Pertussis

Question 1

What is pertussis (whooping cough)?

What causes it?

Answer 1

It is a highly contagious respiratory infection caused by bordetella pertussis. (bacterial)

It is endemic and there is an epidemic every 3/4 years

Question 2

How does the whooping cough present?

Answer 2

Catarrhal phase (runny nose) - 1 week

• It initially presents with coryzal symptoms:
  
  • malaise
  • rhino sinusitis
  • mild fever
  • cough.
• This lasts 1-2 weeks.

Paroxysmal phase - 3-6 weeks

• Paroxysmal cough with a characteristic inspiratory whoop in infant children.
• Worse at night and may culminate in vomiting
• During a paraxysm the child goes blue or red in the face and mucus flows from the mouth and nose
• Older children and adults do not whoop and young infants may have apnoeas.

Convalescent phase - months

• Symptoms gradually decrease but may persit for months

Question 3

Describe the characteristic cough?

Answer 3

The child will cough, cough, cough without drawing breath until the lungs are virtually emptied.

A small child learns to follow this by breathing in through partially closed vocal cords and this causes the characteristic whoop.

Question 4

What are the 2 most common complications?

Answer 4

Pneumonia and apnoeas

Question 5

How should you manage whooping cough?

Answer 5

• Younger than 6 months in age = admit higher mortality and complication rates.
• Treat with clarithromycin only reduces symptoms if started in catarrhal phase but reduces infectivity.
• Prophylactic abx for close contacts and immunisation if not already.

Note: immunisation is not completely effective. However if they develop the disease it will be less severe