Pertussis Flashcards
What is pertussis?
Prolonged respiratory illness characterised by paroxysmal coughing and inspiratory “whoop”. This infection is caused by the bacterium bordetella pertussis. This infection is highly contagious and is spread through respiratory droplets released in intense coughing fits.
Who gets pertussis?
10 million children
What are the clinical features on history in a child with pertussis?
Classical whooping cough.
Cough and coryza for one week but then followed by a more pronounced cough in spells or paroxysms. Pertussis can also present with the non-specific persistent cough.
Vomiting often follows a coughing spasm.
Infants may develop apnoea and/or cyanosis with coughing spasms.
What is the time course of pertussis?
Day 1- 7: Prodromal Catarrhal Stage -> URTI symptoms with NO or LOW grade fever
Lasts 4-6 weeks: Paroxysmal Stage -> Paroxysms of cough (100 day cough) which is sometimes followed by a whoop, with or without post-tussive emesis
Lasts 1-2 weeks: Covalescent Stage -> occasional paroxysms of cough but decreased frequency and severity.
What are the clinical features on examination in a child with pertussis?
Often, there are no clinical signs and the children are usually well between coughing spasms.
What are the investigations conducted on a patient with suspected pertussis?
Laboratory confirmation is not necessary for diagnosis but important for infection control.
Nasopharyngeal Aspirate/Swab for PCR is the investigation of choice.
What are the general principles in the management of a patient confirmed to have pertussis?
Antibiotic Therapy Need to control the diagnosed case – exclude from school and presence of others until 5 days of therapy has been completed. Vaccination Notify the DHS Treatment of Contacts
When is antibiotic therapy considered in a child with confirmed pertussis? What antibiotics are used in the context of pertussis?
Consider ABx when:
pertussis is diagnosed in the early phase as it can reduce severity.
There has been a cough for less than 14 days which can reduce the spread and therefore the school exclusion period.
If there are complications such as pneumonia, cyanosis or apnoea)
Azithromycin for 5 days in neonates and children. If cannot swallow tablets, clarithromycin liquid for 7 days.
Discuss the prophylactic treatment of contacts of the child with pertussis.
Macrolide ABx for all household contacts. Prevention with vaccination in infants and children + booster in adolescents.
