Pertussis

Pertussis

2. Pertussis
Ms Alisha Talwar

3. Introduction
Pertussis is also known as Whooping cough is highly
contagious bacterial diseases mainly caused by Bordetella
pertussis.
Characterized by severe coughing spells, which sometimes
end with Whooping sound when the person breathes in.
Also known as 100 days cough
Habit pattern of coughing may be longer or subsequent
weeks and month i.e., Chinese call it 100 days cough

5. Definition
Pertussis(also known
aswhooping coughor100-
day cough) is a highly
contagiousbacterial disease
which is caused by the
bacteriumBordetellapertussis, It
is anairborne diseasewhich
spreads easily through the
coughs and sneezes of an
infected person

6. Etiology/Agent
BordetellaPertussis-is the cause of
epidemic pertussis and the usual
cause of sporadic pertussis.
B.Parapertussis-is an occasional cause
of sporadic pertussis that contributes
significantly to 5% of the total cases
of pertussis.
B. Bronchiseptica

7. Epidemiology
Spread occurs by direct contact or droplet infections during
cough.
1922-1948---leading causes of death
Infants less than one year of age constitute 50-70% of
diagnosed cases.
Extremely contagious-attack rate 100%
Age : 1-5 years
Incubation period : 7-10 days
Infectivity : first 4 weeks

8. Pathophysiology
B.Pertussisproduces biologically active substances
Patchy Necrosis
Tenacious mucupurulentexudate
Inflammation of the respiratory Mucosa
Bronchiolar Obstruction i.e., Atelectasis, Bronchiestasis

10. Clinical Features

13. Catarrhal Stage
The term "catarrh" is derived from historic Middle English,
meaning "to flow."That is, secretions fromthe nose and mucous
membranes flow, causing nasal congestion and runny nose.
Nonspecific features
Nasal congestion
Runny nose-Rhinorrhoea
Mild fever
Eye redness and excess eye watering
Sneezing

14. Paroxysmal Stage
The term "paroxysm" means a sudden, violent
burst.The paroxysms or "fits" of coughing may...
Start as a dry, intermittent, annoying cough that
increases in intensity and frequency
Occur at least once an hour
Cause the child to turn red, blue, or purple
causethe eyes to bulge and water excessively
cause significant distress in the child
vomiting after coughing

15. Young infants may have small bursts of cough or
no cough before developing...
Gasping
Choking
Turning red, blue or purple
Apnea(episodes of not breathing)

16. Convalescent Stage (recovery)
Episodes of cough becomes less frequent
Less severe
Paroxysms of whooping disappear
Young infants may develop louder coughing but
typically the breathing difficulty improves.

17. Diagnostic Evaluation
A complete blood count may show a high lymphocyte
count.If the neutrophil count is high and/or fever is
present, then other types ofinfection should be
considered.
Absolute Lymphocytosis (15,000-100,000 cells/mm3 )
Flourescentantibody staining
A chest x-ray may be normal or show mild abnormalities.
Bacterial culture of respiratory secretions is the best test.
(Nasopharyngeal aspirate)

18. Complications
Infants less than 6 months of age are at the highest risk for
complications.These include:
Apnea
Bronchopneumonia
Atelectasis
Emphysema
Ear infections
Pneumonia
Seizures
Encephalopathy (brain damage)
Death (approximately 1% of infants less than 2 months of age)

19. Contd..
Epistaxis
Sub-conjunctivalhemorrhage
Intracranial Bleeding
Rectal prolapse
umbilical hernias
Dehydration, Malnutrition
Tetany

20. Management
Goals
Limit the number of paroxysms
Observe the severity of cough and provide assistance when
necessary
Maximize nutrition, rest, and recovery
Pharmacologic therapy
Antimicrobial agents and antibiotics can hasten the eradication
ofB pertussis and help prevent spread
Erythromycin, clarithromycin, and azithromycin are the preferred
agents for patients aged 1 month or older

21. Contd….
Immunization
Prevention through immunization remains the best defensein the
fight against pertussis. CDC recommendations for vaccination are
as follows:
DTaPvaccine: Recommended at the ages of 2, 4, 6, and 15-18
months and at age 4-6 years; it is not recommended for children
aged 7 years or older
Tdapvaccine: Recommended for children aged 7-10 years who
are not fully vaccinated; as a single dose for adolescents 11-18
years of age; for any adult 19 years of age or older; and for
pregnant woman regardless of vaccination history, including repeat
vaccinations in subsequent pregnancies

22. Nursing Diagnosis
Ineffective breathing patterns related to paroxysms of cough,
airway edemaand thick mucus
Risk of dehydration related to lowering volume fluid through
oral fluid intake
Anxiety (children) are associated with respiratory distress
and hospitalization stay.
Altered sleep pattern
Activity intolerant related to fever, severe cough
Altered thermoregulation related to infection

23. Interventions
Assess the respiratory status of children as often as possible or continuously
review the signs and symptoms of increased difficulty breathing and
respiratory obstruction, including increased respiratory rate, stridor, retraction,
dilation of nostrils, expiratory an elongated, cyanosis, confusion, anxiety, noise
reductionbreath, tachycardia, and a barking cough.
Oxygen therapy
High-Fowler's position
Assess the child's ability to tolerate liquid (swallow, choke, or cough).
Provide and monitor intravenous fluids, as instructed.
Careful monitoring of fluid intake and output in children
Assess for signs of dehydration in children, including tugorbad skin, dry
mucous membranes, sunken fontanel, and sunken eyes.

24. Prevention
Pertussis vaccine is part of DPT vaccine
All household contacts should get Erythromycin for 14 days
Close contacts < 7 yrshould get booster
If documented pertussis infection exempt from routine pertussis
vaccination
Hygiene-Cover your mouth and nose with a tissue when you cough or
sneeze.
Put your used tissue in the waste basket.
Cough or sneeze into your upper sleeve or elbow, not your hands, if you
don’t have a tissue.
Wash your hands often with soap and water for at least 20 seconds.
Use an alcohol-based hand rub if soap and water are not available.