This document discusses pertussis (whooping cough), including its etiology, epidemiology, pathophysiology, clinical features, diagnosis, complications, treatment, and prevention. Pertussis is caused by the bacterium Bordetella pertussis and is highly contagious, especially in children ages 1-5 years old. It presents in stages including catarrhal, paroxysmal, and convalescent stages. Diagnosis is usually clinical based on paroxysmal coughing fits. Complications can include respiratory issues, seizures, and intracranial bleeding. Treatment involves erythromycin or similar antibiotics and supportive care. Prevention is through vaccination and prophylactic antibiotics for close contacts when

1. Dr Rai Muhammad Asghar
Professor of Paediatrics
RGH Rawalpindi

2. PERTUSSIS

3. Pertussis
(Whooping Cough)
* Pertussis : Intense Cough
* Highly Infectious disease

4. Etiology:
* Bordetella Pertussis
* B.Parapertussis
* B. Bronchiseptica

5. Epidemiology:
* World wide
* 1922-1948--- leading causes of death
* Endemic---Epidemic cycles
* Extremely contagious-attack rate 100%
* Immunity is never complete
* Protection begins to wane in 3-5 yrs after
vaccination

6. * Unmeasurable after 12 yrs
* Adolescents & adults are major Reservoir
* Age : 1-5 yrs
* Incubation period : 7-10 days
* Infectivity : first 4 weeks
* Transmission by droplet

7. Pathophysiology:
* B. Pertussis produces many biologically
active substances
* Inflammation of respiratory mucosa
* Patchy necrosis
* Tenacious mucopurulant exudate
* Bronchiolar obstruction :
Atelectasis, Bronchiectasis

8. Clinical Features:
* Pertussis is a 6 weeks disease
* CATARRHAL STAGE (1-2 WKS)
* Nonspecific features
* Congestion, Rhinorrhoea
* Sneezing
* Lacrimation, Conjunctival redness
* Low grade fever, mild cough

9. Paroxysmal Stage ( 2-4 wks)
* Cough is first dry & intermittent
* Inexorable paroxysm
* Machine-gun burst of uninterrupted cough
* Series of coughing in single expiration
* Eyes bulging—watering
* Chin & Chest held forward
* Tongue protruding maximally

10. * Face-Red-Blue
* Whoop at the end of paroxysm
* Post tussive emesis
* Number & Severity of Paroxysm
progress over days to weeks

11. Infants < 3 months
* No classical stages
* well appearing infants begins to choke
* Gasp & flail extremities
* Reddend face
* Cough may not be prominent
* Woop infrequent

12. * Immunized children have fore-shortening
of all stages
* Adults have no distinct stages
* Number & severity of paroxysm progress
& remain at that plateau
* Physical examination is unremarkable

13. Convalescent Stage ( 1-2 wks)
* Episodes of cough becomes less frequent
* Less severe
* Paroxysms of whooping disappear

14. Diagnosis:
*Clinical Diagnosis
Paroxysmal stage

15. * Suspect if predominant complaint is
cough especially following are absent
- Fever
- Malaise, Myalgias
- Rash
- Sore throat
- Hoarseness
- Tachypnea
- Wheeze
- Crepitations/ Rales

16. Investigations:
1. Blood Count
Absolute Lymphocytosis
(15,000-100,000 cells/mm3
)
2. Flourescent antibody staining
3. Cultures:
Nasopharyngeal aspirate
4. X-Ray chest

17. Complications:
1. Respiratory
2. Sequelae of forceful cough
3. CNS

18. 1.Respiratory
- Apnea
- Bronchopneumonia
- Atelectasis
- Bronchiectasis
- Emphysema—Interstitial / Subcutaneous
- Otitis media
- Reactivation of quiescent tuberculosis

19. 2. Sequelae of forceful cough
- Epistaxis, sub-conjunctival hemorrhage
- Intracranial Bleeding
- Rectal prolapse, umbilical hernias
- Dehydration, Malnutrition
- Tetany

20. 3. CNS
- Convulsions…..Hypoxemia,
Hemorrhage
- Encephalopathy

21. Treatment:
Specific
* Erythromycin 40-50 mg/kg/day for 14 d
* Clarithromycin 15 mg/kg for 7 d
*Azithromycin 10 mg/kg for 5 d
* Ineffective if given in paroxysmal stage

22. General Measures
* Young infants should be hospitalized
* Adequate hydration, Nutrition
* Oxygen
* Gentle suction
* Cough syrup have no role

23. 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

24. Thank You