Whooping cough (Pertussis) Flashcards

1
Q

Define whooping cough.

A

RTI characterised by paroxysms of coughing followed by a ‘whoop’ (sudden forced inspiration against closed glottis).

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2
Q

Explain the aetiology of whooping cough.

A

Bacterium Bordetella pertussis (gram -ve)

Incubation period of 7-10 (up to 21) days

Communicable for 3w from start of coughing via droplet spread.

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3
Q

Summarise the epidemiology of whooping cough.

A

Immunisation has decreased risk by 80-90%. Previously, epidemics occurred in the UK every 4 years.

Peak: 3 years.

In infants < 6 months, has much higher mortality.

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4
Q

What are signs and symptoms of whooping cough?

A

Catarrhal stage: 1w; Coryzal Sx.

Paroxysmal stage: 1-6w; paroxysms of continuous coughing, inspiratory ‘whoop’ +/- vomiting. Infants < 6m don’t whoop but may have apneic episodes.

Convalescent stage: weeks-months; chronic cough that becomes less paroxysmal.

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5
Q

What Ix are required for whooping cough dx?

A

Clinical dx, confirmed with

Per nasal swab culture for Bordetella pertussis: days-weeks to come back

PCR + serology increasingly used as availability more widespread

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6
Q

What is the management of whooping cough?

A

Oral macrolide (e.g. clarithromycin, azithromycin or erythromycin) if onset of cough within 21 days to eradicate organism + reduce the spread

Does not alter clinical course

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7
Q

What is the criteria for admission with whooping cough?

A

< 6m (increased mortality)

Inability to feed, vomiting, dehydration, weight loss

Respiratory distress/ apnoea +/- cyanosis

Evidence of pneumonia

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8
Q

What are complications associated with whooping cough?

A

Subconjunctival haemorrhage

Secondary infections: Otitis media, bronchiectasis, pneumonia (main cause of pertussis-related deaths).

Seizures (3%): If encephalopathy follows, ⅓ die, ⅓ remain neurologically impaired, ⅓ recover fully.

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9
Q

What is the prognosis of whooping cough?

A

Usually lasts 6-8w; however, a prolonged illness may occur (“100-day cough”).

Significant morbidity + mortality in infants < 6m in whom apnoea associated with paroxysms may cause sudden death.

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10
Q

Give a RF for whooping cough

A

Unvaccinated per schedule

Newborns

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11
Q

What signs and Sx may arise secondary to the paroxysmal cough?

A

Conjunctival haemorrhages

Petechiae

Reduced oral intake: dehydration + weight loss

Anoxia: syncope + seizures

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12
Q

Characterise the cough in Pertussis

A

Worse at night + after feeding

May be ended by vomiting

Associated central cyanosis

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13
Q

How do older children + adolescents differ in presentation of whooping cough?

A

May not exhibit distinct stages.

Sx: uninterrupted coughing, feelings of suffocation + headaches.

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14
Q

How should pertussis be managed from a public health view?

A

Notifiable disease

Household contacts should be offered abx prophylaxis

School exclusion: until 5d after commencing abx (or 21 days from onset of Sx if no abx)

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