Pertusis

Pertusis

• 1.
  Pertusis  highly contagiousacute respiratory tract infection caused by Bordetella pertussis bacteria .  Once diagnosed, treatment involves the use of antimicrobial therapy, particularly macrolide antibiotics .  Bordetella pertussis, an aerobic, gram-negative coccobacillus.  When an infected individual coughs or sneezes, tiny microbe-laden droplets are expelled into the air and may be breathed into the lungs by anyone nearby. Risk factors :  Unimmunized baby  Living around unimmunized persons  Premature babies  Pt. with underlying cardiac, pulmonary, neuromuscular, or neurologic diseases . Pathophysiology : Inhaled bacterium produce a toxin that severely damages the cilia and respiratory epithelium that coat the lining of the lungs, thereby preventing them from clearing airways of pollen, mucus, and microbial invaders and causing uncontrollable coughing episodes .
• 2.
  Complications :  Fracturedrib  Abdominal hernia  Cerebral hemorrhage  Pneumonia  Red eye because of rupture in small arterioles  Pulmonary hypertension  Seizure  Dehydration (because of difficulty during feeding ) Signs and symptoms :  Incubation period 3 to 12 days but can even reach 3 weeks.  disease itself is 6 to 12 weeks in duration .  at first and resemble a common cold.  After a week or two, signs and symptoms may become more intense  severe uncontrollable coughing  prolonged coughing attacks that may provoke vomiting  blue-tinged facial tissue after cough  Infants may not cough much at all; instead, they may struggle to breathe, or may even temporarily stop breathing.  The 1st sign in neonate may be apnea (nelson essential)  whoop (The forceful inhalation against a narrowed glottis that follows this paroxysm of cough). Diagnosis :  Usually it is clinical  isolation of B pertussis in cultures of the nose and/or throat  chest x-ray for complicated pertussis to pneumonia .
• 3.
  treatment :  supportivetherapy (antipyretic , hydration , etc…)  antibiotics (azithromycin is the 1st drug of choice in neonate and infant because it is less side effect and not associated to cause pyloric stenosis ) azithromycin 10mg/kg /24 hr for 5 days or  erythromycin 50mg/kg /24 hr for 14 days or  clarithromycin 15mg/kg/24 hr for 7 days prevention :  by vaccination DTaP  Immunity to B pertussis decreases after 5 to 10 years following administration of the vaccine(booster dose)  It is very important for pregnant women and other people who will have close contact with an infant to be vaccinated against pertussis.  DTaP vaccine given in 5 shootes : At 2 month At 4 month At 6 month At 15 to 18 month At 4 to 6 years  Note : All close contacts should receive prophylactic antibiotics for 5 days (azithromycin) or 7 to 14 days (clarithromycin or erythromycin, duration based on age).