Pertusis

Pertusis

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  PERTUSSIS “WHOOPING COUGH” Dr UbaidN P JR Community Medicine Pariyaram Medical College
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  ▪ Acute infectiousdisease caused by Bordetella pertussis ▪ Hundred day cough ▪ Important cause of death in infants ▪ Insidious onset, mild fever, irritating cough whoop(loud crowing inspiration)
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  EPIDEMIOLOGICAL DETERMINANTS ▪ AGENT –Causative agent is B.pertussis – <5% - B.parapertussis – Encapsulated, phase 1 strains – Carries 3 major agglutinogens 1 2&3 – Survive only short period outside human body • SOURCEOF INFECTION B.Pertussis infects only man Source is a case of pertussis No c/c carrier state
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  ▪ INFECTIVE MATERIAL Nasopharyngealand bronchial secretion ▪ INFECTIVE PERIOD Most infective during catarrhal stage. One week after exposure to 3 weeks after onset of paroxysmal stage ▪ SECONDARY ATTACK RATE Averages 90% in unimmunized household contacts
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  HOST FACTORS ▪ AGE Primarilydisease of infants and preschool children  SEX Incidence and fatality more among females  IMMUNITY Recovery from whooping cough & immunization  ENVIORNMENTAL FACTORS occur through out year more in winter and spring Low socioeconomic group
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  ▪ MODE OFTRANSMISSION Dropletinfection and direct contact ▪ INCUBATION PERIOD 7 to 14 days ▪ CLINICAL COURSE It produces local infection Organism not invasive Multiplies on epithelium of resp tract Cause inflammation necrosis of mucosa
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  (a)Catarrhal stage lasting for10 days. Insidious onset lacrimation,sneezing coryza, malaise, hacking night cough (b)Paroxysmal stage 2-4 weeks Characterized by burst of rapid consecutive cough followed by deep high pitched inspiration[whoop],vomiting In infants, cyanosis apnoea (c)Convalescent stage Lasting for 1-2 weeks 3 stages of clinical course
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  COMPLICATIONS: ▪ Bronchitis,bronchopneumonia,bronchectasis, ▪ Subconjunctivalhaemorrhage ▪ Haemoptysis ▪ Epistaxis, ▪ Punctate cerebral haemorrhage-convulsion and coma ▪ Pertussis- associated encephalopathy
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  CONTROL OF WHOOPINGCOUGH ▪ CASES AND CONTACTS Early dx by bacteriological exmn of secretions Fluorescent antibody technique Erythromycin is doc 30-50 mg/kg bwt 4 divided doses for 10 days ▪ CONTACTS Prophylactic erythromycin or ampicillin for 10 days
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  ▪ Active immunisation DPT3 DOSES 0.5 ML 6,10 14WEEKS BOOSTER 18-24 mnths UNTOWARD REACTION Local reacns: at injection site,mild fever,irritability Rare reacns:inconsolable screaming, seizures,hypotonic hyporesponsive episodes,anaphylactic reaction,encephalopathy.
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  ▪ CONTRAINDICATIONS Anaphylaxis ,encephalopathy,epilepsy,febrile episodes,reaction to previous vaccination
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