Whooping cough

Description of the disease

This is an acute bacterial infection in children affecting the respiratory tract and manifesting with paroxysms of spasmodic cough.

Causative agent

The classic whooping cough is caused by the bacterium Bordetella pertussis. Similar diseases resembling whooping cough can be caused by B. parapertussis, B.brochiseptica. The main factor causing the disease in whooping cough is an exotoxin that damages the respiratory tract cells. Whooping cough bacteria are very sensitive to temperature fluctuations and cold, quickly dying in the external environment.

Spread

Humans are the only host of B. pertussis. The source of infection is the patient. Those infected are most dangerous during the catarrhal period and can spread the pathogen up to 3 weeks. Then the bacteria multiply intensively on the surface of the respiratory tract mucosa. The infection is transmitted through droplets in the air. Routine vaccination of children has significantly reduced the frequency of severe forms of the disease. In countries where routine vaccination is carried out, infants and young children are infected by adults, especially the elderly, who have not been diagnosed with whooping cough. Whooping cough is characterized by periodic outbreaks every 3-4 years. Infection is more common in autumn and winter. The highest incidence is among children aged 1-5 years, especially vulnerable are newborns and infants. In recent years, older individuals have also been affected.

Symptoms

Whooping cough occurs 6-20 days after infection. The disease starts gradually with a runny nose, cough, sometimes fever. After 1-2 weeks, the cough intensifies. Paroxysms of spasmodic cough are characterized by the child constantly coughing, face turning red and blue. After the coughing fits, there is a deep, wheezing breath. Often at the end of a fit, thick, clear sputum is expelled, the child vomits. The fits exhaust, disrupt sleep, reduce appetite, and sores form on the tongue. The period of spasmodic cough lasts 2-4 weeks. Later, the coughing fits become less frequent and milder. Recovery occurs within 1-2 weeks if there are no complications: laryngitis, bronchitis, pneumonia, seizures, brain damage.

Diagnosis

Whooping cough is suspected when typical coughing fits begin. The diagnosis is confirmed by a bacteriological test, when B. pertussis is cultured from nasopharyngeal material.

Treatment

Antibiotic treatment is prescribed with macrolide preparations: azithromycin, erythromycin, clarithromycin, rarely trimethoprim/sulfamethoxazole. Cough is suppressed and spasms relieved with atropine, papaverine, codeine for calming. During fits, a calm environment is maintained, the child is engaged in games, books.

Prevention

The main preventive measure for whooping cough is vaccination. In Lithuania, a cellular pertussis vaccine is administered with diphtheria and tetanus anatoxins at 2 months, 4 months, and 6 months. Children at 18 months and 6-7 years are revaccinated. It is recommended to vaccinate adults every 10 years. Isolation of the patient and prohibition for children under 7 years who have had contact with the patient to attend child collectives for 21 days from the last contact day. For the latter, erythromycin or another antibiotic is prescribed for 7 days.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology