Disease and Other Names–iska
months, and a little older, and carried off an
Also known as Whooping cough is a highly
contagious bacterial disease characterised by
severe coughing spells, which sometimes end with
Whooping sound when the person breathes in.
because of the “whooping” sound that people can
make when gasping for air after a fit of coughing.
Whooping cough can cause rapid, violent, and
uncontrolled coughing fits until all air is gone from
the lungs.
Also known as 100 days cough Habit pattern of
coughing may be longer or subsequent weeks and
month i.e., Chinese call it 100 days cough
Whooping cough used to be called the 100-day
cough because it can last for weeks or months. The
illness often starts like the common cold, with a
runny nose, sneezing, and a mild cough or fever.
After 1 to 2 weeks, severe coughing starts. The
cough often ends with a whooping sound as air is
inhaled.
Origin of the Disease–iska
Pertussis is a relatively recent human infectious
disease. According to Nils Rosen von Rosenstein,
the disease first appeared in France in 1414. The
first epidemic was described in 1578 by Guillaume
de Baillou.The organism was first isolated by Jules
Bordet and Octave Gengou in 1906.
Nils Rosén von Rosenstein (1706-1773) of Sweden is
usually called the founder of modern pediatrics. His
textbook, which was published in 1764, was,
according to Still, the most progressive which had
yet been written.1
The description of the clinical course of whooping
cough in Rosén von Rosenstein's book gives a lucid
account of the clinical course of the disease,
including the typical paroxysms.2
It comes on only by degrees, and is at first dry, but
when it has continued ten or twelve days, it turns
humid and the matter which is then coughed up
looks ripe; nevertheless it increases more and
more, leaving long intervals; the fits return at
certain hours, but continue at each time with such
violence and for so long a time, that the child grows
blue in the face, its eyes look as if they were forced
out, and they run besides, and a bleeding of the
nose is sometimes brought on; it coughs till it is
quite out of breath, that one is in apprehension of
its being choaked [sic]; for if the patient now and
then is capable of drawing some breath, it is with a
sounding which very much indicates with what
difficulty the lungs can admit the air. The coughing
continues, and does not leave off for that time, till
the child vomits up a quantity of slime. If at any
time the coughing should intermit without the
paroxysm being ended with a vomiting, it will
immediately return again, and will not cease but
after a vomiting.
Guillaume de Baillou (1536—1616), often called
"the Sydenham of France," gave the first detailed
description in his Epidemiorum et Ephemeridum
Libri (duo) of an epidemic of whooping cough which
occurred in 1578:
Fevers attacked children of four months, ten
enormous number. Especially that common cough
which is popularly called Quinta or Quintana, of
which mention has been made before. The
symptoms of this are severe. The lung is so irritated
that in its struggle to drive out by utmost effort the
cause of irritation, it can neither inspire, nor with
any ease expire. The patient seems to swell up, and
as if on the verge of suffocation with his breathing
obstructed in midthroat. Why it is popularly called
Quinta, is not altogether clear. Some think the word
is a made-up term of onomatopoeic origin, from
the sound and noise which they make when they
cough like this. Others do not derive it from this
source, but think the cough is called in Latin
‘Quintana,’ because it repeats at certain hours: and
experience shows this is true, for they are free from
this distress of coughing sometimes for an interval
of four or five hours, then the paroxysm of
coughing repeats, sometimes so distressing that
blood is driven out by its violence, through nose
and mouth. Very frequently the stomach empties it
contents. I have never yet read any author who
gives any account of this cough.1
In 1900, Jules Bordet along with Octave Gengou
observed a small ovoid
bacterium in the sputum of a 5-month old child
suffering from pertussis, or whooping
cough. The bacterium was similar to the
Haemophilus influenza, but showed distinct
morphological characteristics, which led Bordet and
Gengou to consider it as a separate
species
Mode of Transmission
Droplets. The primary mode of transmission is
through respiratory droplets. When an infected
person coughs or sneezes, tiny droplets containing
the bacteria are released into the air.
Airborne. Some evidence suggests that airborne
transmission may occur in certain situations. This
means that the bacteria may be present in smaller
droplets that can remain suspended in the air for
longer periods.
Indirect. When a person comes into contact with
surfaces or objects contaminated with respiratory
secretions from an infected individual. The bacteria
can survive on surfaces for some time.
Incubation Period
The incubation period of pertussis is commonly 7
through 10 days, with a range of 4 through 21 days.
he incubation period of pertussis, commonly
ranging from 7 to 10 days with a possible range of 4
to 21 days, refers to the time elapsed between
exposure to the bacterium Bordetella pertussis and
the onset of symptoms. Several factors contribute
to this specific incubation period:
Bacterial Replication and Colonization: After
exposure to the pertussis bacterium, it takes time
for the bacteria to replicate and colonize the
respiratory tract. The initial phase involves the
bacteria attaching to the cilia (hair-like structures)
lining the respiratory tract, leading to local
inflammation.
Immune Response Activation: As the bacteria
multiply, they release toxins that lead to the
characteristic symptoms of pertussis, such as severe
coughing fits. The immune system responds to the
infection, and the incubation period accounts for
the time it takes for the immune response to
become noticeable through symptoms.
Variability in Individual Immune Response: The
range in the incubation period (4 to 21 days)
reflects the variability in individual immune
responses. Some individuals may develop
symptoms earlier due to a more rapid immune
response, while others may take longer. The
immune system's effectiveness in containing the
infection can influence the duration of the
incubation period.
Infectious Period: It's important to note that
individuals with pertussis are contagious during the
incubation period and continue to be so after
symptoms appear. The bacterium is primarily
spread through respiratory droplets during
coughing, which contributes to the transmission of
the disease.
A hallmark feature of pertussis is paroxysmal
coughing, characterized by severe and
uncontrollable coughing spells. These coughing fits
can be prolonged and may occur in rapid
succession, often leading to a distinctive high-
pitched "whooping" sound when the person
inhales.
Diagnostic Test–iska
A nose or throat culture and test. Your doctor takes
a swab or suction sample from the area where the
nose and throat meet (nasopharynx). The sample is
then checked for evidence of the presence of
whooping cough bacteria.
Blood tests. A blood sample may be drawn and sent
to a lab to check your white blood cell count,
because white blood cells help the body fight
infections, such as whooping cough. A high white
blood cell count typically indicates the presence of
infection or inflammation. This is a general test and
not specific for whooping cough.
A chest X-ray. Your doctor may order an X-ray to
check for the presence of inflammation or fluid in
the lungs, which can occur when pneumonia
complicates whooping cough and other respiratory
infections.
Drug of Choice–iska
The recommended antimicrobial agents for
treatment or chemoprophylaxis of pertussis are:
Azithromycin
Clarithromycin
Erythromycin
Clinicians can also use Trimethoprim-
sulfamethoxazole.
Azithromycin, Clarithromycin, Erythromycin, and
Trimethoprim-sulfamethoxazole—are antibiotics
commonly used in the treatment of pertussis, also
known as whooping cough. The choice of these
antibiotics is based on their effectiveness against
the causative agent of pertussis, which is the
bacterium Bordetella pertussis. Here's why these
antibiotics are preferred:
Combination Antibiotic: Trimethoprim-
sulfamethoxazole is a combination antibiotic that
works by inhibiting bacterial growth through the
inhibition of folate synthesis.
Use in Pertussis: While macrolides are the preferred
choice, trimethoprim-sulfamethoxazole may be
considered as an alternative in certain situations,
such as cases where macrolides are contraindicated
or not tolerated.

Macrolide Antibiotics (Azithromycin,

Clarithromycin, Erythromycin):

Mechanism of Action: Macrolides inhibit bacterial

protein synthesis, targeting the growth and
reproduction of bacteria.

Effectiveness: These antibiotics are effective against

Bordetella pertussis and can help reduce the
severity and duration of symptoms.

Early Treatment: Administering macrolides early in

the course of the illness is crucial, especially during
the catarrhal stage (early stage) before severe
coughing begins.

Trimethoprim-sulfamethoxazole: