This document discusses pertussis (whooping cough), caused by the Bordetella pertussis bacterium. It is highly contagious and characterized by intense spasmodic coughing. While the infection rate is 100% in susceptible, exposed individuals, about 80% of immunized people experience subclinical infection. Protection from vaccination wanes after 3-5 years. The document describes the causative bacterium, clinical presentation and stages of the disease, diagnosis, management including antibiotic treatment and vaccination, and prevention.

1. Sunil Kumar Daha
PERTUSSIS
(WHOOPING COUGH)
LAHAREKHOKI

2. •Pertussis
• acute highly contagious upper
respiratory tract infection
• Caused by Bordetella pertussis
• Characterised by intense spasmodic cough
• Attack rate is 100% in susceptible individuals exposed to aerosol
droplets.
• Rate of subclinical infection is about 80% in fully immunized and
naturally immune individuals.
• Protection against this disease wanes 3-5 years after
vaccination and unmeasurable after 12 years.
• More common & serious in infancy and early childhood.
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3. • Aerobic, Gram negative
coccobacillus
• Non motile, Non sporing, Capsulated
but lose capsule in repeated cultivation
• Specific to Humans
• Colonizes the respiratory tract
• Transmission occurs via respiratory
droplets
Bordetella pertussis
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4. Culture characteristics
• Grows best at 35-36 degree
centigrade.
• Bordet-Gengou glycerine-potato-
blood agar – old medium
• Recommended medium: Regan-
Lowe or Charcoal horse blood
agar
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5. Virulence factors
Adhesions
• Filamentous hemagglutinin
• Pertactin
• Fimbriae
Toxins
• Pertussis Toxin
• Adenylate Cyclase
• Tracheal cytotoxin
• Dermonecrotic toxin
• Heat-labile toxin
• Lipopolysaccharide
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6. Two stages:
1. Colonization:
• Fever
• Malaise
• Coughing
2. Toxemic
• Prolonged and
Paroxysmal coughing
• Inspiratory gasp
(Whoop)
Pathogenesis
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7. Clinical Features
• Incubation period 7-14 days
• 3 Stages
• 1st Stage- Catarrhal Stage (most infectious period) - 1-2 weeks
Not distinguishable from URTI
Cough, Coryza with little nasopharyngeal secretions.
Cough become severe as time passage
Annoying and frequent at night
• 2nd Stage- Paroxysmal Stage - 2-6 weeks
Cough progress to episodic paroxysms of increasing intensity ending
High pitched inspiratory whoop
Patient coughs up thick tenacious mucus
Paroxysm cough occurs frequently and terminate after vomiting
Ulceration of frenulum of tongue due to repeated thrusting of tongue over teeth
• 3rd Stage- Convalescent Stage - (<2 weeks)
Paroxysmal of cough decreases
Less frequent vomiting
Appetite, general condition and health gradually improved
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8. Complications
• Respiratory complications
• Otitis media
• Pneumonia
• Atelectasis
• Emphysema
• Pneumothorax
• Neurological complications
• Seizure and encephalopathy
• Bleeding episodes
epistaxis
retinal or sub-conjunctival bleeds
Intracranial hemorrhage
• Malnutrition
• Flare up of tuberculosis
• Inguinal hernia
• Rectal prolapse
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9. • Based on clinical features
 Lymphocytic leukocytosis
 Low Erythrocyte Sedimentation Rate
• Isolation by culture: Nasopharyngeal swab
(often positive in Catarrhal and paroxysmal stage)
• Direct fluorescent antibody
• Serological testing
Diagnosis
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10. • Antibiotic therapy
• Erythromycin (40-50 mg/kg/day in 3 divided doses) for 14 days.
• Nebulization with salbutamol to reduce bronchospasm
• No Antihistaminics and cough suppressants.
Management
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11. Prevention
• Chemoprophylaxis: Erythromycin <2 yrs old for close
family contact
• Vaccination under 7 years of age
• DPT 3 doses in 6,10 and 14 weeks
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12. References
• Nelson’s Textbook of Pediatrics, 20th Edition
• OP. Ghai et al, Ghai Essential Pediatrics, 8th
edition
• Up to Date 21.2

13. Thank You