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Dr Rai Muhammad Asghar
Professor of Paediatrics
RGH Rawalpindi
PERTUSSIS
Pertussis
(Whooping Cough)
* Pertussis : Intense Cough
* Highly Infectious disease
Etiology:
* Bordetella Pertussis
* B.Parapertussis
* B. Bronchiseptica
Epidemiology:
* World wide
* 1922-1948--- leading causes of death
* Endemic---Epidemic cycles
* Extremely contagious-attac...
* Unmeasurable after 12 yrs
* Adolescents & adults are major Reservoir
* Age : 1-5 yrs
* Incubation period : 7-10 days
* I...
Pathophysiology:
* B. Pertussis produces many biologically
active substances
* Inflammation of respiratory mucosa
* Patchy...
Clinical Features:
* Pertussis is a 6 weeks disease
* CATARRHAL STAGE (1-2 WKS)
* Nonspecific features
* Congestion, Rhino...
Paroxysmal Stage ( 2-4 wks)
* Cough is first dry & intermittent
* Inexorable paroxysm
* Machine-gun burst of uninterrupted...
* Face-Red-Blue
* Whoop at the end of paroxysm
* Post tussive emesis
* Number & Severity of Paroxysm
progress over days to...
Infants < 3 months
* No classical stages
* well appearing infants begins to choke
* Gasp & flail extremities
* Reddend fac...
* Immunized children have fore-shortening
of all stages
* Adults have no distinct stages
* Number & severity of paroxysm p...
Convalescent Stage ( 1-2 wks)
* Episodes of cough becomes less frequent
* Less severe
* Paroxysms of whooping disappear
Diagnosis:
*Clinical Diagnosis
Paroxysmal stage
* Suspect if predominant complaint is
cough especially following are absent
- Fever
- Malaise, Myalgias
- Rash
- Sore thro...
Investigations:
1. Blood Count
Absolute Lymphocytosis
(15,000-100,000 cells/mm3
)
2. Flourescent antibody staining
3. Cult...
Complications:
1. Respiratory
2. Sequelae of forceful cough
3. CNS
1.Respiratory
- Apnea
- Bronchopneumonia
- Atelectasis
- Bronchiectasis
- Emphysema—Interstitial / Subcutaneous
- Otitis m...
2. Sequelae of forceful cough
- Epistaxis, sub-conjunctival hemorrhage
- Intracranial Bleeding
- Rectal prolapse, umbilica...
3. CNS
- Convulsions…..Hypoxemia,
Hemorrhage
- Encephalopathy
Treatment:
Specific
* Erythromycin 40-50 mg/kg/day for 14 d
* Clarithromycin 15 mg/kg for 7 d
*Azithromycin 10 mg/kg for 5...
General Measures
* Young infants should be hospitalized
* Adequate hydration, Nutrition
* Oxygen
* Gentle suction
* Cough ...
Prevention:
* Pertussis vaccine is part of DPT vaccine
* All household contacts should get
Erythromycin for 14 days
* Clos...
Thank You
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Pertussis

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Rawalpindi Medical College

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Pertussis

  1. 1. Dr Rai Muhammad Asghar Professor of Paediatrics RGH Rawalpindi
  2. 2. PERTUSSIS
  3. 3. Pertussis (Whooping Cough) * Pertussis : Intense Cough * Highly Infectious disease
  4. 4. Etiology: * Bordetella Pertussis * B.Parapertussis * B. Bronchiseptica
  5. 5. Epidemiology: * World wide * 1922-1948--- leading causes of death * Endemic---Epidemic cycles * Extremely contagious-attack rate 100% * Immunity is never complete * Protection begins to wane in 3-5 yrs after vaccination
  6. 6. * Unmeasurable after 12 yrs * Adolescents & adults are major Reservoir * Age : 1-5 yrs * Incubation period : 7-10 days * Infectivity : first 4 weeks * Transmission by droplet
  7. 7. Pathophysiology: * B. Pertussis produces many biologically active substances * Inflammation of respiratory mucosa * Patchy necrosis * Tenacious mucopurulant exudate * Bronchiolar obstruction : Atelectasis, Bronchiectasis
  8. 8. Clinical Features: * Pertussis is a 6 weeks disease * CATARRHAL STAGE (1-2 WKS) * Nonspecific features * Congestion, Rhinorrhoea * Sneezing * Lacrimation, Conjunctival redness * Low grade fever, mild cough
  9. 9. Paroxysmal Stage ( 2-4 wks) * Cough is first dry & intermittent * Inexorable paroxysm * Machine-gun burst of uninterrupted cough * Series of coughing in single expiration * Eyes bulging—watering * Chin & Chest held forward * Tongue protruding maximally
  10. 10. * Face-Red-Blue * Whoop at the end of paroxysm * Post tussive emesis * Number & Severity of Paroxysm progress over days to weeks
  11. 11. Infants < 3 months * No classical stages * well appearing infants begins to choke * Gasp & flail extremities * Reddend face * Cough may not be prominent * Woop infrequent
  12. 12. * Immunized children have fore-shortening of all stages * Adults have no distinct stages * Number & severity of paroxysm progress & remain at that plateau * Physical examination is unremarkable
  13. 13. Convalescent Stage ( 1-2 wks) * Episodes of cough becomes less frequent * Less severe * Paroxysms of whooping disappear
  14. 14. Diagnosis: *Clinical Diagnosis Paroxysmal stage
  15. 15. * Suspect if predominant complaint is cough especially following are absent - Fever - Malaise, Myalgias - Rash - Sore throat - Hoarseness - Tachypnea - Wheeze - Crepitations/ Rales
  16. 16. Investigations: 1. Blood Count Absolute Lymphocytosis (15,000-100,000 cells/mm3 ) 2. Flourescent antibody staining 3. Cultures: Nasopharyngeal aspirate 4. X-Ray chest
  17. 17. Complications: 1. Respiratory 2. Sequelae of forceful cough 3. CNS
  18. 18. 1.Respiratory - Apnea - Bronchopneumonia - Atelectasis - Bronchiectasis - Emphysema—Interstitial / Subcutaneous - Otitis media - Reactivation of quiescent tuberculosis
  19. 19. 2. Sequelae of forceful cough - Epistaxis, sub-conjunctival hemorrhage - Intracranial Bleeding - Rectal prolapse, umbilical hernias - Dehydration, Malnutrition - Tetany
  20. 20. 3. CNS - Convulsions…..Hypoxemia, Hemorrhage - Encephalopathy
  21. 21. Treatment: Specific * Erythromycin 40-50 mg/kg/day for 14 d * Clarithromycin 15 mg/kg for 7 d *Azithromycin 10 mg/kg for 5 d * Ineffective if given in paroxysmal stage
  22. 22. General Measures * Young infants should be hospitalized * Adequate hydration, Nutrition * Oxygen * Gentle suction * Cough syrup have no role
  23. 23. Prevention: * Pertussis vaccine is part of DPT vaccine * All household contacts should get Erythromycin for 14 days * Close contacts < 7 yr should get booster * If documented pertussis infection exempt from routine pertussis vaccination
  24. 24. Thank You

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