Pertussis in Children(Whooping cough) .pptx

Whooping Cough in children

1. PERTUSSIS

2. Outline

3. Introduction

4. Etiology

5. Epidemiology

6. Transmission  

7. PATHOGENESIS

8. PATHOGENESIS

9. CLINICAL MANIFESTATIONS

10. Atypical presentations

11. Viral URTI vs. Pertussis

12. Diagnoses

13. Diagnoses

14. Laboratory Findings

15. TREATMENT

16. Treatment

17. Dose

18. Erythromycin in neonates

19. COMPLICATIONS

20. Prevention

21. Prognosis

22. Diagnoses

Clinical diagnosis — Pertussis is a clinical diagnosis.
Clinical Criteria: In the absence of a more likely diagnosis a cough illness
lasting >2 weeks, with at least one of the following signs or symptoms:
+ Paroxysms of coughing, OR
+ Inspiratory whoop, OR
Posttussive vomiting, OR

+ Apnea (with or without cyanosis)

23. Diagnoses

+ Laboratory Criteria: Confirmatory laboratory evidence:
Isolation of Bordetella pertussis from a clinical specimen

Positive polymerase chain reaction (PCR) for B. pertussis

24. Laboratory Findings

+ The predominant nonspecific laboratory indication of B.
pertussis infection is a leukocytosis resulting from lymphocytosis,
although the WBC count may be normal

25. TREATMENT

+ Indications for hospitalization in infants and children with pertussis

infection or suspected pertussis infection include:
Evidence of pneumonia
Inability to feed
Cyanosis or apnea, with or without coughing
Seizures

Age <4 months

26. + The specific, limited goals of hospitalization are to:
Assess progression of disease and likelihood of life-threatening

events at peak of disease;
Maximize nutrition;
+ Prevent or treat complications; and

- Educate parents in the natural history of the disease and in care

that will be given at home.

27. Treatment

+ Macrolides are highly effective at eradicating B. pertussis from the
nasopharynx.

+ Recommended antibiotics are azithromycin, clarithromycin or
erythromycin.

+ Clarithromycin is the preferred antimicrobial for use in infants <1

month of age.

28. + Azithromycin and clarithromycin are the preferred antibiotics in

children >1 year of age.

+ Trimethoprim-sulfamethoxazole (Co-trimoxazole) can be used as an
alternative treatment modality if resistance is demonstrated or in

patients who cannot tolerate macrolides

29. + Duration of therapy 一 The duration of therapy depends upon the

agent. We suggest
+ 5 days for azithromycin
14 day for erythromycin
7 days for clarithromycin, and

14 days for trimethoprim-sulfamethoxazole.

30. Dose

+ The dose of azithromycin is 10 mg/kg on day 1 and 5 mg/kg as a
single dose on days 2 to 5.

+ The dose of clarithromycin for children is 15 to 20 mg/kg per day in
2 divided doses for 7 days.

+ The dose of erythromycin for children is 40 to 50 mg/kg per day
given every 6 hours for 14 days;

31. Erythromycin in neonates

+ Caution:

+ Because of the risk of hypertrophic pyloric stenosis, the Centers for
Disease Control and Prevention recommends treating neonates with
azithromycin, rather than erythromycin , at a dose of 10 mg/kg for 5

days.

32. COMPLICATIONS

+ Increased intrathoracic and intraabdominal pressure during coughing

can result in:
Conjunctival and scleral hemorrhages
Petechiae on the upper body

Epistaxis

33. Hemorrhage in the central nervous system and retina
Pneumothorax and subcutaneous emphysema, and
Umbilical and inguinal hernias.

Laceration of the lingual frenulum occurs occasionally.

34. Prevention

+ Educate parents on the importance of following the routine childhood

immunization schedule.
・ Ensure good nutrition
+ Avoid overcrowding

« Booster doses of vaccine in exposed infants

35. + Return to school or day care — Because of the high risk of
transmission, infected children should be excluded from school or day
care until they have completed five days of effective antimicrobial
therapy (regardless of the antimicrobial agent), or, if they are not

treated, 21 days after the onset of symptoms.

36. Prognosis

+ Pertussis carries poor prognosis in infants below | year of age. There
is high morbidity and mortality in the event of complications.

+ Beyond 1 year of age, the prognosis is good provided serious
complications have not occurred.

37. Thank You