Whooping Cough

Question 1

Is Whooping cough a Notifiable Disease?

Answer 1

• Yes it is

Question 2

What bacteria causes Whooping Cough?

Answer 2

• Bordetella Pertussis

Question 3

When are Vaccinations given against Whopping Cough?

Answer 3

• At 2months,3months and 4 months of age
• Booster at 3years and 4 months
• Pregnant women are also given vaccinations as an aim to give passive immunity to the newborn in the first few months of life

Question 4

What is Bordetella Pertussis?

Answer 4

• Bordetella Pertussis is a gram-negative bacilli
• Spreads through aerosolised droplets via a cough

Question 5

What is the Pathophysiology of Bordetella Pertussis?

Answer 5

• The bacteria attach to the respiratory epithelium and produce toxins which paralyse the cilia promoting inflammation and reducing the clearance of respiratory secretions
• Pertussis is highly contagious with up to 90% of household contacts developing the disease

Question 6

What are the Risk Factors for Bordetella Pertussis?

Answer 6

• Non-vaccination
• Exposure to an infected individual

Question 7

What are the three stages seen in Whooping Cough?

Answer 7

• Catarrhal phase
• Paroxysmal phase
• Convalescent phase

Question 8

What are the clinical features seen in the Catarrhal Phase?

Answer 8

• Rhinitis
• Conjunctivitis
• Irritability
• Sore throat
• Fever
• Dry cough

Question 9

What are the clinical features seen in the Paroxysmal Phase?

Answer 9

• This lasts between 2-8 weeks
• Characterised by episodes of Paroxysms of coughing followed by an inspiratory gasp - whooping sound
• these can be severe enough to cause vomiting and even cyanosis

Question 10

What are the clinical features seen in the Convalescent Phase?

Answer 10

• The cough decreases in frequency and severity
• There is a low-grade fever
• Conjunctival haemorrhages and facial petechiae due to vigorous coughing

Question 11

What are the Differential Diagnosis for Whooping Cough?

Answer 11

• Bronchiolitis (Wheeze, under the age of 1 and an acute history)
• Mycoplasma Pneumonia
• Bacterial Pneumonia
• Asthma
• TB

Question 12

What are the Investigations for Whooping Cough?

Answer 12

• If the cough is <2 weeks = Nasopharyngeal Aspirate
• If the cough is >2 weeks = anti-pertussis toxin IgG serology - in children under 5
• If the cough is >2 weeks and the child is aged 5-17 = anti pertussis toxin detection in oral fluids is recommended

Question 13

When does a child with Whooping Cough require hospital admission?

Answer 13

• Those under the age of 6 months
• Those with significant breathing difficulties
• Feeding Difficulties
• Significant complications - pneumoniae and seizures

Question 14

What is the management of Whooping Cough?

Answer 14

• 1. under 1 month = Clarithromycin, over 1 month = Clarithromycin/Azithromycin
• 2. Co-trimoxazole for when macrolide is contra-indicated
• 3. Supportive Managment such as paracetamol/ ibuprofen for symptomatic relief and adequate fluid intake to prevent dehydration
     -4. Inform parents it could take up to 3 months to resolve

Question 15

What are the complications of Whooping Cough?

Answer 15

• Seizures
• Encephalopathy
• Secondary Bacterial Pneumonia
• Otitis Media