cold symptoms first This is followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer The last stage consists of another several weeks of recovery with gradual resolution of symptoms In some children, the recovery period may last for months
How is Pertussis spread?
Pertussis is highly contagious. Humans are the only reservoir The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth.
These may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness (usually 7-10 days), but can be as long as 21 days
How is Pertussis Treated?
If you suspect that your child has pertussis, he or she will need to visit the doctor
The doctor will make a diagnosis by first taking a history and doing a thorough physical exam He or she might take samples of mucus from your child's nose and throat to determine whether your child has a pertussis infection If your child has pertussis, it will be treated with antibiotics, usually for 2 weeks Some children with pertussis need to be treated in a hospital
Infants and younger children are more likely to be hospitalized because they're at greater risk for complications such as pneumonia In infants younger than 6 months of age, pertussis can even be life-threatening
Treatment Supportive : adequate nutrition and hydration Cough suppressants in low doses Erythromycin 20-40 mg/kg/day for 14 days Family members : a full course of erythromycin to prevent further disease and subsequent spread
Immunity After an attack of pertussis, lifelong immunity The second attacks may have been parapertussis, viruses or chlamydia
Can Pertussis be prevented? Whole cell pertussis vaccine (DTP) Whole cell pertussis vaccine (DTP)
Pertussis can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.
DTaP immunizations are routinely given in five doses before a child's sixth birthday
This vaccine is 70-90% effective
The vaccination cannot be given to persons seven years of age or older Immunity from the childhood vaccination series lasts for about ten years
Before a vaccine was available in the 1930’s, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30
What is Pertussis? Bordetella pertussis
• Pertussis , also known as
whooping
cough
•Caused by the bacterium Bordetella pertussis (or B. pertussis) •Highly contagious bacterial infection •Characterized by severe coughing spells that end in a "whooping" sound when the person breathes in
Pertusis is a devastating contagious disease of childhood, particularly infancy
Bordetella pertussis, gram (-), coccobacil, recovered by Bordet & Gengou (1906)
Epidemiology Pertusis is highly contagious, transmitted by intimate respiratory contact No effective transplacental immunity No seasonal variation
Signs & Symptoms of Pertussis
The first symptoms of pertussis are similar to those of a common cold runny nose sneezing mild cough low-grade fever
Elevated white blood cell count with a lymphocytosis Confirmed with laboratory testing
Incubation period : 7-13 days The initial symptom are nonspecific Fever is absent or low Mild coryza like symptoms, and a mild dry cough. The cough progresses in frequency & severity 2 weeks after onset, spells of paroxysmal coughing are recognized whoop, vomiting, cyanosis, the eyes roll back, the child may appear semiconscious (2-6 wks)
In convalescence the cough gradually disappear over a month or more Lethal complication bronchopneumonia and encephalopathy
Diagnosis Clinical picture of full-blown pertussis Culture of nasopharyngeal mucus by using transnasal swab during the catarrhal stage
Laboratory Tests for Pertussis
Gram Stain of Bordetella pertussis
Culture is “Gold Standard” PCR DFA Serological testing Lab tests may be negative for patients with pertussis Culture results may not be available for 710 days
Who gets pertussis?
Although pertussis can occur at any age, it's most severe in unimmunized children and in infants under 1 year of age
About 40% of all pertussis infections occur in children less than 1 year old, and only 15% occur in children over 15 years old
Half of all deaths from pertussis occur in infants under age 1, and serious complications are more common in this group
Child with Pertussis Child demonstrating the characteristic “whooping" cough of Pertussis. It is difficult for him to stop coughing and to get air. The "whooping" sound that follows the cough is typical and means that the child is trying to catch his breath before the next round of
Complications of Pertussis in infants
Infants with pertussis are at highest risk
59% hospitalization 12% Pneumonia 1% Seizures 0.2% Encephalopathy 0.7% Death
Complications Respiratory problems : atelectasis, bronchopneumonia, emphysema, pneumothorax (rare). 90% of deaths resulted from pulmonary complications Effects on CNS (most frequent in young infants) : anoxia and/or cerebral hemorrhage encephalopathy, convulsions, visual disturbances, paralyses. Permanent sequelae mental retardation and pareses Malnutrition
Minor complications : otitis media, epistaxis, petechiae, subconjunctival bleeding
Prognosis With good care the prognosis is excellent
Life-threatening complications of pertussis
Choking Pneumonia (occurs in about 10% of cases) Collapsed lung Seizures (happens about 2% of the time)
Inadequate oxygen supply to the brain
Potentially result in permanent epilepsy Patients breathing slows down or stops completely
Cerebral hemorrhage
Pertussis Duration
Pertussis can cause prolonged symptoms The child usually has 1 to 2 weeks of common cold symptoms first This is followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer The last stage consists of another several weeks of recovery with gradual resolution of symptoms In some children, the recovery period may last for months
How is Pertussis spread?
Pertussis is highly contagious. Humans are the only reservoir The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth.
These may become airborne when the person sneezes, coughs, or laughs. Other people then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses. Infected people are most contagious during the earliest stages of the illness (usually 7-10 days), but can be as long as 21 days
How is Pertussis Treated?
If you suspect that your child has pertussis, he or she will need to visit the doctor
The doctor will make a diagnosis by first taking a history and doing a thorough physical exam He or she might take samples of mucus from your child's nose and throat to determine whether your child has a pertussis infection If your child has pertussis, it will be treated with antibiotics, usually for 2 weeks Some children with pertussis need to be treated in a hospital
Infants and younger children are more likely to be hospitalized because they're at greater risk for complications such as pneumonia In infants younger than 6 months of age, pertussis can even be life-threatening
Treatment Supportive : adequate nutrition and hydration Cough suppressants in low doses Erythromycin 20-40 mg/kg/day for 14 days Family members : a full course of erythromycin to prevent further disease and subsequent spread
Immunity After an attack of pertussis, lifelong immunity The second attacks may have been parapertussis, viruses or chlamydia
Can Pertussis be prevented? Whole cell pertussis vaccine (DTP) Whole cell pertussis vaccine (DTP)
Pertussis can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.
DTaP immunizations are routinely given in five doses before a child's sixth birthday
This vaccine is 70-90% effective
The vaccination cannot be given to persons seven years of age or older Immunity from the childhood vaccination series lasts for about ten years
Before a vaccine was available in the 1930’s, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30
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