PERTUSSIS OR WHOOPING

COUGH
INTRODUCTION
• Pertussis/ whooping cough is a highly contagious disease
mainly of children caused by bordetella pertussis
• It is characterised by severe uncontrollable coughing spells
which can sometimes end in a whoop sound when person
breathes in
• Also called as 100 day cough by chinese
 Epidemiological determinants

Agents factors

• Causative agent is bordetella pertussis

Source of infection- only man

Infective material-

• nasopharyngeal and bronchial secretion

• Fomites contaminated by such discharge are also infective.

Infective period-

• catarrheal stage most infective

• Extends from weak after exposure to about 3 weeks after onset of paroxysmal stage

• Secondary attack rate- average 90% in unimmunized people

HOST FACTORS.

• AGE- infants and pre school(<5 years)

• Developing countries (20-30 months)

• And developed countries (50 months)

• Highest mortality below 6 months

• Sex- more common among females

• Immunity – immunity develops after a case or immunization

• No cross immunity

• Secondary attack occur in declining immune person

ENVIRONMENT-

• More cases occur during winter and spring

• Lower socio economic group due to overcrowding

Incubation period- 7-14 days not more than 3 weeks

Clinical course

• Causes local infection by multiplying in the surface epithelium of respiratory

mucosa

• Leads to inflammation and necrosis of mucosa

• Occurs in 3 stages

• 1. catarrhal 2. paroxysmal stage 3. convalescent stage

1. catarrhal stage

• Lasts for 10 days

• Characterized by- insidious onset, lacrimation, sneezing, coryza,

anorexia, malaise, hacking night cough that becomes diurnal

2. paroxysmal stage

• Last for 2-4 weeks

• Characterized by burst of rapid, consecutive cough followed by

deep, deep pitched inspiration(whoop) followed by vomiting

• In infants- causes cyanosis and apnoea

• In adults and adolescents- uncharacteristic, persistent cough.

3. convalescent stage
• Last for 1-2 weeks

• Decrease in paroxysms of coughing both in frequent and

severity
• Cessation of vomiting
COMPLICATION

• Occurs in 5-6 % cases

• Frequent in infants aged less than 6 month

• Mainly- bronchitis

- bronchopneumonia

-bronchiectasis

- subconjunctival hemorrhage

- Epistaxis

- Heomptysis

- Punctate cerebral hemorrhage

- Coma and convulsions

CONTROL OF WHOOPING COUGH
• Cases and contacts

• 1. cases – early diagnosis by bactoriological exam. Of nose

and throat secretions(60% chances within 10-14 days from
onset)
• 2. contact- isolation of case, prophylactic antibiotics
• Active immunization - DPT