I.

Pertussis

INTRODUCTION

Also known as whooping cough is a highly contagious bacterial disease caused by Bordetella pertussis. In some countries, this disease is called the 100 days' cough or cough of 100 days. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air after coughing. The coughing stage lasts for approximately six weeks before subsiding. Prevention via vaccination is of primary importance as treatment is of little clinical benefit to the person infected. Antibiotics, however, do decrease the duration of infectiousness and are thus recommended. It is estimated that the disease currently affects 48.5 million people yearly, resulting in nearly 295,000 deaths Signs and Symptoms The classic signs of pertussis are a paroxysmal cough, inspiratory whoop, and vomiting after coughing. The cough from pertussis has been documented to cause subconjunctival haemorrhages, rib fractures, urinary incontinence, hernias, postcough fainting, and vertebral artery dissection. If there is vomiting after a coughing spell or an inspiratory whooping sound on coughing, the likelihood that the illness is pertussis is nearly doubled. On the other hand, the absence of a paroxysmal cough or posttussive emesis makes it almost half as likely Complication of whooping cough: 1) Otitis media. 2) Hernia. 3) Pneumonia. 4) Prolapsed rectum. 5) Ulcerative tongue. Management The treatment of pertussis is generally ineffective at changing clinical outcomes; thus, prevention is of primary importance Antibiotics do, however, decrease the duration of infectiousness and thus prevent spread. The antibiotic erythromycin is currently the first line treatment. Newer macrolides are frequently recommended due to lower rates of side effects Trimethoprim-sulfamethoxazole may be used in those with allergies to first line agents or in infants who have a risk of pyloric stenosis from macrolides. Effective treatments of the cough associated with this condition have not yet been developed. Lifestyle and home remedies The following tips on dealing with coughing spells apply to anyone being treated for whooping cough at home: 1.Get plenty of rest. A cool, quiet and dark bedroom may help you relax and rest better.

2.Drink plenty of fluids. Water, juice and soups are good choices. In children, especially, watch for signs of dehydration, such as dry lips, crying without tears and infrequent urination. 3.Eat smaller meals. To avoid vomiting after coughing, eat smaller, more frequent meals rather than large ones. 4.Vaporize the room. Use a mist vaporizer to help soothe irritated lungs and to help loosen respiratory secretions. If you use a vaporizer, follow directions forkeeping it clean. If you don't have a vaporizer, a warm shower or bath also cantemporarily help clear the lungs and ease breathing. 5.Clean the air. Keep your home free of irritants that can trigger coughing spells, such as tobacco smoke and fumes from fireplaces. 6.Prevent transmission. Cover your cough and wash your hands often. If you must be around others wear a mask Nursing care: 1- Isolation during catarrhal stage. 2- Bed rest, mental rest. 3- Provide restful environment and reduce factors that promote paroxysm (dust, smoking). 4- Encourage fluid, small frequent feeding. 5- Increase humidity. 6- Observe for signs of air way obstruction. 7- Small amount of sedatives may be necessary to quiet the child. 8- Protect the child from secondary infection; antibiotics may be given to treat secondary infection. 9- Pertussis immune antiserum may be given.