Respiratory: Pertussis (Whooping Cough) Flashcards
What is pertussis caused by?
The gram negative bacteria bordetella pertussis
Does it typically present in adults or children?
Children
Is it highly contagious?
Yes
Describe the presentation
A week of coryza = catarrhal phase
Followed by characteristic paroxysmal or spasmodic cough then inspiratory whoop
When are the coughing spasm most common?
At night
After feeding
What can the coughing culminate in?
Vomiting
Central cyanosis
What can happen during a paroxysm?
Child goes red or blue in face
Mucus flows from nose or mouth
The whoop may be absent in infants, but…. is common
Apnoea
What can happen as a result of vigorous coughing?
Epistaxis
Subconjunctival haemorrhage
Syncope
Seizures
How long does the paroxysmal phase last?
Up to 3 months
What complications can occur?
Pneumonia
Seizures
Bronchiectasis
Uncommon but significant mortality particularly in infants who have not completed primary vaccinations at 4 months
What is characteristically found on FBC?
Marked lymphocytosis >15x10^9
When should whooping cough be suspected?
Acute cough lasting 14 days or more without another apparent cause One or more of following features: Paroxysmal cough Inspiratory whoop Post-tussive vomiting Undiagnosed apnoeic attacks in infants
How is it diagnosed?
Nasal swab culture
PCR and serology now increasingly used
Should infants under 6 months with suspected pertussis be admitted?
Yes
Is it a notifiable disease in UK?
Yes
How is it managed?
Macrolide antibiotics if onset of cough occurred within previous 21 days to eradicate organism and reduce spread
Symptoms only decreased if started in the catarrhal phase
Close contacts offered macrolide prophylaxis
Unimmunised infant contacts should be vaccinated
Does antibiotic therapy alter the course of the illness?
No
What can reduce the risk of pertussis in first few months of life?
Reimmunisation of mothers during pregnancy - it is currently recommended in the UK between 20-32w gestation
