WHOOPING COUGH

(PERTUSSIS)
HUNDRED DAY COUGH
BY
Dr. Saja Alkafajy
 An acute infectious disease, usually of young children, caused by
Bordetella pertussis. It is clinically characterized by an insidious onset
with mild fever and an irritating cough, gradually becoming
paroxysmal with the characteristic "whoop" often with cyanosis and
vomiting. the spectrum of disease varies from severe illness to
atypical and mild illness without whoop.
 Pertussis is an important cause of death in infants worldwide, and continues to
be a public health concern even in countries with high vaccination coverage.
 Pertussis occurs throughout the year, but the disease shows a seasonal trend
with more cases occurring during winter and spring months.
 Socioeconomic conditions and ways of life also play a role in the epidemiology
of the disease. Thus, the risk of exposure is greater in the lower social classes
living in overcrowded conditions than in well-to-do groups.
 Immunity is never complete.

 Second attacks may occur in persons with declining immunity, but these are
usually mild.
Bordetella Pertussis
 Bacterial Gram-negative rod, Humans are the only host.
 Expected occurrence 3-to-5 year cycles of increased disease.
 Pertussis is under reported, 40-160 fold less than actual illness.
 Asymptomatic infections are 4–22 times more common than
symptomatic infections.
Rarely :
B.Parapertussis
Incubation period
Usually 7 to 14 days, but not more than 3 weeks.

INFECTIVE PERIOD :
Whooping cough is most infectious during catarrhal stage. The infective period may be
considered to extend from a week after exposure to about 3 weeks after the onset of the
paroxysmal stage although communicability diminishes rapidly after the catarrhal stage.
 Close person to person contact via aerosolized droplets from respiratory
secretions of patients with disease.
 90% of non immune household contacts acquire the disease.
 Adolescents and adults are the major source of infection in unvaccinated
children.
 Infants and young children are infected by older siblings who have mild
to asymptomatic disease.
Pertussis is primarily a toxin-mediated disease.

The bacteria attach to the cilia of the respiratory epithelial cells,

produce toxins that paralyze the cilia, and cause inflammation of
the respiratory tract, which interferes with the clearing of
pulmonary secretions.
Until recently, scientists thought that B. pertussis did not invade
the tissues; however, recent studies have suggested that the
bacteria are present in alveolar macrophages.
 catarrhal Paroxysmal stage
convalescent
7 to 14d

1 to 2 weeks 2 to 6 weeks 2 weeks or more

Nonspecific features.
 Congestion
 Rhinorrhoea
 Sneezing
 Lacrimation, Conjunctival redness
 Low grade fever, mild cough.
 Cold-like (coryza, conjunctival irritation, occasionally a slight cough).
 Duration 7-14 days.
Long duration (2-6 weeks), No fever.
A series of rapid, forced expirations, followed by gasping inhalation the typical whooping sound.
vomiting common, in Very young infants may present with apnea or cyanosis in the absence of cough.
Series of coughing in single expiration which is first dry & intermittent.
Eyes bulging—watering.
Chin & Chest held forward.
Tongue protruding maximally.
Face-Red-Blue.
Whoop at the end of paroxysm.
 Episodes of cough becomes less frequent.

 Duration more than 2 weeks

 Less severe.

 Paroxysms of whooping disappear.

Most severe in infants <6 months.
Atypical presentation.
Apnea most common symptom.
Whoop is absent.
Hospitalization often needed.
No classical stages
well appearing infants begins to choke
Gasp & flail extremities.
Cough may not be prominent.
 Blood Count:
Absolute Lymphocytosis
(15,000-100,000 cells/mm3( .
 Cultures:
nasopharyngeal swab or aspirate from all persons with
suspected cases.
 X-Ray chest
may be normal or show mild abnormalities.
 Increase of pertussis antibody
 Aim is to eradicate nasopharyngeal carriage.

 Macrolides: (erythromycin 14 days, azithromycin 5 days, and clarithromycin 7 days).

 Azithromycin eradicates naso-pharyngeal carriage the fastest.

 Hypertrophic pyloric stenosis has been reported with oral erythromycin in infants younger
than 6 weeks.
 Trimethoprim-sulfamethoxazole is an alternative to erythromycin-resistant strain, or for
intolerance to macrolides.
 Penicillins, first and second generation cephalosporins are not effective.

 Treatment shortens the period of communicability.

Infants less than 6 months of age are at the highest risk for complications. These include:
 Apnea
 Otitis media
 Pneumonia
 Atelectasis
 Emphysema
 Seizures
 Encephalopathy
 Epistaxis
 sub-conjunctival hemorrhage
 Intracranial bleeding
 Death (approximately 1% of infants less than 2 months of age)
1. CASES AND CONTACTS
Cases : Early diagnosis, isolation and treatment of cases and disinfection of discharges from
nose and throat are the general principles of control of whooping cough. Early diagnosis is
possible only by bacteriological examination of nose and throat secretions which may be
obtained by nasopharyngeal swabs.
Contacts : Infants and young children should be kept away from cases. Those known to have
been in contact with whooping cough may be given prophylactic antibiotic treatment for 10
days to prevent the infecting bacteria to become established.
2. ACTIVE IMMUNIZATION
The vaccine is usually administered in the national childhood immunization programme as
combined DPT or DTaP vaccine.
 Immunization
Prevention through immunization remains the best defense in the fight against pertussis.
CDC recommendations for vaccination are as follows:
DTaP vaccine:
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.
Tdap vaccine:
Recommended for children aged 7-10 years who are not fully vaccinated; as a single dose for
adolescents 11-18years of age; for any adult 19 years of age or older; and for pregnant
woman regardless of vaccination history, including repeat vaccinations in subsequent
pregnant.
DIPHTHERIA
 Epidemiology
 Diphtheria is a vaccine preventable disease, but multiple doses and booster doses are needed to
produce and sustain immunity.
 In 2023, an estimated 84% of children worldwide received the recommended 3 doses of diphtheria-
containing vaccine during infancy, leaving 16% with no or incomplete coverage.
 There is wide coverage variation between and within countries.
 Diphtheria can affect anyone but was most common in unvaccinated children.
 Diphtheria is a disease caused by a bacterium that affects the upper respiratory tract and less often
the skin.
 Skin, conjunctiva, vulva and other parts may be affected.
 Bacilli multiply locally in throat and produce powerful exotoxin.
 Diphtheria is a rare disease in most developed countries owing to routine children vaccination.
 However the disease is seen occasionally among non-immunized children in developed countries.
 Improved socio-economic conditions are changing the epidemiology of
diphtheria.
 The epidemics are largely due to decreasing immunization coverage among
infants and children, waning immunity to diphtheria in adults.
 movement of large groups of population in the last few years, and an irregular
supply of vaccine . These outbreaks highlight the need for booster vaccinations.
 Recent diphtheria outbreaks in a number of countries have demonstrated a
shift in the age distribution of cases to older children and adults.
 In developing countries, the disease continues to be endemic due to lack of
adequate widespread immunization.
 The true numbers of diphtheria cases and deaths are unknown because of
incomplete reporting from most countries where the disease occurs.
 Causative agent
 Caused Coryne bacterium diphtheriae.
 Gram positive
 Aerobic
 Generally non motile rods.
 No spores forming
 The bacilli multiply locally. usually in the throat, and elaborate a powerful exotoxin which is responsible for
the formation of a greyish or yellowish membrane ("false membrane") commonly over the tonsils, pharynx
or larynx (or at the site of implantation), with well-defined edges and the membrane cannot be wiped
away.
 PERIOD OF INFECTIVITY

 The period of infectivity may vary from 14 to 28 days from the

onset of the disease, but carriers may remain infective for much
longer periods .
 A case or carrier may be considered non-communicable, when at
least 2 cultures properly obtained from nose and throat, 24 hours
apart, are negative for diphtheria bacilli.
 TRANSMISSION

1. Droplet infections
2. Can also be transmitted directly to susceptible persons
from infected cutaneous lesions.
3. Transmission by objects contaminated by naso-
pharyngeal secretions of patients is also possible.
 INCUBATION PERIOD

2- 6 days, occasionally longer.

 CLINICAL FEATURES

Respiratory tract forms of diphtheria

 pharyngo-tonsillar
 laryngo tracheal
 nasal
 combinations
Pharyngo-tonsillar diphtheria

Sore throat
Difficulty in swallowing
Low grade fever at presentation
Presence of pseudo membrane
over tonsils
Oedema in sub mandibular region
Bull necked appearance
Laryngo-tracheal diphtheria

Preceeded by pharyngo tonsillar

diphtheria
Fever, hoarseness and croupy
cough
Dyspnoea
Nasal diphtheria

 Mildest form
 Localized in septum or turbinates of one side of nose
 Membrane extends to pharynx.
Cutaneous diphtheria

• Common in tropical areas

• Secondary infection of previous
infection or skin abrasion
• Presenting lesion an ulcer
surrounded by erythema and
covered with membrane.
 DIAGNOSIS

 Clinical findings
 Bacteriological examination:
Isolation of Coryne Bacterium diphtheriae on cultures confirm the diagnosis.
 In all patients in whom diphtheria is suspected, obtain specimens from the
nose and throat (nasopharyngeal and pharyngeal swabs) for culture.
 Isolation of C. diphtheria from close contacts may confirm the diagnosis,
even if the results of cultures on specimens taken from the patient are
negative
 TREATMENT
Antibiotics
 Procaine penicillin
 Oral penicillin
 Erythromycin
 Recommended duration is 14 days
Antitoxin
 Sensitivity testing
 Single daily dose 20, 000 to 100, 000 units

Two negative cultures at 24 hours intervals should be obtained before the patient is
declared free of the organism
 CONTROL OF DIPHTHERIA

CASES AND CARRIERS

Early detection : An active search for cases and carriers should start immediately amongst family and school
contacts.
Isolation :
All cases, suspected cases and carriers should be promptly isolated, preferably in a hospital, for at least 14 days
or until proved free of infection. At least 2 consecutive nose and throat swabs, taken 24 hours apart, should be
negative before terminating isolation.
Treatment :
The carriers should be treated with 10 days course of oral erythromycin, which is the most effective drug for the
treatment of carriers.
CONTACTS:
They should be throat swabbed and their immunity status determined.
Different situations pose different options :
(a) where primary immunization or booster dose was received within the
previous 2 years, no further action would be needed.
(b) where primary course or booster dose of diphtheria toxoid was received
more than 2 years before, one booster dose of diphtheria toxoid need
be given.
(c) Non immunized close contact should receive prophylactic penicillin or
erythromycin and immunization.
COMMUNITY:
The only effective control is by active immunization with diphtheria
toxoid of all infants as early in life as possible, as scheduled, with
subsequent booster doses every 10 years thereafter.
The aim should be to immunize before the infant loses his maternally
derived immunity so that there will be continuous protection from
birth without any gap in immunity to natural disease.
Vaccination:
Immunization with diphtheria toxoid, combined with tetanus
and pertussis toxoid (DTP vaccine), should be given to all
children at 2,4,6 and 15-18 months of age. The child is given
a further booster vaccine before leaving school and is then
considered to be protected for a further 10 years.
THANK YOU