Whooping Cough (Pertussis)


Whooping cough or pertussis is a serious, contagious infection of the respiratory tract caused by the bacteria Bordetella pertussis that attacks the lining of the breathing passages which leads to inflammation and narrowing of the airways. Though it can affect anyone, it generally affects infants and children less than 4 years of age who are not immunized. It can become very severe in children under the age of one as they are unable to eat, drink, or even breathe when affected. The name whooping cough comes from the sound that’s made when an infected person draws in a breath after a coughing fit. A less severe form of this disease is called parapertussis caused by B. parapertussis bacteria.

Risk factors

Whooping cough is a very contagious disease and can be spread from someone who is already infected to anybody who comes in close contact—face-to-face within 6 feet, close by for more than an hour, or direct contact with mucus—with someone with symptoms. The bacteria are present in the infected person’s lungs, throat, and nose. When the infected person has an intense coughing spell the germs are spread into the air and can infect others when breathed in.

The following people are most vulnerable to the disease:
• Infants under one year.
• Children who are not immunized or infants who have not been fully immunized yet.
• Those whose immunization is wearing off.
• Those who are suffering from viral cold and cough or asthma.

The disease is most likely to be transmitted by children and from adults who have the milder form of the disease. A person with pertussis is usually not contagious after 3 weeks.

Prevention

The only source of prevention, other than keeping away from infected people, is full immunization. Immunization is done by administering the pertussis vaccine, which is given to children in five doses at ages two months, four months, six months, 15-18 months, and 4-6 years. The vaccine is usually given in combination—DTaP (diptheria, tetanus, pertussis). Vaccinations or previous infections do not guarantee life-long immunity from whooping cough. However, later bouts with pertussis can be less severe. According to the CDCs Immunization schedule for Adults, if you are an adult and haven’t had at least 3 tetanus-and-diphtheria-containing shots sometime in your life (Tdap), you need to get them now. Start with dose #1, followed by dose #2 in 1 month, and dose #3 in 6 months. (Recommended Immunizations for Children 0-6) .

Symptoms

On average, symptoms begin 7-10 days after exposure to the pertussis bacteria. The symptoms of pertussis can be divided into three different stages.

Symptoms of the first stage are much like a common cold and occur 7-10 days after exposure.

First Stage symptoms include:

• runny nose
• sneezing
• watery eyes
• loss of appetite
• loss of energy
• low-grade, if any, fever
• mild hacking coughing at night, then increasingly during the day

Symptoms of Stage two begin 10-14 days after first symptoms:

• the nasal discharge becomes thicker and copious causing congestion in the respiratory tract.
• bouts of a series of rapid coughs (coughing fits)—5 to 15 times in one expiration—which is followed by the ‘whooping’ sound when the person breathes in. After a few normal breaths another coughing fit may begin.
• The severity of the cough leads to vomiting, drooling, protrusion of the tongue, bulging of the eyes, and/or change of color of the face to red or even bluish lips.
• The coughing leaves the patient very weak and exhausted which can make them susceptible to other infections such as pneumonia.
• Weight loss is a common.

In the third stage (4-6 weeks after first symptoms):

• This final phase lasts for approximately two to four weeks as gradually the intensity and frequency of the cough reduces and finally disappears. However, a mild cough can linger for several months and can return with subsequent respiratory infections.
• Vomiting decreases and the person/child starts to look better.
• Occasional coughing fits can occur for months.

Diagnosis

In order to identify pertussis, the doctor will do a thorough history and physical examination and confirm the symptoms or any possible recent exposure to someone infected with whooping cough. Then depending on the findings, the doctor can take a swab of mucus from the nose and throat and for DFA or direct fluorescent antibody or culture testing.

Treatment

Treatment will depend on how severe the symptoms are. Severely ill infants have to be hospitalized. Children can usually be treated at home. They need extra rest, plenty of fluids, to take any medicines as prescribed, to be kept away from others when possible, and be watched to see if complications develop. Whooping cough generally runs its course in about 6 weeks but can range anywhere from 3 weeks to 3 months. However, the following measures can reduce the symptoms and speed the healing process.

  • Removal of secretions from the nasal passage and upper respiratory tract by suction to prevent congestion (if hospitalized).
  • Administering oxygen if required (if hospitalized).
  • Giving plenty of fluids to prevent dehydration.
  • Maintaining proper nutrition even though the patient may not feel like eating.
  • Administering antibiotics in the early phase can help prevent the progression of the illness and reduce spreading, but does not treat the cough.
  • In the severe coughing phase, medications are not really helpful. For infants below the age of six months, the disease can prove fatal as this very often leads to pneumonia, encephalopathy, or respiratory failure. Therefore, infants with whooping cough need hospitalization.

Cough medicines do not relieve the cough, so your doctor may prescribe other treatments to mange the cough. A cool mist vaporizer can help soothe irritated lungs and breathing passages and help loosen mucus. Ask your doctor about postural drainage positions that use gravity to help move the mucus from the lungs to the bronchi, trachea and throat so they can be expelled. The drainage positions depend on which area of the lungs you’re trying to clear.

Keep the child in bed or resting until the fever disappears. He can resume normal activity based on how he is feeling. Drink plenty of extra fluids such as fruit juice, tea, carbonated drinks, and clear soups. If vomiting is present offer Pedialyte or Powerade to replace lost fluids and electrolytes. Eat small frequent meals for good nutrition.

Complications

The strain while coughing or vomiting can cause:

  • Changes in the voice.
  • Subconjunctival hemorrhage—bleeding in the white part of the eye.
  • Petechiae—red spots on the skin surface.
  • Tearing of ligament at the base of the tongue.
  • Umbilical hernia.

Other complications of whooping cough include pneumonia, nose-bleeds, ear infections, dehydration, and convulsions. Death may occur—though very rarely—in infants when whooping cough leads to pneumonia, brain injury, or respiratory failure.

When to call the doctor

Whooping cough starts out like a common cold, but you should start thinking about the chance it is whooping cough if the following conditions are also present or develop:
• The infected person is a very young child that has not been fully immunized (see link above to immunization chart)
• If the person has been exposed to someone that has a chronic cough or known to have whooping cough
• The cough becomes more severe and frequent
• Vomiting persists for more than a day or two
• The lips or fingernails become dark blue
• Your child becomes exhausted after coughing episodes, eats poorly, vomits after coughing
• You are concerned about any symptoms

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