whooping cough


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Whooping Cough

 

Definition

Whooping cough, also known as pertussis, is a highly contagious disease which causes classic spasms (paroxysms) of uncontrollable coughing, followed by a sharp, high-pitched intake of air which creates the characteristic "whoop" of the disease's name.

Description

Whooping cough is caused by a bacteria called Bordatella pertussis. B. pertussis causes its most severe symptoms by attaching itself to those cells in the respiratory tract which have cilia. Cilia are small, hair-like projections that beat continuously, and serve to constantly sweep the respiratory tract clean of such debris as mucus, bacteria, viruses, and dead cells. When B. pertussis interferes with this normal, janitorial function, mucus and cellular debris accumulate and cause constant irritation to the respiratory tract, triggering coughing and increasing further mucus production.
Whooping cough is a disease which exists throughout the world. While people of any age can contract whooping cough, children under the age of two are at the highest risk for both the disease and for serious complications and death. Apparently, exposure to B. pertussis bacteria earlier in life gives a person some immunity against infection with it later on. Subsequent infections resemble the common cold.

Causes and symptoms

Whooping cough has four somewhat overlapping stages: incubation, catarrhal stage, paroxysmal stage, and convalescent stage.
An individual usually acquires B. pertussis by inhaling droplets infected with the bacteria coughed into the air by someone already suffering with the infection. Incubation is the symptomless period of seven to14 days after breathing in the B. pertussis bacteria, and during which the bacteria multiply and penetrate the lining tissues of the entire respiratory tract.
The catarrhal stage is often mistaken for an exceedingly heavy cold. The patient has teary eyes, sneezing, fatigue, poor appetite, and an extremely runny nose (rhinorrhea). This stage lasts about 10-14 days.
The paroxysmal stage, lasting two to four weeks, begins with the development of the characteristic whooping cough. Spasms of uncontrollable coughing, the "whooping" sound of the sharp inspiration of air, and vomiting are all hallmarks of this stage. The whoop is believed to occur due to inflammation and mucous which narrow the breathing tubes, causing the patient to struggle to get air into his/her lungs; the effort results in intense exhaustion. The paroxysms (spasms) can be induced by over activity, feeding, crying, or even overhearing someone else cough.
The mucus which is produced during the paroxysmal stage is thicker and more difficult to clear than the more watery mucus of the catarrhal stage, and the patient becomes increasingly exhausted attempting to clear the respiratory tract through coughing. Severely ill children may have great difficult maintaining the normal level of oxygen in their systems, and may appear somewhat blue after a paroxysm of coughing, due to the low oxygen content of their blood. Such children may also suffer from swelling and degeneration of the brain (encephalopathy), which is believed to be caused both by lack of oxygen to the brain during paroxysms, and also by bleeding into the brain caused by increased pressure during coughing. Seizures may result from decreased oxygen to the brain. Some children have such greatly increased abdominal pressure during coughing that hernias result (hernias are the abnormal protrusion of a loop of intestine through a weak area of muscle). Another complicating factor during this phase is the development of pneumonia from infection with another bacterial agent; the bacteria takes hold due to the patient's already-weakened condition.
If the patient survives the paroxysmal stage, recovery occurs gradually during the convalescent stage, usually taking about three to four weeks. However, spasms of coughing may continue to occur over a period of months, especially when a patient contracts a cold, or other respiratory infection.

Diagnosis

Diagnosis based just on the patient's symptoms is not particularly accurate, as the catarrhal stage may appear to be a heavy cold, a case of the flu, or a simple bronchitis. Other viruses and tuberculosis infections can cause symptoms similar to those found during the paroxysmal stage. The presence of a pertussis-like cough along with an increase of certain specific white blood cells (lymphocytes) is suggestive of pertussis (whooping cough). However, cough can occur from other pertussis-like viruses. The most accurate method of diagnosis is to culture (grow on a laboratory plate) the organisms obtained from swabbing mucus out of the nasopharynx (the breathing tube continuous with the nose). B. pertussis can then be identified by examining the culture under a microscope.

Treatment

Treatment with the antibiotic erythromycin is helpful only at very early stages of whooping cough, during incubation and early in the catarrhal stage. After the cilia and the cells bearing those cilia, are damaged, the process cannot be reversed. Such a patient will experience the full progression of whooping cough symptoms; symptoms will only improve when the old, damaged lining cells of the respiratory tract are replaced over time with new, healthy, cilia-bearing cells. However, treatment with erythromycin is still recommended, to decrease the likelihood of B. pertussis spreading. In fact, all members of the household where a patient with whooping cough lives should be treated with erythromycin to prevent the spread of B. pertussis throughout the community. The only other treatment is supportive, and involves careful monitoring of fluids to prevent dehydration, rest in a quiet, dark room to decrease paroxysms, and suctioning of mucus.

Prognosis

Just under 1% of all cases of whooping cough cause death. Children who die of whooping cough usually have one or more of the following three conditions present:
  • severe pneumonia, perhaps with accompanying encephalopathy
  • extreme weight loss, weakness, and metabolic abnormalities due to persistent vomiting during paroxysms of coughing
  • other pre-existing conditions, so that the patient is already in a relatively weak, vulnerable state (such conditions may include low birth weight babies, poor nutrition, infection with the measles virus, presence of other respiratory or gastrointestinal infections or diseases)

Prevention

The mainstay of prevention lies in programs similar to the mass immunization program in the United States which begins immunization inoculations when infants are two months old. The pertussis vaccine, most often given as one immunization together with diphtheria and tetanus, has greatly reduced the incidence of whooping cough. Unfortunately, there has been some concern about serious neurologic side effects from the vaccine itself. This concern led huge numbers of parents in England, Japan, and Sweden to avoid immunizing their children, which in turn has led to major epidemics of disease in those countries. However, several carefully constructed research studies have disproved the idea that the pertussis vaccine is the cause of neurologic damage. Furthermore, a newer formulation of the pertussis vaccine is available. Unlike the old whole cell pertussis vaccine, which is composed of the entire bacterial cell which has been deactivated (and therefore unable to cause infection), the newer acellular pertussis vaccine does not use a whole cell of the bacteria, but is made up of (between two and five) chemical components of the B. pertussis bacteria. The acellular pertussis vaccine appears to greatly reduce the risk of unpleasant reactions to the vaccine, including high fever and discomfort following vaccination.

Resources

Periodicals

Jenkinson, Douglas. "Natural Course of 500 Consecutive Casesof Whooping Cough: A General Practice Population Study." British Medical Journal310, no. 6975 (February 4, 1995): 299+.

Key terms

Cilia — Tiny, hair-like projections from a cell. In the respiratory tract, cilia beat constantly in order to move mucus and debris up and out of the respiratory tree, in order to protect the lung from infection or irritation by foreign bodies.
Encephalopathy — Swelling and degeneration of the brain.

whooping cough

 [ho̳p´ing kof]
an infectious disease characterized by catarrh of the respiratory tract and peculiar paroxysms of coughing, ending in a prolonged crowing or whooping respiration; the causative organism is Bordetella pertussis. Called also pertussis. Whooping cough is a serious and widespread disease, with about 300,000 cases a year reported in the United States. Although it may attack at any age, most cases occur in children under 10, and half of these are in children under 5.



The organisms are spread by the victim's coughing and sneezing and by objects he has touched. The incubation period is usually about 7 days, although it may vary between 2 and 21 days. Unlike other respiratory diseases, whooping cough is more likely to occur in spring and summer than in winter. It affects females much more often than males.
Symptoms. Whooping cough frequently starts with a running nose, a slight fever, and a persistent cough. This stage usually lasts about 2 weeks. After this, the child feels chilled and begins to vomit. His coughing increases. He begins to cough in spells of eight to ten times in one breath. This forces the air from the lungs, and the face may turn purple or blue from the effort and the shortage of air. Finally he catches his breath in a long, noisy intake, or “whoop.” In the very young (under 6 months) the true whoop is often not present, even when paroxysms are severe and frequent.



The coughing stage of the disease usually lasts 4 to 6 weeks, and the coughing may be very severe at night. Then the coughing spells become less frequent and less severe until the disease has run its course.

Stage three (convalescent stage) may last from 4 months to 2 years. The coughing spells diminish but the patient usually experiences them again each time he has an upper respiratory infection.

Complications of whooping cough include pneumonia, atelectasis, and emphysema; of these, pneumonia is the most serious, accounting for 90 per cent of the fatalities in young children. Brain damage, another complication, should be suspected if convulsive seizures occur in the pertussis patient.
Immunization. An attack of whooping cough gives immunity but does not confer life-long immunity. The vaccine usually is given in combination with diphtheria and tetanus and is available as a preparation that should be given intramuscularly, preferably in the lateral thigh.
Treatment and Patient Care. Precautions against the spread of the disease entail following respiratory isolation precautions for 7 days after effective therapy is begun. Recommendations for preventive measures after exposure can be found in the CDC Guidelines for Infection Control in Hospital Personnel.

Treatment is primarily supportive, including bed rest as long as the fever persists, antibiotics to avoid secondary infections, and antipyretics to control fever. In very serious cases, especially in infants, whooping cough may cause severe breathing difficulties. Suction may be necessary at frequent intervals to remove accumulations of mucus from the air passages. Fatalities, particularly in infants, are not uncommon. A proper diet is essential during whooping cough. Because vomiting may be a problem, small frequent feedings of bland foods are considered best.

per·tus·sis

(per-tŭs'is),
An acute infectious inflammation of the larynx, trachea, and bronchi caused by Bordetella pertussis; characterized by recurrent bouts of spasmodic coughing that continues until the breath is exhausted, then ending in a noisy inspiratory stridor (the "whoop") caused by laryngeal spasm.
[L. per, very (intensive), + tussis, cough]

whooping cough

(ho͞o′pĭng, wo͞o′-, hwo͞o′-, ho͝op′ĭng)
n.
A highly contagious disease of the respiratory system, usually affecting children, that is caused by the bacterium Bordetella pertussis and is characterized in its advanced stage by spasms of coughing interspersed with deep, noisy inspirations. Also called pertussis.

whooping cough

See pertussis.

whooping cough

Pediatrics The characteristic cough of pertussis, which infects ± 60 million and kills 1 million/year worldwide, caused by the gram-negative nonmotile Bordetella pertussis; the 'whoop' occurs during the paroxysmal stage of infection–1-2 wks after onset, lasting 2-6 wks; a 'paroxysm' consists of 10-20 coughs of ↑ intensity, a deep inspiration–the 'whoop' after which a thick, viscid plug of mucus is expelled, occasionally with vomiting; the paroxysms may occur every12 hr, often accompanied by ↑ venous pressure, plethoric conjunctivae, periorbital edema, petechiae and epistaxis, infants may be cyanotic until relieved of the obstructing plug of mucus Management Supportive; young infants may need hospitalization if coughing is severe Prevention Immunization with DPT vaccine. See DTP.

per·tus·sis

(pĕr-tŭs'is)
An acute infectious inflammation of the larynx, trachea, and bronchi caused by Bordetella pertussis; characterized by recurrent bouts of spasmodic coughing that continues until the breath is exhausted, then ends in a noisy inspiratory stridor (the "whoop") caused by laryngeal spasm.
Synonym(s): whooping cough.
[L. per, very (intensive), + tussis, cough]

whooping cough

An acute, highly infectious, disease of early childhood acquired by droplet infection and caused by the organism Bordetella pertussis . For the first 2 weeks the infection resembles a common cold but then a characteristic cough develops. There is a succession of short, rapid coughs with no time to draw breath between them. This is followed by a long, inspiration with a whooping sound. From 3 to 50 paroxysms of coughing may occur and these are very exhausting. The final paroxysm in a series is often followed by vomiting. The cough may persist for weeks. Whooping cough may be complicated by OTITIS MEDIA, PNEUMONIA, collapse of part of a lung or seizures from lack of oxygen to the brain. Vomiting may interfere with nutrition. Antibiotics are of no value once the cough has developed but if given earlier reduce the severity of the disease. All babies should be immunized against whooping cough unless there is a sound medical objection. Also known as pertussis.

whooping cough

an infectious disease, common in children, caused by the bacterium Bordetella pertussis, in which there is firstly a range of symptoms similar to the common cold; these then develop into severe coughing, usually ending in a characteristic ‘whoop’ as air is breathed in. Frequently there is vomiting, and lung damage often occurs if ANTIBIOTICS such as erythromycin are not administered. In some cases, particularly in very young children, whooping cough can be fatal.

whooping cough,

n a bacterial disease triggered by
Bordetella pertussis. The illness is characterized by the distinctive spasmodic cough, difficult-to-dislodge mucus, and general weakness.

per·tus·sis

(pĕr-tŭs'is)
Acute infectious inflammation of larynx, trachea, and bronchi caused by Bordetella pertussis.
Synonym(s): whooping cough.
[L. per, very (intensive), + tussis, cough]

whooping cough,

References in periodicals archive ?
The cause of death was found to be bronchopneumonia, brought on by a whooping cough.
Whooping cough is a highly contagious bacterial infection of the lungs and airways but, due to the success of an NHS vaccination scheme, it is now uncommon in young children.
and Ms Sheffield engaged in misleading and deceptive conduct and made false and misleading representations to the effect that there was an adequate foundation in medical science for the statement that homeopathic treatments are a safe and effective alternative to the whooping cough vaccine, when in fact no such foundation exists and the vaccine is the only treatment currently approved for use and accepted by medical practitioners for the prevention of whooping cough.
PHE Head of Immunisation, Dr Mary Ramsay, said: 'We welcome JCVI's advice that the vaccination programme for pregnant women is continued, particularly while whooping cough continues to circulate at elevated levels.
Mums are being encouraged to have the whooping cough vaccination, between 28-38 weeks of pregnancy.
Bouressa, who has worked as a pediatrician in Lane County for 15 years, said the cluster of local whooping cough cases is notable, although similar upticks have been seen in the past.
The results show the importance of following up patients with exposure to whooping cough in childhood, particularly pregnant women", Luciana Quaranta, the PhD candidate at the university said.
Unfortunately, right now this prime location finds us sandwiched between two recent epidemics of whooping cough that have affected thousands in those two neighboring states.
Dr Mary Ramsay, head of immunisation at the HPA said: "We usually see a rise in cases of whooping cough every three to four years as the disease peaks in cycles, with 2008 being the last peak year.
During the study, Pejman Rohani (based at the University of Georgia during completion of this study) and Helen Wearing used mathematical models to explore various scenarios and compared the predictions generated by those models to data on whooping cough incidence.
Whooping cough (also called pertussis) can last up to 10 weeks and can cause long bouts of coughing and choking, making it hard to breathe.