Overview
The incidence of pertussis is quite high and is up to 10 million people a year. Approximately 6% of patients die from a variety of complications. The source of infection appears only sick people. The most dangerous for the surrounding is catarrhal period when pathogenic bacteria actively spread by airborne droplets.
whooping cough can flow into the erased or asymptomatic form. The patient himself can not be aware of existing infection, maintain high social activity and at the same time highlight the pathogen into the environment. This means that contact with the patient leads to infection and more than seven out of 10 people. It is worth remembering that the immune defense against whooping cough is not transmitted from mother to child, so infants are also susceptible to infection. Seasonal variations of the disease is practically not observed.
Causes
Pertussis - Bordetella pertussis is a fixed coccobacilli, which is not stained by Gram stain. For the normal life she needs some oxygen. Such bacteria are called aerobic. Germs are very unstable in the environment. Their death in a matter of seconds can cause:
- low temperature;
- the heating;
- ultraviolet radiation;
- drying;
- antiseptic treatment.
route of transmission - airborne. Once in the body, the bacteria begin to actively proliferate on the surface of the ciliated epithelium lining the respiratory organs. Thus there is an irritation of the bronchi of the receptor system, the bronchial tubes, trachea, larynx specific exotoxin secreted by Bordetella pertussis.
Chronic exposure of the chemical to the vagus nerve closure creates a persistent excitation in the medulla sections, responsible for the breathing. it provokes attacks of whooping cough. Furthermore respiratory center, may be affected by pertussis:
- vomiting center;
- vasomotor center, which is accompanied by the reaction of the cardiovascular system;
- brainstem.
It is worth remembering that immunity after diseases relatively stable, but over time there is a chance of re-infection.
symptoms of pertussis
The clinical picture of pertussis in children is 4 stages, replacing each other. After a short incubation period of 5-7 days, on average, a patient is diagnosed:
- catarrhal stage disease, during which there are no specific symptoms of whooping cough. The length of this period may be up to 2 weeks. The patient noted a slight fever, runny nose, unpleasant sensation in the throat - the typical symptoms of respiratory viral infections. The most significant symptom of exiting to the fore, is a dry cough. He begins to bother with the early days of the disease, it is amplified in the evening and night periods not adjusted symptomatic drugs, gradually acquires paroxysmal character.
- With the development of these attacks begins second stage - spasmodic cough. During this period, the correct diagnosis is not much difficulty because of the characteristic clinical picture of infection. Attack of painful cough convulsive jerks allowed to breath - Reprise. They follow each other cyclically.
- The number of such cycles in one fit of spasmodic cough can reach 15. At the end of the attack separates a large amount of viscous mucus. In addition to spastic cough, at this stage there are practically no other symptoms of pertussis. In the interictal period, the overall health of the child is normal. over time, the number of attacks decreased, normal quality of life. Duration period spastic coughing may be a month or more.
- Period of return It continued for 2-4 weeks and it is characterized by the disappearance of cough attacks.
- AT the phase of convalescence says low immunity, so ill with whooping cough person becomes susceptible to various infections. In addition, the diagnosed asthenic syndrome that includes fatigue, general weakness, irritability.
In addition to the typical form of whooping cough is sometimes diagnosed:
- Asymptomatic form, which does not have any signs of illness.
- Erased form, characterized by a long dry cough, whose intensity is not reduced after receiving symptomatic drugs.
- Abortive form a typical step catarrhal manifestations, after which there is a very short period paroxysmal spastic coughing.
Young children suffer the most. They often extended period of spasmodic cough may delay the development or cessation of breathing.
In adults, whooping cough passes without the typical coughing, often obliterated.
Diagnostics
In addition to spastic cough nature, help to diagnose whooping cough findings of laboratory studies:
- Expressed leukocytosis with a significantly increased number of lymphocytes with normal erythrocyte sedimentation rate.
- The appearance of specific antibodies and increase their titers, which are determined by an enzyme immunoassay technique.
- Isolation of the pathogen from sputum or scrape the back wall of the pharynx.
treatment of pertussis
Treatment of pertussis in young children and patients with severe disease is carried out in an infectious diseases hospital. For a child it is necessary to organize an adequate mode:
- ensure complete isolation from other children;
- excluding external stimuli;
- create a favorable micro-climate in the chamber, continuously moistening air by means of special devices or open containers with water;
- possible to spend time outdoors, avoid contact with other children.
During the period of infection is important good nutrition. Babies breastfed adjust daily amount of food by increasing the number of feedings and decrease the volume of a single milk. Older children need to increase the amount of alkali drinking. It can be juices, mineral water, milk. It is worth remembering that dry food irritates the back of the throat, causing coughing. Therefore, eating cold food contraindicated in whooping cough.
At the stage of catarrhal changes antibacterial agents used, which is sensitive to pertussis. It can be:
- macrolides;
- tetracyclines;
- aminopenicillin;
- chloramphenicol.
Antibiotics are assigned a course of 5-7 days, however, did not always include them brings visible results in the scheme of therapy. Unambiguous indication for their use are developed bacterial complications (pneumonia, bronchitis).
The main therapy with pertussis are centrally acting agents that inhibit hyperactivity cough center in the medulla oblongata. Therapy of substance is carried out in the period of spasmodic cough. The duration of their application is 10-14 days. These medicines include:
- antipsychotics. In a hospital environment parenterally administered solutions of these drugs. The dosage is calculated according to patient body weight. Medicines administered twice a day, day and night before going to bed to avoid attacks. Antipsychotics are not only on the cough center. They reduce the activity of the vasomotor and vomiting center.
- tranquilizers. Due to intensive sedation, these drugs may reduce the severity of attacks spastic coughing. The regimen of pertussis are often used drugs in this treatment group.
Also possess sedative antihistamines. But some of them may provoke dryness of mucous membranes, which is why there are new cough.
The use of enzymes with proteolytic activity enables to normalize the rheological properties of sputum. Some studies suggest the usefulness of corticosteroids in severe infectious disease.
complications
These conditions are often exacerbated during pertussis in young children.
prevention
The main preventive method is vaccination. It is carried out in children aged 3 months to 3 years old, three times at intervals of 1 month. For pertussis vaccination was killed microbial cells are administered intramuscularly. After injection are possible:
- redness or swelling at the injection site;
- fever;
- violation of the general well-being;
- allergic reactions.
Complications from vaccination are rare. Children with convulsive disorders or hyperthermia should be immediately admitted to the hospital.
The important point for limiting the spread of infection is the isolation of whooping cough patients. It is carried out in special boxes infectious. The duration of the insulation is at least 25 days after the onset of symptoms of the disease whooping cough.
Forecast
prognosis in most cases favorable. Special conditions require monitoring newborn babies and children up to a year.
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