PERTUSSIS“WHOOPING

COUGH”Dr Ubaid N P JR Community Medicine Pariyaram Medical College

▪ Acute infectious disease caused by Bordetella pertussis

▪ Hundred day cough

▪ Important cause of death in infants

▪ Insidious onset, mild fever, irritating cough whoop(loud crowing inspiration)

EPIDEMIOLOGICAL DETERMINANTS

▪ AGENT– Causative agent is B.pertussis– <5% - B.parapertussis– Encapsulated, phase 1 strains– Carries 3 major agglutinogens 1 2&3– Survive only short period outside human body

• SOURCE OF INFECTIONB.Pertussis infects only manSource is a case of pertussisNo c/c carrier state

▪ INFECTIVE MATERIAL

Nasopharyngeal and bronchial secretion

▪ INFECTIVE PERIOD

Most infective during catarrhal stage. One week after exposure to 3 weeks after onset of paroxysmal stage

▪ SECONDARY ATTACK RATE

Averages 90% in unimmunized household contacts

HOST FACTORS

▪ AGEPrimarily disease of infants and preschool

children

SEXIncidence and fatality more among females

IMMUNITYRecovery from whooping cough & immunization

ENVIORNMENTAL FACTORSoccur through out year more in winter and springLow socioeconomic group

▪ MODE OF TRANSMISSION

Droplet infection and direct contact

▪ INCUBATION PERIOD

7 to 14 days

▪ CLINICAL COURSE

It produces local infection

Organism not invasive

Multiplies on epithelium of resp tract

Cause inflammation necrosis of mucosa

(a)Catarrhal stage lasting for 10 days. Insidious onset

lacrimation,sneezing coryza, malaise, hacking night cough

(b)Paroxysmal stage 2-4 weeks

Characterized by burst of rapid consecutive cough followed by deep high pitched inspiration[whoop],vomiting

In infants, cyanosis apnoea

(c)Convalescent stage

Lasting for 1-2 weeks

3 stages of clinical course

COMPLICATIONS:

▪ Bronchitis,bronchopneumonia,bronchectasis,

▪ Subconjunctival haemorrhage

▪ Haemoptysis

▪ Epistaxis,

▪ Punctate cerebral haemorrhage-convulsion and coma

▪ Pertussis- associated encephalopathy

CONTROL OF WHOOPING COUGH

▪ CASES AND CONTACTS

Early dx by bacteriological exmn of secretions

Fluorescent antibody technique

Erythromycin is doc 30-50 mg/kg bwt 4 divided doses for 10 days

▪ CONTACTS

Prophylactic erythromycin or ampicillin for 10 days

▪ Active immunisation

DPT 3 DOSES 0.5 ML 6,10 14 WEEKS BOOSTER 18-24 mnths

UNTOWARD REACTION

Local reacns: at injection site,mild fever,irritability

Rare reacns:inconsolable screaming, seizures,hypotonic hyporesponsive episodes,anaphylactic reaction,encephalopathy.

▪ CONTRAINDICATIONS

Anaphylaxis ,encephalopathy,epilepsy,febrile episodes, reaction to previous vaccination

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