Pertussis dr yusuf imran

Pertussis dr yusuf imran

• 1.
  (Whooping cough) By; DrYusuf Imran Dept. of Pediatrics J.N Medical College AMU (INDIA)
• 2.
   Pertussis isan acute respiratory tract infection caused by Bordetella pertussis  Characterized by intense spasmodic cough "whoop.“  Sydenham first used the term pertussis (intense cough) in 1670  worldwide prevalence is decreased by active immunization
• 3.
   Continues tobe public health concern even in countries with high immunization coverage  About 1.29 lac cases were reported to WHO globally, in 2010  In India ,marked decline in incidence occurred after launch of UIP ( 1.63 lac cases in 1987 vs only 39,091 cases in 2011; 76% decrease)
• 4.
   DROPLETS  Highlycontagious,almost 100% in susceptible host(under fives) Undiagnosed adults may be a source when source is not obvious Do not survive in dust for too long
• 5.
   Bordetella pertussisis the sole cause of epidemic pertussis and usual cause of sporadic pertussis  B. parapertussis is an occasional cause ( fewer than 5% of cases )  These two are exclusive human pathogen (and for some primates)  B. bronchiseptica is common animal pathogen  Pertussoid syndrome : protracted coughing can also be caused by Mycoplasma, parainfluenza or influenza viruses, enteroviruses, RSV & adenoviruses.
• 6.
  A E RO S O L A C Q U I S I T I O N O F B P E R T U S S I S A T T A C H T O R E S P I R A T O R Y E P I T H . C E L L S W I T H S U R F A C E F I L A M E N T O U S H E M A G G L U T I N I N ( F H A ) , F I M B R I A E ( T Y P E S 2 A N D 3 ) & P E R T A C T I N P R O D U C E T R A C H E A L C Y T O T O X I N , A D E N Y L A T E C Y C L A S E A N D P E R T U S S I S T O X I N ( P T ) W H I C H D A M A G E L O C A L E P I T H E L I U M & E X E R T V A R I O U S B I O L O G I C A C T I V I T I E S
• 7.
  Classically pertussis isdivided into :  catarrhal stage- begins after an incubation period of 3-12 days with symptoms of congestion, rhinorrhea , low-grade fever, sneezing, lacrimation, and conjunctivitis (last 1-2wks)  Paroxysmal stage- dry, intermittent, irritative cough characterized by whoop(forceful inspiratory gasp) infrequently occurs in infants <3 mo .Post- tussive emesis is common (lasts for 2-6 wks )  convalescent stage- no. & severity of episodes decreases over next 1-4 weeks
• 8.
  Goals of therapy:  Supportive- give oxygen if cyanosed, proper nutrition, rest, hydration & avoid stimulation  salbutamol (albuterol) – nebulization may alleviate symptom(cough suppressants are contraindicated)  Antimicrobial Agents – 1)Erythromycin (40-50 mg/kg/24 hr divided qid) for 14 days is standard treatment 2)Clarithromycin , azithromycin & co- trimoxazole are useful alternatives
• 9.
   Patients placedin respiratory isolation for ≥5d  Chemoprophylaxis: Erythromycin for 14 days should be given to all household and other close contacts  Close contacts <7 yr of age who have received less than four doses of pertussis vaccines should have vaccination initiated or continued  Prevention : Universal immunization of children <7 yr of age , beginning in infancy, is central to the control of pertussis  Combination acellular pertussis (DTaP) vaccines are preferred over those containing whole-cell pertussis (DTP) vaccines because of fewer adverse reactions
• 11.
  The principal complicationsof pertussis are  Respiratory complications eg a) bronchieactasis b) secondary infections ( otitis media,pneumonia) c) atelectasis ,emphysema &pneumothorax  Sequelae of forceful coughing :(raised pressure) - conjunctival and scleral hemorrhages - petechiae on the upper body, epistaxis - hemorrhage in the CNS and retina
• 12.
  -umbilical and inguinalhernias -rectal prolapse  Neurological complications : -seizures( several reasons) -encephalopathy  Malnutrition due to persistent vomiting & reduced appetite  Flare up of tuberculosis(decrease CMI)
• 13.
   Those <2mo of age have the highest reported rates of pertussis-associated complications like-  apnea  pneumonia(25%)  seizures (4%)  encephalopathy (1%)  and death (1%) and so hospitalized in 82% case  Apnea, cyanosis, and secondary bacterial pneumonia are events precipitating intubation and ventilation  The need for intensive care and artificial ventilation is usually limited to infants <3 months