Study hard fellow students

1. Pertussis

2. • Highly contagious respiratory infection
• Classic pertussis, the whooping cough
syndrome, usually is caused by B. Pertussis
• a gram-negative bacillus with fastidious
growth requirements
• Bordetella parapertussis, which causes a
similar but milder illness that is not affected
by B. pertussis vaccination
• Transmission:person to person by coughing.
• Adenoviruses have been associated with the
pertussis syndrome.

3. EPIDEMIOLOGY
• Outbreaks first described in 16th century
• Bordetella pertussis isolated in 1906
• Estimated >500,000 deaths annually
worldwide

4. Pertussis Epidemiology
• Reservoir Human
Adolescents and adults
• Transmission Respiratory droplets
Airborne rare

5. CLINICAL MANIFESTATIONS
• Incubation period 3-12 days (up to 21 days)
• Insidious onset, similar to minor upper
respiratory infection with nonspecific cough
• Fever usually minimal throughout course
• Apnea & Cyanosis in infant

6. Pertussis Clinical Features
• Catarrhal stage 1-2 weeks
• Paroxysmal
cough stage 2-4 weeks
• Convalescence Weeks to
months

7. Pertussis Clinical Features
Stage 1 :
Rinorrhea’Lacrimation’Conjectival Injection’Mild cough’’Low
grade fever’
Stage 2:
Severe cough’Whoop’Cyanosis’Red face’
Vomiting
Stage 3:
Decrease Cough & Vomiting’Chronic cough

8. • Young infants may not display the classic
pertussis syndrome
• the first signs may be episodes of apnea.
• Young infants are unlikely to have the classic
whoop
• are more likely to have CNS damage as a result
of hypoxia
• Adolescents and adults with pertussis usually
present with a prolonged bronchitic

9. Bilateral scleral hemorrhages and periorbital edema in a young
boy with pertussis.

11. Ecchymoses and conjunctival hemorrhage in a 6-year-old
unimmunized child with pertussis

12. Diagnosis:
History &P/E
Leuckocytosis (Lymphocytosis)
Culture(Nasopharengeal swab)
Direct Flurocent Antibody , PCR
(Nasopharengeal)
Perihilar Infiltration’…signs of segmental lung
atelectasis

13. Differential Diagnosis:
• Pneumonia
• Asthma
• RSV, parainfluenza virus, and C. pneumoniae
• TB
• CF
• Foreign body
• Bronchiolitis
• Mediastinal Lymphadenopathy

14. COMPLICATIONS
• Major complications are most common among infants
and young children:
hypoxia, apnea, pneumonia, seizures, encephalopathy,
and malnutrition
• The most frequent complication is pneumonia
• Atelectasis may develop secondary to mucous plugs.
• The force of the paroxysm may rupture alveoli and
produce pneumomediastinum pneumothorax, or
interstitial or subcutaneous emphysema
• epistaxis; hernias; and retinal and subconjunctival
hemorrhages

15. Treatment
• Erythromycin 50 mg/kg/D PO (14 DAY)
• Azithromycin , clarithromycin ,TMP-SMZ
• Salbutamol
• Moist O2
• Nasopharengeal suction
• IV Fluid
• No Immunoglobulin’No Antitussive drugs’No
Steroid

16. PREVENTION
• Pertussis vaccine has an efficacy of 70% to 90%
• Erythromycin and other macrolides are effective in
preventing disease in contacts exposed to pertussis
• Close contacts older than age 7 should receive
prophylactic macrolide antibiotic for 10 to 14 days,
but not the vaccine