Whooping cough
Whooping cough: Excerpt from Professional Guide to Diseases (Eighth Edition)
Whooping cough, also known as pertussis, is a highly contagious respiratory infection usually caused by the nonmotile, gram-negative coccobacillus Bordetella pertussis and, occasionally, by the related similar bacteria B. parapertussis and B. bronchiseptica. Characteristically, whooping cough produces an irritating cough that becomes paroxysmal and commonly ends in a high-pitched inspiratory whoop.
Since the 1940s, immunization and aggressive diagnosis and treatment have significantly reduced mortality from whooping cough in the United States. Mortality in children younger than age 1 is usually a result of pneumonia and other complications. The disease is also dangerous in the elderly but tends to be less severe in older children and adults.
Causes and incidence
Whooping cough is usually transmitted by the direct inhalation of contaminated droplets from a patient in the acute stage; it may also be spread indirectly through soiled linen and other articles contaminated by respiratory secretions.
Whooping cough is endemic throughout the world, usually occurring in late winter and early spring. In about 50% of cases, it strikes unimmunized children younger than age 1, because the immunization series hasn’t been completed and the child has had contact with an adult harboring the organisms.
Signs and symptoms
After an incubation period of about 7 to 10 days, B. pertussis enters the tracheobronchial mucosa, where it produces progressively tenacious mucus. Whooping cough follows a classic 6-week course that includes three stages, each of which lasts about 2 weeks.
First, the catarrhal stage characteristically produces an irritating hacking, nocturnal cough, anorexia, sneezing, listlessness, infected conjunctiva and, occasionally, a low-grade fever. This stage is highly communicable.
After a period of 7 to 14 days, the paroxysmal stage produces spasmodic and recurrent coughing that may expel tenacious mucus. Each cough characteristically ends in a loud, crowing inspiratory whoop; excessive coughing; and choking on mucus, causing vomiting. (Patients with persistent cough should be evaluated for whooping cough, because not every patient will develop paroxysms or the distinctive whooping sound.) Paroxysmal coughing may induce such complications as nosebleed, increased venous pressure, periorbital edema, conjunctival hemorrhage, hemorrhage of the anterior chamber of the eye, detached retina (and blindness), rectal prolapse, inguinal or umbilical hernia, seizures, atelectasis, and pneumonitis. In infants, choking spells may cause apnea, anoxia, and disturbed acid-base balance. During this stage, patients are highly vulnerable to fatal secondary bacterial or viral infections. Suspect such secondary infection (usually otitis media or pneumonia) in any whooping cough patient with a fever during this stage, because whooping cough itself seldom causes fever.
During the convalescent stage, paroxysmal coughing and vomiting gradually subside. However, for months afterward, even a mild upper respiratory tract infection may trigger paroxysmal coughing. (Paroxysmal coughing may not be present in partially immunized individuals.)
Diagnosis
Classic clinical findings, especially during the paroxysmal stage, suggest this diagnosis; laboratory studies will confirm it. Nasopharyngeal swabs and sputum cultures show B. pertussis only in the early stages of this disease; fluorescent antibody screening of nasopharyngeal smears provides quicker results than cultures but is less reliable. In addition, the white blood cell (WBC) count is usually increased, especially in children older than age 6 months and early in the paroxysmal stage. Sometimes, the WBC count may reach 175,000 to 200,000/µl, with 60% to 90% lymphocytes.
Treatment
Vigorous supportive therapy requires hospitalization of infants (commonly in the intensive care unit) and fluid and electrolyte replacement. Other measures include adequate nutrition; codeine and mild sedation to decrease coughing; oxygen therapy in apnea; and antibiotics, such as erythromycin and, possibly, ampicillin, to shorten the period of communicability and prevent secondary infections.
Because very young infants (younger than age 1) are particularly susceptible to whooping cough, immunization — most commonly with the diphtheria-tetanus acellular-pertussis vaccine — begins at ages 2, 4, and 6 months. Boosters follow at age 18 months and at ages 4 to 6. The risk of pertussis is greater than the risk of vaccine complications such as neurologic damage. However, seizures or unusual and persistent crying may be a sign of a severe neurologic reaction, and the physician may not order the other doses. The vaccine is contraindicated in children older than age 6 because it can cause a severe fever.
Special considerations
Whooping cough calls for aggressive, supportive care and droplet precautions (surgical masks only) for 5 to 7 days after initiation of antibiotic therapy.
❑Monitor acid-base, fluid, and electrolyte balances.
❑Carefully suction secretions, and monitor oxygen therapy. Remember: Suctioning removes oxygen as well as secretions.
❑Create a quiet environment to decrease coughing stimulation. Provide small, frequent meals, and treat constipation or nausea caused by codeine.
❑Offer emotional support to the parents of children with whooping cough.
❑To decrease exposure to organisms, empty the suction bottle and change the trash bag at least once each shift. Change soiled linens as often as needed.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Chronic lower respiratory diseases
More Medical Textbooks Online about Chronic lower respiratory diseases
Review other book chapters online related to Chronic lower respiratory diseases:
Medical Books Excerpts
- COUGH
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- COUGH
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Cough
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Cough
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Cough, barking
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Cough, productive
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Cough
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- COUGH
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Cough, barking (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
