3. Introduction
Pertussis is also known as Whooping cough is highly
contagious bacterial diseases mainly caused by Bordetella
pertussis.
Characterized by severe coughing spells, which sometimes
end with Whooping sound when the person breathes in.
Also known as 100 days cough
Habit pattern of coughing may be longer or subsequent
weeks and month i.e., Chinese call it 100 days cough
4.
5. Definition
Pertussis (also known
as whooping cough or 100-
day cough) is a highly
contagious bacterial disease
which is caused by the
bacterium Bordetella pertussis, It
is an airborne disease which
spreads easily through the
coughs and sneezes of an
infected person
6. Etiology/Agent
Bordetella Pertussis-is the cause of
epidemic pertussis and the usual
cause of sporadic pertussis.
B.Parapertussis- is an occasional cause
of sporadic pertussis that contributes
significantly to 5% of the total cases
of pertussis.
B. Bronchiseptica
7. Epidemiology
Spread occurs by direct contact or droplet infections during
cough.
1922-1948--- leading causes of death
Infants less than one year of age constitute 50-70% of
diagnosed cases.
Extremely contagious-attack rate 100%
Age : 1-5 years
Incubation period : 7-10 days
Infectivity : first 4 weeks
8. Pathophysiology
B.Pertussis produces biologically active substances
Patchy Necrosis
Tenacious mucupurulent exudate
Inflammation of the respiratory Mucosa
Bronchiolar Obstruction i.e., Atelectasis, Bronchiestasis
13. Catarrhal Stage
The term "catarrh" is derived from historic Middle English,
meaning "to flow." That is, secretions from the nose and mucous
membranes flow, causing nasal congestion and runny nose.
Nonspecific features
Nasal congestion
Runny nose- Rhinorrhoea
Mild fever
Eye redness and excess eye watering
Sneezing
14. Paroxysmal Stage
The term "paroxysm" means a sudden, violent
burst. The paroxysms or "fits" of coughing may...
Start as a dry, intermittent, annoying cough that
increases in intensity and frequency
Occur at least once an hour
Cause the child to turn red, blue, or purple
cause the eyes to bulge and water excessively
cause significant distress in the child
vomiting after coughing
15. Young infants may have small bursts of cough or
no cough before developing...
Gasping
Choking
Turning red, blue or purple
Apnea (episodes of not breathing)
16. Convalescent Stage (recovery)
Episodes of cough becomes less frequent
Less severe
Paroxysms of whooping disappear
Young infants may develop louder coughing but
typically the breathing difficulty improves.
17. Diagnostic Evaluation
A complete blood count may show a high lymphocyte
count. If the neutrophil count is high and/or fever is
present, then other types of infection should be
considered.
Absolute Lymphocytosis (15,000-100,000 cells/mm3 )
Flourescent antibody staining
A chest x-ray may be normal or show mild abnormalities.
Bacterial culture of respiratory secretions is the best test.
(Nasopharyngeal aspirate)
18. Complications
Infants less than 6 months of age are at the highest risk for
complications. These include:
Apnea
Bronchopneumonia
Atelectasis
Emphysema
Ear infections
Pneumonia
Seizures
Encephalopathy (brain damage)
Death (approximately 1% of infants less than 2 months of age)
20. Management
Goals
Limit the number of paroxysms
Observe the severity of cough and provide assistance when
necessary
Maximize nutrition, rest, and recovery
Pharmacologic therapy
Antimicrobial agents and antibiotics can hasten the eradication
of B pertussis and help prevent spread
Erythromycin, clarithromycin, and azithromycin are the preferred
agents for patients aged 1 month or older
21. Contd….
Immunization
Prevention through immunization remains the best defense in the
fight against pertussis. CDC recommendations for vaccination are
as follows:
DTaP vaccine: Recommended at the ages of 2, 4, 6, and 15-18
months and at age 4-6 years; it is not recommended for children
aged 7 years or older
Tdap vaccine: Recommended for children aged 7-10 years who
are not fully vaccinated; as a single dose for adolescents 11-18
years of age; for any adult 19 years of age or older; and for
pregnant woman regardless of vaccination history, including repeat
vaccinations in subsequent pregnancies
22. Nursing Diagnosis
Ineffective breathing patterns related to paroxysms of cough,
airway edema and thick mucus
Risk of dehydration related to lowering volume fluid through
oral fluid intake
Anxiety (children) are associated with respiratory distress
and hospitalization stay.
Altered sleep pattern
Activity intolerant related to fever, severe cough
Altered thermoregulation related to infection
23. Interventions
Assess the respiratory status of children as often as possible or continuously
review the signs and symptoms of increased difficulty breathing and
respiratory obstruction, including increased respiratory rate, stridor, retraction,
dilation of nostrils, expiratory an elongated, cyanosis, confusion, anxiety, noise
reduction breath, tachycardia, and a barking cough.
Oxygen therapy
High-Fowler's position
Assess the child's ability to tolerate liquid (swallow, choke, or cough).
Provide and monitor intravenous fluids, as instructed.
Careful monitoring of fluid intake and output in children
Assess for signs of dehydration in children, including tugor bad skin, dry
mucous membranes, sunken fontanel, and sunken eyes.
24. Prevention
Pertussis vaccine is part of DPT vaccine
All household contacts should get Erythromycin for 14 days
Close contacts < 7 yr should get booster
If documented pertussis infection exempt from routine pertussis
vaccination
Hygiene-Cover your mouth and nose with a tissue when you cough or
sneeze.
Put your used tissue in the waste basket.
Cough or sneeze into your upper sleeve or elbow, not your hands, if you
don’t have a tissue.
Wash your hands often with soap and water for at least 20 seconds.
Use an alcohol-based hand rub if soap and water are not available.
