Whooping Cough (Pertussis): Complications, Diagnosis, Treatment And Prevention

Funom Makama By Funom Makama, 1st Apr 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Diseases & Infections

The disease has to be suspected clinically, particularly in an unimmunized child with known contact with the disease. Total leucocyte count is elevated to 20,000 to 50,000/cmm with absolute lymphocytosis. A leukemoid reaction may sometimes occur.

Complications Of Whooping Cough

Complications easily develop and this is very common:

Respiratory: Otitis media, especially in infants; Bronchitis, Bronchopneumonia, Atelectasis (segmental or lobar), Interstitial or subcutaneous emphysema or Pneumothorax due to rupture of alveoli; Bronchiectasis and Flare up of tuberculosis.
Central nervous system: convulsions (due to anorecia, encephalopathy, or rarely intracranial hemorrhage).
Gastrointestinal: severe vomiting with dehydration, tetany, ulceration of the frenum of the tongue (due to biting during a paroxysm), prolapsed rectum, hernia.
Hemorrhages: Epistaxis subconjunctival hemorrhage, Hemoptysis, hematemesis
Malnutrition: Severe emaciation occurs in most of the affected children. In poor communities, it is the starting point for marasmus and kwashiorkor.

Diagnosis: The disease has to be suspected clinically, particularly in an unimmunized child with known contact with the disease. Total leucocyte count is elevated to 20,000 to 50,000/cmm with absolute lymphocytosis. A leukemoid reaction may sometimes occur. Chest X-rays may show peri-hilar infiltrates or segmental collapse. Bacteriological diagnosis is established by culturing (in Bordt-Gengou medium), the organism obtained from nasopharyngeal swabs. Fluorescent antibody staining of pharyngeal speciments provides a rapid and specific diagnosis.

Differential diagnosis: Whooping cough has to be differentiated from other conditions in childhood causing spasmodic cough. These are acute bronchitis, bronchopneumonia, aspiration of foreign bodies; extrinsic compression of the trachea and bronchi by tuberculous glands or other masses, obstructive airway disease, cystic fibrosis and congenital malformations of the upper respiratory tract. Infections with B. prarapertussis, B bronchiseptica and adenovirus types 1, 2, 3 and 5 closely resemble whooping cough and cannot be clinically differentiated.

The Treatment Of Whooping Cough

Supportive care is important to maintain nutrition, prevent aspiration into the respiratory tract, and maintain the airway. The airway is cleared by suction of the exudates. Anoxic convulsions are managed by administration of oxygen and anti-convulsants. Small, frequent feeds are tolerated if given soon after a paroxysm of cough. Intravenous fluids may be required if the child is dehydrated. In general, administration of antibiotics does not shorten the paroxysmal stage, once it is established. Erythromycin 50 mg/Kg/day given for 5 to 7 days will reduce the period of communicability. It may even abort or prevent the progress of the disease if given in the catarrhal stage. Ampicillin, chloramphenicol and cotrimoxazole may also be used as alternative drugs.

Antibodies are not transferred transplacentally in the case of whooping cough. In most patients, a single attack confers life long immunity.

Prevention: Active immunization is achieved by the administration of pertussis vaccine, usually given in combination with diphtheria and tetanus toxoids (DPT). The vaccine containes killed B. pertussis. The initial dose is given at 2 months, with 2 more doses at 6 to 8 weeks intervals. The first booster is given 1 year later and the next one at school entry. Adverse reactions may develop after vaccination. These are local reactions, fever developing within 12 to 24 hours of injection, and rarely post-vaccination encephalitis. The reported risk of encephalitis is 1 in 105 to 106 vaccinations. At present, the benefits of vaccination should be recommended for all infants.

For more Health Articles, visit the following links:
1. Fitness And Exercise From A Doctor’s Perspective: Maintaining The Lifestyle
2. Special Types Of Anemia: Sideroblastic Anemias And Paroxysmal Nocturnal Hemoglobinuria (PNH)
3. Diphtheria: The Health Significance Of Its Clinical Diagnosis And Phases Of Treatment

Tags

Atelectasis, Bronchitis, Bronchopneumonia, Convulsions, Dehydration, Emphysema, Encephalopathy, Epistaxis, Hematemesis, Hemoptysis, Hernia, Intracranial Hemorrhage, Otitis Media, Pneumothorax, Prolapsed Rectum, Subconjunctival Hemorrhage, Tetany, Ulceration Of The Tongue

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author avatar Funom Makama
A medical Practitioner and a passionate writer. A proud published Author of 2 books, more than 2,000 articles online and 500 Poems!
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