Pertussis, or whooping cough, is an acute infectious disease caused by the bacterium Bordetella pertussis. It initially presents with mild fever and an irritating cough that later develops into paroxysmal coughing fits followed by a characteristic "whoop". It is highly contagious and if left untreated can lead to complications in infants under 6 months old such as bronchitis, pneumonia, and even death. The document discusses the epidemiology, clinical presentation, diagnosis, treatment, and control of pertussis including vaccination and isolation of cases and contacts.

1. PERTUSSIS
(WHOOPING COUGH)
Dr. Sushrit A. Neelopant
Assistant Professor,
Department of Community Medicine
RIMS, Raichur

2. INTRODUCTION
• Acute infectious disease
• Insidious onset, mild fever, irritating cough
paroxysmal– whoop
• Often- cyanosis, vomiting
• Chinese- 100 days cough

3. PROBLEM STATEMENT
• Important cause of death in infants
– Esp. unimmunized, malnourished, inf.
– CFR- 4-15%
• Globally- 2012- 2.49 cases
• USA- 21% of adults with cough >2wks Pertussis
• India-
– 1987- 1.63L
– 2013- 0.36661L 70% decline

4. EPIDEMIOLOGY

5. AGENT FACTORS
• Agent:
– B. pertussis (95%), parapertussis (5%)
– Phases- smooth and rough,
– Capsule- capsulated (encap ph. 1) and non-capsulated
– Toxin- exo and endo
– Agglutinogens- 1, 2, 3 and other minor
• Source: man, no carrier, no subclinical
• Infective material: nasopharyngeal, bronchial sec.n
• Infective period: wk. after exp. to 3wks after
paroxysmal stage, SAR- 90%

6. HOST FACTORS
• Age:
– Infants and pre-school children
– Highest incidence- <5 yrs,
– highest mortality- < 6months
• Gender: incidence and fatality F > M
• Immunity:
– 2nd attacks- declining immunity

7. Environmental
Factors
•Throughout
the year
•Seasonal-
winter, spring
•Overcrowding
•SES
Mode of
transmission
•Droplet inf.
•Direct contact
Incubation
period
• 7-10 days
• Not > 3wks.

8. CLINICAL COURSE
• Local inf.  Multiplies on surface epith.  Inflamm.
and necrosis  secondary bact. Inf.
• 3 stages:
1. Catarrhal stage
2. Paroxysmal stage
3. Convalescent stage

9. CATARRHAL STAGE
PAROXYSMAL STAGE
CONVALESCENT STAGE
• 10 days
• Insidious
• Lacrimation, sneezing, coryza, anorexia, malaise,
• Hacking night cough diurnal

10. CATARRHAL STAGE
PAROXYSMAL STAGE
CONVALESCENT STAGE
• 2- 4 wks.
• Bursts- rapid, consecutive coughs 
• Deep high pitched inspiration (whoop) 
• Vomiting
• Cyanosis, apnoea- young infants

11. • 1 – 2 wks
• COMPLICATIONS:
– 5-6%, in infants < 6mths
– Bronchitis, bronchopneumonia, bronchiectasis
– Paroxysms subconjunctival haemorrhages,
epistaxis, haemoptysis, punctate cerebral
haemorrhages  convulsions, coma
CATARRHAL STAGE
PAROXYSMAL STAGE
CONVALESCENT STAGE

12. CONTROL
1. CASES AND CONTACTS
1. CASES
2. CONTACTS
2. ACTIVE IMMUNIZATION
3. PASSIVE IMMUNIZATION

13. CASES
• EDT, isolation, disinfection of discharges- nose, throat
• ED: naso-pharyngeal swabs, <60% chance- <10-14d
• FAT: rapid
• PCR
• Isolate until non-infectious
• T: Erythromycin- 30-50 mg/kg, QID x 10 days
– Helpful – control- sec. bact. Inf.

14. CONTACTS
• Infants and children- keep away
• Prophylaxis: 10 days
• The best protection: Booster dose DPT

15. ACTIVE IMMUNIZATION
• DPT/ DTWP, DTaP
• Untoward reactions:
– Persistent inconsolable crying
– Seizures
– Hypotonic hypo-responsive episodes
– Anaphylaxis
– Encephalopathy

16. PASSIVE IMMUNIZATION
• No evidence of efficacy