Pertusis is a contagious disease which is also known as whooping cough which is characterised by a whooping sound cough commnly occuring in preschool age children which can be deadly.

1. PERTUSIS/
WHOPPING
COUGH
BY
SUDHA SANJIBANEE
ROLL NO.17
BSN 2ND YEAR
GOPABANDHU INSTITUTE OF MEDICAL SCIENCE
AND RESEARCH SCHOOL AND COLLEGE OF
NURSING, MADHAPUR, ATHAGARH, CUTTACK

2. 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.HABBIT PATTERN OF COUGHING MAY LONGER OR
SUBSCQUENT WEEKS & MONTH, SO CHINIESE CALL IT; 100
DAYS COUGH”.

3. 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

4. IMAGE: BORDETELLA PERTUSSIS

5. EPIDEMIOLOGICAL FACTOR
• AGENT:
1. BORDETELLA PERTUSIS(GM +VE, ROD SHAPED,
NON MOTILE)
• TRANSMISSION: BY DIRECT CONTACT OR
DROPLET INFECTIONS DURING COUGH.
• INCUBATION PERIOD : 7-10 DAYS
• RESERVOIR: HUMAN.

6. CONTD…
• AGE:
• 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
• SEX:
• IT IS MORE COMMON IN FEMALES THEN MALES
• IMMUNITY:
• SINGLE ATTACK CONFERS LIFE LONG IMMUNITY.

7. CONTD…
• ENVIORNMENTAL FACTOR: PERTUSIS 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

8. PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS (B- PERTUSIS)
LIBERATES NUMBERS OF ANTIGEN & TOXINS
PATHOLOGICAL CHANGES IN THE RESPIRATORY TRACT.(NASOPHRAYNX TO
BRONCHIOLES)
INFLAMMATORY RESPONSE TO MUCOSA & SECREATION APPEAR
LOCAL EPITHELIUM DAMAGE & SYMPTOM APPEAR
ONSET OF SIGN AND SYMPTOMS(FEVER,COUGH ETC.)

9. CLINICAL MANIFESTATIONS
• THERE ARE 3 STAGES OF PERTUSSIS.
1. CATARRHAL STAGE (PRE PAROXYMAL STAGE, 0-
2 WEEKS)
2. PAROXYMAL STAGE (SPASMODIC STAGE, 2-4
WEEKS)
3. CONVULSCENT STAGE (LAST 2 WEEKS)

10. STAGE-I CATARRHAL STAGE
THIS STAGE IS THE SYMPTOMS ARE MILD AND IS MOST
INFECTIOUS.
• LOW GRADE FEVER
• RUNNINY NOSE
• SNEEZING
• MALAISE
• NAUSEA & VOMITING
• LACRIMATION
• IRRITATING COUGH AT NIGHT (AT END OF THIS
STAGE)

11. STAGE-II PAROXYMAL STAGE
• THE PAROXYSMAL STAGE OF PERTUSSIS IS CHARACTERIZED BY EPISODES OF COUGHING WITH
A DISTINCTIVE “WHOOPING” SOUND WHEN BREATHING IN (INSPIRATION).
• EXPECTORATE LARGE AMOUNT OF MUSOUS
• BULGING EYES
• PROMINENT VEINS IN THE NECK
• PROTRUSION OF THE TONGUE, AND/OR EXCESSIVE SALIVATION
• INFECTIONS OF THE MIDDLE EAR (OTITIS MEDIA)
• ASPIRATION OF MUCOUS INTO THE LUNGS MAY CAUSE BACTERIAL PNEUMONIA

12. STAGE-III CONVULSCENT STAGE
• BEGINS AFTER 4 WEEKS OF ONSET OF DISEASE.
• EPISODES OF COUGHING BECOME LESS FREQUENT AND
LESS SEVERE.
• SLOW RECOVERY.

13. DIAGNOSTIC EVALUATION
• CBC: HIGH LYMPHOCYTE RATE.
• FLOURESCENT ANTIBODY STAINING
• CHEST X-RAY
• BACTERIAL CULTURE OF RESPIRATORY SECRETIONS IS
THE CONFIRMATORY TEST.

14. COMPLICATIONS
• OTITIS MEDIA IS QUITE FREQUENT.
• RESPIRATORY COMPLICATIONS ARE:
• PNEUMONIA (SPECIALLY IN INFANTS)
• ATELECTASIS
• BRONCHIECTASIS
• EMPHYSEMA
• NEUROLOGICAL COMPLICATION
• INTRA CRANIAL HAEMORRHAGE,SEIZURES (DUE TO CEREBRAL
HYPOXIA)
• HAEMIPLEGIA(PARTIAL PARALYSIS)
• ENCEPHALITIS(DUE TO CEREBRAL HYPOXIA)

15. PREVENTION
• ACTIVE IMMUNIZATION IS BEST PREVENTIVE MEASURE FOR
PERTUSIS.
1. DPT VACCINE = 0.5 ML. IM, 5 DOSE
• DPT 1¹ DOSE →6 WEEKS
• DPT 2ND DOSE → 10 WEEKS
• DPT 3RD DOSE→ 14 WEEKS
• DPT 1ST BOOSTER → 16-18 MONTH
• DPT 2ND BOOSTER→5 YEARS

16. CONTD…
2. TRIPEDIA:AN ACELLULAR VACCINE, WHICH IS MADE
WITH PART OF THE BACTERIUM THAT CAUSES PERTUSSIS
RATHER THAN THE WHOLE BACTERIUM.
3.CERTIVA:COMBINED VACCINE FOR DIPHTHERIA,
TETANUS, AND ACELLULAR PERTUSSIS (DTAP)

17. TREATMENT
• ANTIBIOTICS (3-4DAYS)
• ERYTHROMYCIN
• AZITHROMYCIN
• CLARITHROMYCIN
• COMBINATION OF TRIMETHOPRIM-
SULFAMETHOXAZOLE IS GIVEN TO THOSE WHO
CANNOT TOLERATE ERYTHROMYCIN.

18. CONTD…
• COUGH SUPPRESSANTS(ANTITUSSIVE)
• TRACHEOSTOMY:A TEMPORARY OPENING INTO THE THROAT
• SERIOUSLY ILL PATIENTS SHOULD BE KEPT IN DARK QUIET ROOM
AND SHOULD NOT BE DISTRIBUTED.
• FOR VERY SERIOUS PATIENTS IV THERAPY CAN BE GIVEN.
• SUCTIONING:TO CLEAR EXCESSIVE MUCOUS SECRETIONS
• OXYGEN SUPPLY TO LUNGS

19. ROLE OF NURSE
• EDUCATE ABOUT EFFECTIVE COUGHING AND DEEP
BREATHING.
• PROVIDE PROPER POSITIONING TO REDUCE COUGH.
• ENCOURAGE TO INCREASE IN ORAL FLUID.
• ADMINISTER MEDICATIONS AS PRESCRIBED.
• PROVIDE CHEST PHYSIOTHERAPY. PROVIDE POSTURAL
DRAINAGE, PERCUSSION, AND VIBRATION AS ORDERED.

20. CONTD…
• 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 CHECK UP.
• EDUCATE PREGNANT WOMEN TO KEEP DISTANCE TO