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Whooping Cough - Bordatella Pertussis (Clinical Presentation (Catarrhal…
Whooping Cough - Bordatella Pertussis
Epidemiology
Mainly a disease of childhood with 90% of cases occurring below 5 years of age
However, no age is exempt as the antibody levels fall over the years, although in adults, mild infection may not be recognised
Caused by Bordatella pertussis, a GRAM NEGATIVE COCCOBACILLUS (rod)
Pathophysiology
In early stages it is distinguishable from other upper respiratory tract infections
Lymphoid hyperplasia and Th17 skewing of immune response contribute to chronic inflammation and cough
Highly contagious and spread by droplet infection
Clinical Presentation
Lungs clear to auscultation
Incubation period is 7-10 days
Sub-conjunctival haemorrhage
Catarrhal phase (1-2 weeks)
Malaise
Anorexia
Cultures from respiratory cultures are positive in 90% of cases
Rhinorhoea (nasal cavity congested with significant amount of mucus)
Patient highly infectious
Conjunctivitis
Febrile & vitals stable
Paroxysmal phase (1-6 weeks)
These coughing spasms usually terminate in vomiting
Cough for more than 14 days
Classic inspiratory whoop in only seen in younger individuals in whom the lumen of the respiratory tract is compromised
May be associated with complications - pneumonia, encephalopathy, sub-conjunctival haemorrhage
Coughing spasms
Begins 1 week later from catarrhal phase
Denies fever or weight loss
Diagnosis
Suggested clinically by the characteristic whoop and history of contact with an infected individual
PCR tests are rapid and highly sensitive
Chronic cough and history of contact or microbiological diagnosis is used to confirm pertussis
But culture of a nasopharyngeal swab remains necessary for definitive diagnosis
Chronic cough and one clinical feature indicated pertussis
Treatment
In the paroxysmal stage, antibiotics have little role to play in altering the course of the illness
Vaccination - acellular pertussis
Antimicrobials such as macrocodes will eliminate carriage of bacteria and reduce symptoms in catarrhal stage and early paroxysmal stage