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WHOOPING COUGH
Paroxysms of coughing
Inspiratory whooping
Post-tussive vomiting without apparent cause
PERTUSSIS
Description (WHO): Pertussis, or
whooping cough, is a disease of the
respiratory tract caused by bacteria
that live in the mouth, nose, and throat.
Many children who contract pertussis
have coughing spells that last four to
eight weeks. The disease is most
dangerous in infants. Pertussis spreads
very easily from child to child in
droplets produced by coughing or
sneezing
EPIDEMIOLOGY
PERTUSSIS EPIDEMIC
PATHOPHYSIOLOGY
Paralysis of cilia
Causing inflammation of the respiratory tract
Impairing clearance of mucous
Increasing insulin secretion
Inhibiting phagocytic function
Induction of lymphocytosis by inhibiting migration from blood stream
CLINICAL FEATURES
1-3 wks
Paroxysmal: 2-4 wks
Convalescent: 1-2 wks
CATARRHAL STAGE
Symptoms:
Low-grade
fever
Rhinorrhea
Mild
cough
Mild conjunctival injection
CMAJ, 2005
PAROXYSMAL STAGE
Paroxysmal cough
Short,
May
CONVALESCENT STAGE
COMPLICATIONS
NEUROLOGIC
COMPLICATIONS
Seizures (3%)
Encephalopathy
Cerebral hemmorhage
INFECTIOUS
COMPLICATIONS
Apnea (12%)
Pertussis pneumonia(6%)
Bacterial superinfected
pneumonia (6%)
May include aspiration
pneumonia
Leading cause of death
Otitis Media
Viral Co-Infections
PULMONARY
COMPLICATIONS
Pulmonary Hypertension
Patients
present in shock.
Usually require mechanical
ventilation and possibly
ECMO
Atelectasis
Due
to mucous plugs
COUGH-INDUCED
COMPLICATIONS
Subcutaneous
emphysema
Pneumothorax
Pneumomediastinum
Diaphragmatic
rupture
Subconjunctival bleed
Petechiae
Epistaxis
Hemoptysis
Umbilical/inguinal
hernias
Rectal prolapse
Failure to thrive
DIFFERENTIAL DIAGNOSIS
Trankeobronkitis
bronkiolitis
DIAGNOSIS
INFECTIOUS
PRECAUTIONS
Respiratory droplet
precautions for 5 days
after initiation of antibiotic
therapy.
Contact precautions due to
nasopharyngeal secretions
TREATMENT
POST-EXPOSURE
ADMISSION CRITERIA
Feeding difficulties
Paroxysms associated with apnea or
cyanosis
Hypoxia
Respiratory distress
Other complications (seizures, respiratory
failure, etc.)
DISCHARGE CRITERIA
PREVENTABLE DISEASE
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