Whooping cough - symptoms, causes, treatment and prevention of whooping cough
A paroxysmal reflex expulsion of air in a sequence, for 3-4 minutes (on average) does not allow the baby to take a breath, because of which he may stop breathing and suffocation.
Other signs of the disease include a runny nose, fever, catarrh of the upper respiratory tract, and sometimes vomiting.
The name of the disease comes from the French word "coqueluche".
Development of pertussis
Cough is a necessary tool for the normal functioning of the body, designed to cleanse the respiratory tract of infectious agents, foreign objects, etc. Cough control occurs in the brain, where the cough center is located.
Cough with whooping cough is the main sign of this disease, but it is this symptom, which sometimes causes suffocation in infants, and even harms other people quite seriously, due not only to the bacterial infection itself.
The fact is that the trachea and bronchi are internally covered with epithelial cells, on which there are small villi similar to cilia (ciliated epithelium). These cilia are designed to filter the air flow - so that dust, foreign objects and various debris do not get into the lungs. These cilia also regulate the movement of mucus produced by the respiratory system.
The causative agent of whooping cough is pertussis (Bordetella pertussis), which also has microscopic villi on its surface, by which the bacterium literally sticks to the ciliated epithelium when it enters the respiratory tract. In addition, the peculiarity of this bacterium is that its reproduction is possible only on the ciliated epithelium, i.e. only within the trachea and bronchi.
Any irritation of the villi causes increased secretion of sputum and cough, designed to cleanse the airways. But due to the presence of villi, a regular cough does not allow the body to clear, therefore, an inflammatory process develops in the place of their subsidence, coughing attacks occur.
Sustainable “adhesion” of bacteria and their active reproduction in the trachea and bronchi irritate the cough center so much that even after the destruction of the infection, the cough still continues to manifest itself, and for a rather long time.
The situation is aggravated by the fact that pertussis, like many other bacteria, during its stay in the body, poisons it with its waste products, which are toxins (poisonous substance). It is intoxication with these substances that causes symptoms such as increased and high body temperature, general malaise, weakness, nausea, and loss of appetite.
The incubation period of pertussis (from the moment of infection to the first signs of the disease) is from 7 to 14 days.
Infection occurs by airborne droplets. The greatest activity of the pathogen to infect surrounding people falls on the catarrhal period (initial stage) of whooping cough, when the bacterium settles in the respiratory tract, only begins to multiply and, together with a wet cough, spreads around its carrier. The patient is contagious from 1 to 30 days after infection.
Pertussis bacillus is unstable in the external environment, therefore, infection is possible only when within 1-2 meters next to the coughing medium. When talking, you can’t get infected. The probability of infection by contact with Bordetella pertussis is approximately 90%.
With timely therapy, which is based on the use of antibiotics, paroxysmal cough and the period of infectiousness of the carrier can be significantly reduced.
If this is not done, then the further development of whooping cough leads to ulceration of the ciliated epithelium, focal necrosis, decreased clearance due to inflammation and purulent-mucous obstruction of the respiratory tract, focal atelectasis, emphysema, peribronchial infiltration appear. All this can lead to the development of bronchitis, pneumonia (pneumonia), respiratory arrest.
Constant irritation of the cough center through the nervous system can lead to irradiation to other organs, which sometimes causes nonspecific signs of whooping cough, such as an increase or decrease in blood pressure, the appearance of spasms of blood vessels or muscles of the face and body, and convulsions.
A person does not have innate immunity in relation to Bordetella pertussis, however, after recovery, some protection against whooping cough is developed for the rest of his life. Pertussis in adults and re-infection occurs in about 5% of cases.
At risk of pertussis infection are children, employees of medical and preschool institutions, and teachers.
Pertussis statistics
The disease of pertussis is epidemic in itself, because in the first week after infection, when there are still no obvious signs of this disease (whooping cough), the carrier of the infection manages to infect all those around him.
A certain frequency of the epidemic is noticed - every 2-4 years.
According to WHO statistics, pertussis is diagnosed annually in 60,000,000 people, 600,000 of whom die, i.e. the disease has 1% mortality.
Most often, this disease affects children of preschool age - more than 50%.
If we talk about the seasonality of the disease, then there is no pronounced picture, however, still autumn-winter slightly increases the number of cases. Based on this, it can be said that nevertheless hypothermia, an insufficient amount of vitamins and trace elements (hypovitaminosis) and other similar factors that contribute to a decrease in immunity have a role in the spread of the disease.
Whooping cough - symptoms
The development of pertussis occurs in 4 periods (stages):
1. The incubation period
The incubation period of pertussis is from 2 to 14 days.
2. The first signs of whooping cough (prodromal, or catarrhal period)
Cough (single cough);
Body temperature is normal or slightly elevated - up to 37-37.5 ° C;
Runny nose
The patient's health is normal.
3. The main symptoms of whooping cough (spasmodic period)
Cough with whooping cough is its main symptom, and it has some peculiarity, because of which it is also called - whooping cough. Pertussis cough usually occurs at the end of the 2nd week after infection and is characterized by a series of coughing tremors, after which the patient takes a deep wheezing breath (reprisal) and a series of coughing convulsive reflexes is repeated. One attack usually lasts 4-5 minutes, consists of 2-15 cycles, and ends with copious release of viscous sputum or vomiting. The number of attacks per day can be from 5 to 50, which depends on the age, stage and state of human health. The period of pertussis coughing attacks is 3-4 weeks, after which they are replaced by the usual cough, which can last even up to 2 months. Pertussis in adults usually disappears without coughing, but is often accompanied by a prolonged course of bronchitis.
Other symptoms of a spasmodic period:
Runny nose (rhinitis);
Elevated body temperature (low-grade);
General malaise, weakness;
Nausea, decreased appetite;
Swelling of the face;
Cyanosis of the face and mucous membranes;
Vomiting
Apnea;
The appearance of hemorrhages in the sclera;
Diarrhea (diarrhea);
Dehydration;
Short-term loss of consciousness is possible.
Pertussis in children is additionally manifested in the form of:
Increased nervousness and irritability of the child;
Blue face
Expansion of the veins in the neck;
Bloodshot eyes;
Tongue sticking out;
Sometimes an injured frenum of the tongue.
The duration of attacks on average is 4 minutes.
Important! In vaccinated children, the disease can occur in an erased form.
4. Permission period
Pertussis cough is becoming less frequent, after disappears, being replaced by a single cough;
Clinical manifestations of the disease pass.
Complications of whooping cough
Pneumonia (pneumonia);
Atelectasis of the lung;
Acute laryngitis (inflammation of the larynx);
False croup (stenosis of the larynx);
Bronchiolitis;
Nosebleeds;
Respiratory arrest;
Hernia (umbilical or inguinal);
Encephalopathy
Pulmonary heart;
Hypoxia;
Suffocation.
Causes of Pertussis
The causative agent of whooping cough is the Bordetella pertussis bacteria (pertussis, the Bordet-Jangu bacterium), named in 1906 in honor of their discoverers, the Belgian scientist J. Borde and the French O. Jangu.
The causative agent of mild pertussis is Bordetella parapertussis (pertussis bacillus), which is very similar to Bordetella pertussis, but does not develop immunity to whooping cough.
The susceptibility of the body to bacteria is up to 90%.
An increase in the already high risk of getting sick is facilitated by a weakened body, hypovitaminosis, hypothermia.
Vaccination against pertussis minimizes the susceptibility of the organism to pertussis bacillus, but infection cannot always be completely prevented. If the vaccinated person becomes ill, then the disease proceeds mainly in a mild form without complications.
The causative agents of pertussis and pertussis are unstable in the environment. They die upon drying, ultraviolet radiation, the processing of disinfectants.
Types of Pertussis
Classification of pertussis occurs as follows:
With the flow:
Typical - the development of the disease occurs in all 4 periods (described in the symptoms of the disease). Subdivided into:
Mild - characterized by no more than 15 seizures per day, which occasionally end in vomiting, a prodromal period of 10-14 days, a slight cyanosis of the nasolabial triangle, swelling of the face, symptoms of pulmonary emphysema;
Moderate form - characterized by 16-25 seizures per day for 5 or more weeks, with frequent reprisals, wheezing in the lung area, a prodromal period of 6-9 days, worsening of the patient's condition, lethargy, cyanosis and puffiness of the face, respiratory failure during absence coughing attacks, insomnia;
Severe - characterized by 30 or more seizures (often long) per day, a prodromal period of 3-5 days, deterioration in general health, weight loss, cyanosis, vomiting, apnea, tachypnea (outside the attack), depression of consciousness, encephalopathy, seizures, expressed leukocytosis with lymphocytosis.
Atypical (obliterated) - the disease can occur without a pronounced picture characteristic of whooping cough, including without whooping cough. Subdivided into:
Worn out form;
Subclinical form.
By development (periods of pertussis):
1. The incubation period (2-14 days);
2. Prodromal (catarrhal) period (7-14 days);
3. Spasmodic period (4-6 weeks);
4. The period of permission (2-3 weeks).
Diagnosis of pertussis
Diagnosis of pertussis includes the following examination methods:
Anamnesis;
Patient examination;
Bacteriological examination of a smear from the nasopharynx for the presence of a pathogen;
The method of “cough plates” - installation of a Petri dish with a nutrient medium at a distance of 10 cm from the mouth of a coughing child;
Detection of antibodies (immunoglobulins of classes A and M) using the enzyme immunoassay.
Some clinics may use outdated diagnostic methods - RSK, RPGA, agglutination reaction.
Analysis for pertussis (smears) must be taken quickly and placed in a special container that protects them from drying out and cooling, since, as we have said, pertussis bacillus is very unstable in the environment.
Pertussis treatment
How to treat whooping cough? Treatment of pertussis includes the following items:
1. Hospitalization and treatment;
2. Drug treatment;
3. Physiotherapeutic treatment;
4. Diet.
1. Hospitalization of the patient and mode
Hospitalization of the patient is subject to persons with severe forms of the disease, prolonged attacks of whooping cough, complications of the disease. This is especially true for young children under the age of 2 years.
Children are also subject to hospitalization for epidemiological reasons, so as not to provoke massive outbreaks of infection - from closed childcare facilities.
Patients must be protected from negative psycho-emotional stress, stressful situations, as well as various external stimuli - bright light, loud sounds.
Long walks in the air are beneficial for the body. Remember, cough intensification occurs in dry and cold air, therefore, the room with the patient should also be maximally ventilated, and the air must be moistened with an air humidifier or the presence of wet towels in the room, a sheet. Walking in the summer is best done in the early morning, when the air is still humid and cool.
Hospitalization is not needed for adults, children with a mild form of the disease, except for the presence of complications of the disease.
2. Drug treatment
Important! Before using drugs, be sure to consult your doctor!
2.1. Antibiotic therapy
Since the cause of whooping cough is a bacterial infection, its destruction must be carried out using antibacterial drugs. The good point is that the bacteria Bordetella pertussis and Bordetella parapertussis practically do not have antibiotic resistance (resistance), so their relief is quite easy.
Antibiotics for whooping cough - macrolides (Erythromycin, Clarithromycin, Azithromycin), 3rd generation cephalosporins (Cefotaxime, Ceftriaxone).
Penicillins against pertussis and pertussis are not effective.
In severe pertussis and the lack of oral antibiotics, preference is given to aminoglycosides, carbenicillin, levomicetin sodium succinate.
Once again, it should be noted that the antibiotic intake does not need to be prolonged after the course prescribed by the doctor, even though the cough is still ongoing, because coughing after antibiotic therapy continues no longer because of the presence of infection in the airways, but because of the activity of the cough center.
2.2. Symptomatic therapy
To destroy pertussis and pertussis toxin, pertussis gammaglobulin is administered intramuscularly - for 3 days in a daily dose of 3 ml.
To dilute thick sputum, which will improve its expectoration from the respiratory tract, and accordingly reduce the risk of complications, mucolytics are used - Ambroxol, Bromhexine, Acetylcysteine, Lasolvan.
Important! It is forbidden to give mucolytics to children under the age of 2 years!
To relieve spasms in the bronchi and improve bronchial well-proven - "Eufillin", "Relanium", "Seduxen".
To prevent diarrhea, antidiarrheal drugs are used - Mezim Forte, Smecta, Polyphepan, Imodium, Enterosgel, and Khilak Forte.
Anti-emetic drugs are used against emetic attacks - Motilium, Raglan, Tserukal.
With frequent and severe bouts of vomiting, fluid must be administered intravenously.
To prevent dehydration, apply - "Rehydron", "Hydrovit".
To prevent hypoxia (an insufficient amount of oxygen in the body) that develops due to the difficulty of breathing, oxygen therapy, Phenobarbital, Dibazol, and Piracetam are used.
Elevated body temperature for children is removed with the help of cool compresses on a water-vinegar basis, rubbing their forehead, temples, wrists.
Treatment of pertussis also includes an additional intake of vitamins.
In some cases, the attending physician may prescribe antihistamines.
2.3. In severe pertussis, apnea are used:
Hormonal drugs (glucocorticoids) that reduce the inflammatory process, stop apnea, reduce the frequency and duration of pertussis cough, prevent encephalic disorders, improve hemodynamics - Hydrocortisone (daily dose 5-7 mg / kg), Prednisolone (daily dose 2 mg / kg) for 2-3 days, after the dose is gradually reduced;
Carrying out oxygen therapy in oxygen tents;
Stimulating the aerobic type of cellular or tissue respiration;
Some doctors transfer sick children to prolonged automatic mechanical ventilation (IVL).
2.4. At the first or mild signs of brain disorders (symptoms of encephalopathy)
It is necessary to carry out emergency therapy, which consists of the use of:
Hormonal drugs (glucocorticoids) - Hydrocortisone, Prednisolone;
Diuretics - “Diacarb” (daily dose of 10 ml / kg), “Lasix” (daily dose of 0.3-0.4 mg / kg);
Anticonvulsants - Seduxen (daily dose 0.3-0.4 mg / kg);
Nootropic drugs (improve cerebral circulation due to vasodilation, prevent oxygen starvation, stimulate the brain) - Piracetam (daily dose of 30-50 mg / kg in 2 divided doses), Cavinton (daily dose of 5-10 mg in 3 reception), "Pantogam" (daily dose of 0.75-3 g).
Important! In the case of continued signs of seizures after emergency care, the patient is transferred to the intensive care unit of the medical institution.
3. Physiotherapeutic treatment
For the treatment of pertussis, the following physiotherapeutic procedures can additionally be prescribed:
Aerosol therapy;
Breathing exercises;
Massage;
Suction of pathological secretions from the respiratory tract, especially in the case of young children.
4. Diet for whooping cough
Diet with whooping cough implies a sparing diet with the use of foods enriched with vitamins and microelements.
The number of meals is 5-6 times a day.
Cooking mode - steaming, stewing, cooking.
Food should be chopped so as not to strain the stomach.
In severe cases, portions should be small with small intervals between meals.
In case of vomiting after eating, children should be fed 10-15 minutes after the vomiting.
Babies are given barbiturates 15 minutes before feeding.
In the case of the acute phase of the disease and the pronounced symptoms of hypoxia, infants are fed with expressed milk using a pipette.
Treatment of pertussis folk remedies
Important! Before using folk remedies for pertussis, be sure to consult your doctor!
Garlic with milk. Grind or mince 5 medium cloves of garlic thoroughly through a garlic, pour them with a glass of boiling water and put on fire. Bring the product to a boil, boil for 5 minutes, then cool and take several times a day. Many traditional healers use this tool to treat pertussis in children at home.
Bow. Finely chop the onions, put it in a 500 ml jar and pour it in 4 tbsp. tablespoons of sugar. When the onion starts juice, the resulting syrup should be taken several times a day, 1 teaspoon each.
Naphthalene. Pour a little naphthalene into a doubled cheesecloth, tie a bundle of laces to the child's neck. At night, the bag should be removed and laid next to the head so that the child can constantly breathe.
Fir oil. It is used for poor discharge of sputum. Drop 1-2 drops of fir oil to the baby on the upper chest and back, then rub it lightly into the skin. Improving blood circulation, as well as inhaling essential oil, which has antimicrobial, sedative and many other medicinal properties, will help to clear the airways of pathological secretions.
To enhance the effect, fir oil can be used as the basis for aroma lamps.
Mumiyo. Dissolve 0.1 g of Mumiyo in 50 g of warm water. The resulting mixture should be drunk in the morning, on an empty stomach. The number of receptions 10 times, within 10 days, every day, 1 time.
Licorice. Grind 350 g of licorice root, fill it with 1 liter of water and put on fire. Bring the product to a boil, boil it for about 8 minutes, then cover and let it brew for 1 hour. When the broth becomes warm, strain it and take 1-2 teaspoons 3 times a day. You need to take the broth in a warm form, so slightly warm it before taking.
Surprise. As we wrote at the beginning of the article, pertussis cough may still persist for more than one day after stopping the infection, which is due to the continued activity of the irritated cough center. To prevent coughing, it is necessary to switch the activity to another center, which is facilitated by a strong positive experience of the child, for example - to make a flight on an airplane, ride it in the cab of a truck, give a puppy or kitten. The longer the positive experiences, the faster the child will recover. By the way, it’s not necessary to buy a puppy or a kitten, they usually “exist” in large numbers in animal shelters, therefore, give a happy life to a future member of your family.
Pertussis Prevention
Prevention of whooping cough includes:
Compliance with personal hygiene;
Avoiding hypothermia, stress;
The use of foods enriched with vitamins and minerals;
In the autumn-winter period, avoid closed places with a large crowd of people;
Dissociation of children after contact with the carrier of infection and monitoring their health for 14 days;
Vaccination.
Pertussis vaccination
It must be said right away that the pertussis vaccine does not give a 100% guarantee of safety against the occurrence of this disease. Doctors note that this vaccine basically only minimizes the chance of getting sick, and if infection does occur, the course of the disease proceeds mainly in a mild form without complications. Of course, there are exceptions everywhere.
To date, the following pertussis vaccines exist:
"Infanrix" - a cell-free vaccine against diphtheria, pertussis and tetanus;
"Tritanrix" - a vaccine against pertussis, tetanus, diphtheria and hepatitis B;
"Tetracock" - a vaccine against pertussis, diphtheria, tetanus and poliomyelitis;
"DTP" is an adsorbed pertussis-diphtheria-tetanus vaccine. This vaccine, according to numerous sources and reviews, has a lot of complications, so many doctors recommend the use of other vaccines.
After the first vaccination, revaccination is done after 1.5-2 years.
Immunity to infection is more persistent than after vaccination.