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Pertussis

OF Njokanma
Professor of Paediatrics
Lecture objectives

• At the end of the lecture, the student should :


– Describe the natural history and clinical
presentation of measles
– Understand the complications of the disease
– Recognize its potentially fatal nature
– Be able to outline the principles and specifics of
management
– Articulate the preventive measures
Introduction

• Aetiology: It is caused by a Gram negative


coccobacillus named Bordetella pertussis
• Pertussis is highly contagious
• The disease is mediated through the production of
pertussis toxin among other biologic factors and
toxins.
• Fatality rate is high
Clinical manifestations (1)

• Clinical features
Incubation period: 10 days to 14 days.
• The symptomatic phase of the illness may
conveniently be divided into three stages:
– Catarrhal stage
– Paroxysmal stage
– Convalescent stage
Clinical manifestations (2)

• 1. Catarrhal stage (1 week to 2 weeks)


– Mild fever
– Cough
– Rhinorrhoea
The presentation does not differ from common
cold or many other childhood infections
Clinical manifestations (3)

• 2. Paroxysmal stage (2 weeks to 4 weeks)


Cough becomes:
 more intense,
 strangulating,
 occurs in longer bouts
 occurs in paroxysms i.e. three or more bouts of
cough occur within the same respiratory cycle.
Clinical manifestations (4)

 No preparatory inspiration prior to cough. Thus


inspiration does not occur for a long time.
 When the child finally gets a chance to inspire,
the glottis is partially closed causing a
whooping sound – hence the old name
whooping cough.
Clinical manifestations (5)

 Not all who whoop have pertussis (adenovirus


infection)
 Not all who have pertussis whoop (infants)
– Infants with pertussis are more likely to
present with apnoeic spells and cyanosis.
Hospitalization and close monitoring are
therefore mandatory
Clinical manifestations (6)

• During bouts of cough:


– the eyes bulge,
– the tongue protrudes,
– the neck veins are distended
– The face becomes suffused as a result of
raised intrathoracic pressure and reduced
venous return from the head and neck.
Clinical manifestations (7)

In addition,
• The sputum is thick, tenacious and stringy
• There may be post-tussive vomiting.
Clinical manifestations (8)

• 3. Convalescent stage (1 week to 2 weeks)


– Gradual reduction in severity of symptoms but
there may be one or two relapses
– Note: The entire coughing phase of the illness
may last up to 3 months – that is the basis for the
old name 100-day cough.
Laboratory features

– Leukocytosis (absolute lymphocytosis) – usually,


a leukaemoid reaction is seen.
– Chest radiograph may show infiltrates,
atelectasis or emphysema
Complications (1)

• Pneumonia – usually from secondary bacterial


organisms or less commonly by B. pertussis
• Peumothorax
• Bronchiectasis
• Activation of latent tuberculosis
• Seizures – febrile or hypoxic
• Encephalopathy – very rare but occurs more often
in children with underlying CNS disorder
Complications (2)

• Sub-conjunctival haemorrhage (WHY?)


• Intracranial haemorrhage (WHY?)
• Hernia: Rectal prolapse (WHY?)
• Malnutrition (WHY?)
Prevention

• Vaccination
– DPT (Diphtheria, Pertusis and Tetanus) – the
pertussis component is a whole cell vaccine
– DTaP (Diphtheria, Tetanus and acellular
Pertussis)
Treatment

• Erythromycin clears B. pertussis from the


respiratory tract. It may abort the illness if given
before the paroxysmal phase.

• Supportive care:
– intermittent supplemental oxygen
– gentle airway suctioning
– adequate hydration and nutrition
Search deeper

• List other conditions that cause leukaemoid reaction