Pertussis

1. Pertussis (Whooping Cough)
Introduction
• Pertussis, also known as whooping cough is a highly contagious bacterial disease mainly caused by
Bordetella pertussis.
• It's characterized by severe coughing spells, which can sometimes end in a "whooping" sound when the
person breathes in.
• Whooping cough is also known as 100 days cough.
• Habit pattern of coughing may longer or subsequent weeks & month, so chinese call it;
‘100 DAYS COUGH’.
Definition
• Pertussis is acute highly contagious disease which cause classic spasm (paroxyms) of uncontrollable
coughing, that is violent and persistence followed by a sharp, high pitched intake of air which create
characteristic “WHOOP” sound.
• Children who have typically illness of pertussis try to take deep breath between cough result in whooping
sound.
Agent
Agent of pertussis are-
I. Bordetella Pertussis (gm +ve, rod shaped, non-motile)
II. Bordetella Parapertussis
III. Haemophillus Haemolyticus
IV. Adeno Virus
V. Bronchi Septica
Incubation period
The incubation period is typically seven to ten days in infants or young children, after which there are
usually mild respiratory symptoms, mild coughing, sneezing, or runny nose.
Mode of transmission
• Tiny droplets that comes from mouth & nose of infected patient.
• Respiratory Aerosole (Droplets)
• Close Contact
• It spreads through close contact with oral secretions or respiratory droplets. So it's easily spread through
the cough, especially when people are in close contact, like living in the same house with a person who has
whooping cough. It can also be spread through sneezes.
Age group & sex
• It is primarily disease of pre schoolar (3-5 years) & may occur in infants, new born, pregnant lady.
• Pre schoolar are responsible for about 50% of total case
• It is more common in females than males, and single attack confers lifelong immunity.
Enviornmental factor
• Pertussis spread throughout year but more cases found in winter/spring season.
• Over crowding place.
• Low sanitation area.
• Poor environmental hygiene.
• Person with decreased immunity.
• Unimmunized persons against whooping cough.

2. Pathogenesis
Causative Agent (B-Pertussis)

Liberates numbers of antigen & toxins

Pathological changes in the respiratory tract. (Nasophraynx to Bronchioles)

Inflammatory response to mucosa & secretion appear

Local epithelium damage & symptom appear

Pertussis disease
Clinical manifestation
Clinical manifestation include ‘3’ stages;
1. Catarrhal Stage (Pre-paroxymal stage, 0-2 weeks)
2. Paroxymal Stage (Spasmodic stage, 2-4 weeks)
3. Convulscent Stage (Last 2 weeks)
Stage-i catarrhal stage
Catarrhal symptoms appear that are:
• Fever
• Rhinitis
• Sneezing
• Anorexia
• Nausea & Vomiting
• Lacrimation
• Irritating cough at night (nocturnal but later become diurnal)
Stage-ii paroxymal stage
• Cough means in paroxymus (repeatating) & is accompanied by vomiting.
• A typical attack consist of repeated series of many cough in expiration followed by sudden deep, violent
inspiration with characterise crowing sound “WHOOP”.
• Ulcer of franulum of tounge.
• Sweating
• Congestion of neck & scalp vein.
• Patient appears suffocated with congested (red) face with or without cyanosis.
• Mouth opened, periorbital oedema
• Subconjunctival haemorrhage
• Convulsion may be present.
Stage-iii Convulscent stage
• Disturbing cough & vomiting stops and appetite too improves (start of hungerness)
• Habit pattern of coughing may be longer to several weeks & month.
Complications
• Otitis media is quite frequent.
• Respiratory complications are:
 Pneumonia (specially in infants)
 Atelectasis

3.  Bronchietasis
 Emphysema
• Neurological complication
 Intra cranial hage (Haemorrhage)
 Seizures (due to cerebral hypoxia)
 Paralysis
 Haemiplegia
 Encephalopathy (Encephalitis) (Due to cerebral anoxia)
• Rupture of diaphragm.
• Rectal prolapse, umbilical & inguinal hernia over whelming strain of violent cough.
• Malnutrition due to vomiting.
Diagnostic evaluation
• Pertussis is difficult to diagnose because coughing may be due to common cold, bronchitis or chest
infection.
• For accurate diagnosis:-
1. CBC (Lymphocytosis increased)
2. Chest X-Ray (Perihilar infiltration, atelectasis, emphysema)
3. ELISA (To detect IgM, IgG, IgA)
4. Nasophrayngeal swab (Mainly in stage-I)
Prevention & control
• Active immunization is best preventive measure for pertussis.
DPT Vaccine = 0.5 ml. IM, 5 dose
• DPT 1st dose  6 weeks
• DPT 2nd dose  10 weeks
• DPT 3rd dose  14 weeks
• DPT 1st Booster  16-18 month
• DPT 2nd Booster  5 Years
Antibiotics
• Erythromycin
• Azithromycin
• Clarithromycin
Health education
• Emphasis should be placed on minimizing exposure to susceptible person, specially infant. • Isolation &
restriction of case, should be excluded from work, school, preschool & child care centers.
• Regular health checkup.
• Educate pregnant women to keep distance to such cases.
• Active immunization.