Whooping Cough Flashcards
Is whooping cough an upper respiratory tract infection or lower respiratory tract infection?
Upper respiratory tract infection
What is whooping cough?
It refers to an upper respiratory tract infection caused by Bordetella pertussis
Is Bordertella pertussis gram positive or negative?
Gram negative
Why is whooping cough rarer nowadays?
This due to the fact that children and pregnant women are vaccinated against pertussis
However, the vaccine becomes less effective a few years after each dose
Describe the immunisation schedule of Bordatella Pertussis
It is administered at 2, 3, 4 months and 3 -5 years
It is administered to pregnant patients between 16 - 32 weeks gestation
What are the seven clinical features of whooping cough?
Mild Coryzal Features
Low Grade Fever
Paroxysmal ‘Whooping’ Cough
Cyanosis
Vomiting
Apnoeas
Seizures
Describe the cough associated with whooping cough
The individual will suffer from intermittent coughing fits, which tend to occur at night and after feeding
These coughing fits are severe and intensify until the patient is completely out of breath
Due to this, individuals produce a loud inspiratory whoop when the coughing ends, in an attempt to forcefully inspire air against a closed glottis
The coughing fits may be ended by central cyanosis, vomiting or seizures
What are the three phases of whooping cough?
Catarrhal Phase
Paroxysmal Phase
Convalescent Phase
What is the catarrhal phase of whooping cough? How long does it persist for?
It is when the individual suffers from viral upper respiratory tract infection features
It tends to last between 1 - 2 weeks
What is the paroxysmal phase of whooping cough? How long does it persist for?
It is when individuals suffer from parxysmal whooping cough fits
It tends to last between 2 - 8 weeks
What is the convalescent phase of whooping cough? How long does it persist for?
It is when individuals experience gradual resolvement of their cough
It tends to occur between weeks to months
What are the two investigations used to diagnose whooping cough?
Nasopharyngeal/Nasal Swab
Anti-Pertussis Toxin Immunoglobulin G Testing
What two tests can be conducted on nasopharyngeal/nasal swabs to confirm whooping cough?
PCR testing
Bacterial culture
When can nasopharyngeal/nasal swabs be used to diagnose whooping cough?
They must be conducted within 2-3 weeks of the clinical feature onset
What is anti-pertussis toxin immunoglobulin G testing?
It involves detecting antibodies produced by the body’s immune response to a pertussis infection
What sample is used to conduct anti-pertussis toxin immunoglobulin G testing in patients aged between 5-16 years old?
Oral fluid
What sample is used to conduct anti-pertussis toxin immunoglobulin G testing in patients aged over 17 years old?
Blood
When can anti-pertussis toxin immunoglobulin G testing be used to diagnose whooping cough?
When clinical features have been present for over 2 weeks
What are the four diagnostic criteria of whooping cough?
A diagnosis can be obtained when individuals experience an acute cough that has persisted for more than 14 days without another apparent cause, and has one or more of the following features:
- Paroxysmal Cough
- Inspiratory Whoop
- Post-Tussive Vomiting
- Apnoea Attacks
In most cases, how is whooping cough managed?
It can be managed at home, with simple supportive treatment (fluids, rest) and safety netting advice on when to seek further medical attention
What advice should be given to parents about school exclusion in whooping cough?
They can return to school 48 hours after commencing antibiotics OR 21 days from onset of clinical features if no antibiotic administration
What are the three indications for admission of whooping cough patients?
Child < 6 Months Old
Acutely Unwell Patients
Apnoea/Cyanosis/Severe Coughing Fit Features
How do we pharmacologically manage whooping cough?
Macrolide antibiotics
What three macrolide antibiotics are used to manage whooping cough?
Azithromycin
Erythromycin
Clarithromycin
When do we administer macrolide antibiotics to manage whooping cough?
It is administered to all patients who present within 21 days of clinical features onset
When should we administer prophylactic macrolide antibiotics?
It is recommended in close contacts of infected patients if they are in a vulnerable group
For example pregnant women, unvaccinated infants or healthcare workers that have contact with children or pregnant women
What alternative antibiotic can be administered to manage whooping cough when macrolide antibiotics are contraindicated?
Co-trimoxazole
Pertussis is a notifiable disease. What does this mean?
Public health need to be notified of all suspected and confirmed cases
How long do the clinical features of whooping cough take to resolve?
8 weeks, however they can last several months
It can be referred to as the ‘100 day cough’ due to the potential long duration of the cough
What are the four complications of whooping cough?
Pneumonia
Bronchiectasis
Subconjunctival Haemorrhage
Seizures
