Pertussis in Children

What is Pertussis in Children?

Whooping cough is an acute infectious disease that is transmitted by airborne droplets, manifests itself as a kind of convulsive paroxysmal cough and has a cyclic protracted course.

According to the International Classification, pertussis caused by Bortletellapertussis, pertussis caused by Bordetellaparapertussis, pertussis caused by another specified pathogen of the species Bordetella, pertussis, unspecified are distinguished.

Infection is spread by sick children or adults who are dangerous from the last days of the incubation period. The patient is especially dangerous to others at the beginning of the seizure period, then the infectiousness becomes lower over time. How contagious the patient is depends on the severity of the cough. Since in the process of coughing from the respiratory tract, an infected secret gets into the external environment. At risk are children from 2 to 5 years. In recent years, people in their teens, adults and infants 1-3 months old are becoming more and more sick. Antibodies that the baby received from the mother while in her womb do not protect against whooping cough.

Causes of Pertussis in Children

Three types of pathogens lead to the disease: Bordetella pertussis, B. parapertussis and B. bronchiseptica. The last of them is very little studied by science.

Bordetella pertussis are coccobacteria (gram-negative small sticks) that are motionless, have a soft capsule. They belong to strict aerobes, highly sensitive to external influences. In direct sunlight they die within an hour, and in contact with disinfectants within 1-5 minutes. Bordetella pertussis produce exotoxin, which is known as pertussis toxin.

Pathogenesis during pertussis in children

Bordetella fall on the mucous membrane of the upper respiratory tract. Reproduction occurs in the cells of the cylindrical epithelium. The causative agent “passes” on the small bronchi, bronchioles and alveoli. For pertussis, bacteremia is not characteristic. In the pathogenesis of the disease, the toxin plays a major role. It acts on the mucous membrane of the respiratory tract, which leads to coughing.

The nerve receptors of the mucous membrane of the respiratory tract are irritated by the toxin for a long time, due to which the cough acquires the character of spasmodic attacks, during which the respiratory rhythm is broken, which is called inspiratory pause in science.

Violation of the rhythm of breathing with spasmodic cough (apnea) leads to a disorder of pulmonary ventilation and hemodynamics. The process is accompanied by hypoxia and hypoxemia.

In the development of the disease, oxygen deficiency is important. Circulatory disorders occur in the cerebral cortex, which leads to focal changes and seizures.

In the medulla oblongata, a persistent focus of excitation is formed. As the pathological impulses from the respiratory tract decrease, a slow extinction of the dominant focus of excitation in the central nervous system occurs.

The respiratory tract is subject to the greatest pathomorphological changes. In the lungs, pronounced circulatory disorders occur. Edema of peribronchial, perivascular and interstitial lung tissue is observed.

Blood circulation disorders are observed in the central nervous system, kidneys, liver, etc.

Symptoms of Pertussis in Children

From 3 to 15 days, the incubation period for whooping cough lasts. The average term is 5-8 days. The disease is divided into three periods: catarrhal, spasmodic, and resolution period. Whooping cough proceeds slowly, in cycles.

Catarrhal period. The disease begins gradually. A dry cough appears, sometimes the body temperature rises slightly and a slight runny nose occurs. The general condition of the child is normal. Inspection does not detect objective changes. Over the course of 1-2 weeks, the cough becomes more and more intense, intrusive, and later it happens in seizures. The catarrhal period lasts approximately 2 weeks. If the course of pertussis in children is severe, the catarrhal period lasts 5-7 days.

This is followed by a spasmodic period, which is characterized by spasmodic coughing attacks. Cough tremors alternate with a whistling breath. Gradually, coughing attacks become more frequent and stronger, reaching a maximum of 2-3 weeks after the onset of this period of the disease.

During a coughing attack, the patient’s face may turn red or blue, swelling of the veins in the neck, tearing of the eyes, the head goes forward, the tongue sticks out as much as possible. In severe cases of the disease during a coughing fit, hemorrhages in the sclera, nosebleeds, involuntary urination and defecation, apnea occur. After a coughing fit, viscous viscous sputum and vomiting are released.

In the period between attacks with mild to severe pertussis in children, the condition is normal. Activity is maintained, appetite is normal. If the attacks are severe and often recur, the child becomes lethargic and irritable.

Inspection shows swelling of the eyelids, puffiness of the face, slight pallor of the skin. The X-ray diffraction pattern reveals increased transparency of the pulmonary fields, the appearance of retina, flattening of the diaphragm, etc. The child has tachycardia and high blood pressure.

A blood test shows leukocytosis, monocytosis. ESR is normal or slightly reduced. During the spasmodic period, changes in the blood are maximum.

The spasmodic period of pertussis in children lasts 2-4 weeks. After this period, coughing attacks become weaker, the period of resolution of the disease begins. Coughing spells are more rare, sputum is easier to separate. The recovery period lasts 1.5-3 months.

Classification. Whooping cough is typical and atypical. Typical cases are those that pass with spasmodic cough. Atypical whooping cough is an erased and subclinical form. Typical forms of pertussis in severity are divided into mild, moderate and severe.

With whooping cough, such complications can occur: central nervous system lesions, manifested by convulsions or encephalopathy, subcutaneous and mediastinal emphysema, pneumothorax, nosebleeds, umbilical or inguinal hernia.

Most often, complications arise due to the appearance of a secondary bacterial infection. This leads to focal or confluent pneumonia, purulent pleurisy and pleuropneumonia.

The course of pertussis in children under 12 months of age is much more severe. Incubation lasts 4-5 days, and the duration of the catarrhal period is up to 7 days. During the catarrhal phase, Nose’s breathing is difficult, coughing and sneezing are noted. The temperature is normal, the general condition is normal or slightly worsens.

There are rare cases when the catarrhal period is absent, whooping cough then immediately manifests itself with bouts of spasmodic cough. In children under 12 months of age, especially newly born, more severe gas exchange disorders with the phenomena of hypoxemia and hypoxia are observed. In the spasmodic period, the general condition is serious. They fix hand tremor, sleep disturbance, light convulsive twitching even in a dream, an increase in tendon reflexes. When a child coughs, he often vomits. In infants, equivalents of coughing spasms often occur in the form of spasmodic sneezing, which usually result in nosebleeds.

Disease in children under 12 months, as a rule, takes a long time. The spasmodic period can be 2-3 months long. In frequent cases, ARVI joins, and then pneumonia develops. In children who are vaccinated against pertussis, the disease passes in an erased form, there is no such symptom as spasmodic cough. With such forms, there is mild and prolonged coughing, which lasts from 5 to 7 weeks. Complications do not happen.

Diagnosis of Pertussis in Children

In the spasmodic period, diagnosis of whooping cough is quite simple. For diagnosis, they rely on symptoms such as spasmodic cough with reprise, discharge of viscous viscous sputum, in frequent cases – vomiting after an attack, the patient’s puffy face. There is an ulcer on the bridle because the tongue is maximally stuck out of the mouth in a coughing fit.

Whooping cough is also diagnosed based on a successive change in the periods of the disease that are listed above. Changes in peripheral blood are important: severe leukocytosis and lymphocytosis, ESR is normal.

Pertussis in children in the catarrhal period is difficult to identify. Doctors are guided by a persistent, obsessive cough, a complete absence of physical changes in the lungs, the occurrence of vomiting during coughing, the ineffectiveness of the therapy, and characteristic hematological changes.

Laboratory methods for the diagnosis of pertussis in children are used. The pathogen is isolated. The biomaterial is taken using the “cough plate” method using a dry swab or a swab moistened with a nutrient medium, and inoculated on elective media.

Pertussis is sometimes detected using rapid diagnosis, namely, the immunofluorescence method. This requires smears of mucus, which are taken from the nasopharynx.

Serological diagnostics is carried out using methods such as RSK, RA, RPGA. In children under 2 years old, the results are often negative.

In the catarrhal period, pertussis is distinguished in diagnosis from SARS, such as parainfluenza, influenza, respiratory syncytial infection, adenovirus infection. Unlike SARS, with pertussis, catarrhal phenomena on the mucous membrane of the nose and oropharynx are weakly expressed, in frequent cases the body temperature is normal, there is no intoxication, the cough progresses, despite the treatment, there is a high leukocytosis and lymphocytosis.

In the spasmodic period, pertussis is similar to acute respiratory viral infections, occurring with tuberculous bronchoadenitis, with obstructive syndrome, etc.

The diagnosis of pertussis helps establish epidemiological data, hematological changes, a typical spasmodic cough with reprise, the cyclical nature of the disease.

A more complicated differentiation of pertussis and pertussis, with the latter coughing can be spasmodic. The pertussis has a milder course. Pertussis-like cough lasts from 2-3 days to 2 weeks. In the blood, as a rule, there are no changes. Bacteriological and serological studies are crucial for diagnosis.

Treatment of Pertussis in Children

Hospitalize infants and preschoolers, as well as children with severe forms of whooping cough and with complications. The pathogenetic and symptomatic treatment of pertussis in children is used. At the very beginning of the disease, effective antibiotic therapy. Antibiotics are also used in the early days of spasmodic cough.

When antibiotics are used at the onset of the disease, coughing fits are much easier, and the duration of the disease is reduced. Doctors prescribe azithromycin, erythromycin in doses adequate to the age of the sick child. Treatment lasts 5-7 days.

In the spasmodic period of the disease, antibiotics are not used, since their effectiveness is almost zero. To reduce the severity and frequency of coughing attacks, antipsychotics such as chlorpromazine and propazine are used. They relieve spasm of the bronchi, help calm the patient, lower the excitability of the respiratory center.

Oxygen therapy is used to eliminate hypoxia and hypoxemia. During apnea, it is necessary to aspirate the mucus from the nose and oropharynx and carry out artificial ventilation of the lungs.

With whooping cough, allergic processes often occur, because doctors can also prescribe antihistamines such as diprazine, diphenhydramine, suprastin, etc. to the patient.

Pathogenetic therapy is carried out by Erespal syrup. Severe cases are treated with corticosteroids in a course of 7 to 10 days.

Also, drugs are needed to thin out viscous sputum and improve respiratory function. Doctors may prescribe aerosol inhalation with proteolytic enzymes and antispasmodics.

For treatment, a sick child needs to organize the correct regimen. During treatment, you need to provide the patient with cool fresh air. It affects the weakening of coughing attacks and soothes the central nervous system. It is recommended to exclude external stimuli leading to coughing attacks. Nutrition should be fortified and complete. If the baby has frequent bouts of vomiting, feeding is recommended. Inflammation is treated with antibiotics.

Prevention of Pertussis in Children

Specific prophylaxis against pertussis has been carried out since 1959. Active immunity is created with the help of tetracoc, DTP, infanrix.

A child with whooping cough is separated from peers for 25-30 days from the onset of the disease. For children under the age of 7 who have been in contact with patients and who have not previously had any whooping cough and have not been vaccinated (if they have no cough), quarantine is set for a period of 14 days from the moment of the last contact with the patient.

If treatment of a child with a pertussis child is carried out at home, children under 7 years of age who have had contact with him who have not had pertussis should be separated by 25 days from the onset of coughing in the first sick child.

Children who have had whooping cough and children from 7 years old should not be separated, but they will be placed under medical supervision for 25 days from the onset of cough in a sick child. Final disinfection is not carried out.

In the outbreak, general preventive measures should be taken, such as disinfecting dishes, airing, etc.

For children under 12 months of age who did not suffer from whooping cough and did not receive the vaccine, in contact with the disease it is recommended that a normal human immunoglobulin be given in a dose of 6 ml (3 ml every other day).