Pertussis, commonly known as whooping cough, is a highly contagious respiratory tract infection, caused by the bacterium Bordetella pertussis.
Pertussis is a significant cause of morbidity and mortality in infants younger than 2 years.
First let’s discuss the etiology and pathogenesis of the disease.
Bordetella pertussis is a gram-negative, pleomorphic bacillus, which spreads via the aerosolized respiratory droplets of infected individuals.
Once inside the respiratory tract, they attach to the respiratory epithelium and cause destruction while multiplying.
This will initiate an inflammatory response, which leads to the formation of an inflammatory exudate, obstructing the airway.
So, affected children are prone to have alveolar collapse, cough, cyanosis, and pneumonia.
It is important to note that this condition affects only the airways, and lung parenchyma is spared.
Risk factors for pertussis include the following.
Prematurity.
Non-vaccination in children.
Pregnancy.
Epidemic exposure.
And underlying cardiac, respiratory, or neurologic illnesses.
The incubation period of the bacterium is around 3 to 12 days.
Pertussis is typically a six-week disease, which occurs in 3 stages, each lasting about 2 weeks.
Catarrhal phase.
Paroxysmal phase.
And convalescent or recovery phase.
During the catarrhal phase, patients have non-specific symptoms such as nasal congestion, rhinorrhea, and sneezing.
Some children may also have a low-grade fever, tearing, and conjunctival injection.
During the paroxysmal phase, children have paroxysms of intense cough, which last for several minutes.
In older infants and children, these paroxysms of cough are followed by a loud whoop, hence the name whooping cough.
However, infants less than 6 months will not have a characteristic whoop. Instead, they have apneic episodes.
Most children turn red when they are coughing, and post-tussive vomiting may also occur.
During the convalescent phase, patients will have a chronic cough.
Complications of pertussis include the following.
Pneumonia.
Hypoxic encephalopathy.
Otitis media.
Nose bleeding and conjunctival hemorrhages due to extensive coughing.
Hernia, which is also due to rigorous coughing.
Activation of tuberculosis.
Seizures.
Cerebral hemorrhages.
Coma, and death.
Isolation of Bordetella pertussis in culture of deep nasopharyngeal aspirates is the gold-standard method for diagnosing pertussis.
In addition, PCR is another reliable method.
Blood cultures are not useful since the organism does not enter the blood during illness.
Complete blood count will show leukocytosis with absolute lymphocytosis.
Finally, the treatment of pertussis is mainly supportive, which includes adequate oxygenation, proper hydration, nutritional optimization, and rest.
Infants should be carefully observed for apnea, cyanosis, and hypoxia.
Antibiotics do not alter the severity of symptoms or duration of the illness.
However, they are effective in preventing the spread of the disease to others.
Therefore, children with pertussis are started on azithromycin during the paroxysmal phase.
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