Pertusis / Whooping Cough

Introduction

Whooping cough is an infection of airways caused by a bacterium called Bordetella pertusis

Causative Agent

Bacterium Bordetella Pertusis

Pathogenesis

Symptoms can take 5 – 21 days to appear following the infection but in most cases they appear after 7 – 10 days. The infection results in inflammation and swelling of the airways and makes them produce a lot of mucus.

When a patient with the disease coughs or sneezes hundreds of infected droplets are released into the air. This is why whooping cough is so infectious.

Symptoms and Signs

Symptoms can take 5 -21 days to appear after infection, but usually they appear after 7 – 10 days.

The early symptoms of whooping cough are similar to a cold

·         Runny Nose

·         Dry, Irritating Cough

·         Raised Temperature

As the cold symptoms start to improve, coughing attacks may make a whooping sound as the end of a bout of coughing as they gasp for air. (The disease gets its name from this sound) or may cause the child to vomit. The coughing may be particularly bad at night. Young babies may not whoop following the bout of cough. These episodes of coughing can cause the child’s face to go red and their eyes to water. Medical attention is needed if the child seems very unwell or goes blue in the face.

Younger babies, particularly those under 6 months old are the most seriously affected and adults may only have a dry, irritating cough that lasts for a few months.

Usually the bouts of coughing last for 6 – 8 weeks, even with antibiotic treatment.

Complications

Complications of whooping cough mostly affect babies. The risk of death is highest in younger babies. The complications of whooping cough include pneumonia, bronchiectasis (pockets of infection form in the small airways of the lungs) and collapse of lung. The babies that die of whooping cough die due to pneumonia or apnoea (when they temporarily stop breathing)

Very severe coughing may lead to nose bleeds, bleeding into the whites of the eyes (sub conjunctival haemorrhage), bruises or hernia. The nervous system may also be affected leading to convulsions, seizures and permanent brain damage.

Management

People with whooping cough are given antibiotics to kill the bacteria. Even with antibiotics, the bouts of coughing will probably last for 6 – 8 weeks but after about 5 days of antibiotics you will no longer be infectious.

If your child has mild whooping cough, they should get lots of rest, drink lots of fluids and stay away from other children while they are infectious (for 2 weeks after the symptoms begin). Clear away any excess mucus or vomit so your child does not inhale it and choke.
If the illness is severe, your baby needs hospital admission,

Prevention

After the symptoms begin, the child is very infectious for approximately 2 weeks and should be kept away from other children, especially babies to prevent the disease from spreading. Once they have been given antibiotics, they will only be infectious for 5 days.

Whooping cough can be easily prevented by vaccination. In Sri Lanka the national Immunization program (EPI) includes vaccination against whooping cough which is given as part of the triple vaccine at the age of 2, 4, 6 and 18 months.