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PERTUSSIS- etiology, complications, management pptx
- 1.
- 2. Introduction •Pertussis is ahighly contagious bacterial disease caused by Bordetella pertussis •Characterized by severe coughing spells, which at times end with a whooping sound when the person breathes in •Also known as 100 days cough •Habit pattern of coughing may be longer or subsequent weeks or months
- 3. Epidemiology •Spread occurs bydirect contact or droplet infections during cough •Risk of transmission is greatest during the catarrhal stage •The incidence is greatest in infants under one year, who are at greatest risk of morbidity and mortality •Extremely contagious attack-rate 80-100%
- 4. Etiology •Bordetella pertussis: Gramnegative pleomorphic rod is the cause of epidemic pertussis •B.parapertussis: an occasional cause of sporadic pertussis that contributes significantly to 5% of total cases of pertussis •B. Bronchiseptica
- 5. Pathophysiology • B. pertussisspreads via aerosolized droplets produced by the cough of infected people • It attaches to and damages the ciliated respiratory epithelium • It also multiplies on the respiratory epithelium, from the nasopharynx and ending primarily in the bronchi and bronchioles • A mucopurulent exudate forms in the respiratory tract and compromises the small airways (especially those in infants) and predisposes the affected individual to atelectasis, cough, cyanosis and pneumonia • Lung parenchyma and bloodstream are not invaded hence negative
- 6. Pathophysiology blood cultures. • Thevirulence factors include proteins called toxins and adhesins. Pertussis Toxin induces lymphocytosis, enhances sensitivity to histamine. Elevated white blood cells are involved in pulmonary hypertension. Filamentous hemagglutinin; role in interaction of B. pertussis with host cells Pertactin plays the same role as an adhesin Fimbriae are surface appendages and are adhesins Adenylate cyclase toxin – increases cAMP levels resulting in inhibition
- 7. Pathophysiology Of phagocytosis andactivation of apoptosis in some cells. tracheal cytotoxin (TCT) – kills respiratory epithelial cells
- 8. clinical manifestations •Classically, pertussisis divided into catarrhal, paroxysma and convalescent stages. Catarrhal stage (lasts 1-2 weeks) •The term catarrh means to flow i.e. secretions from the nose and mucous membranes flow causing nasal congestion and runny nose •Indistinguishable from common cold but highly contagious •Low grade fever or afebrile •Malaise
- 9. clinical manifestations •Mild drycough •Rhinorrhea or rhinitis •Sneezing •Lacrimation Paroxysmal cough stage (2-6 weeks) •The term paroxysmal means a sudden violent burst. The paroxysms of coughing may… •Start as a dry intermittent annoying cough that increases in intensity and frequency
- 10. clinical manifestations •Occur atleast once an hour •Cause the child to turn red, blue or purple •Cause significant distress to the child •Cause the eyes to bulge and water excessively •Vomiting after coughing Young infants may have small bursts of cough or no cough before developing… •Apnea •Choking or gagging
- 11. clinical manifestations •Gasping •Cyanosis Convalescent stage(>/= 2 weeks) •Episodes of cough become less frequent •Less severe •Paroxysms of whooping disappear •Young infants may develop louder coughing but typ the breathing difficulty improves
- 13. Coughing spells ofpertussis
- 14. Diagnosis Pertussis is aclinical diagnosis •Most clinical case definitions require 2 weeks of cough illness with at least 1 characteristic feature of pertussis •(paroxysms, whoop, post tussive emesis, apnea, with or without cyanosis) •An acute cough illness with at least one of the above, and contact with a lab confirmed case (i.e. epidemiologic linkage) •Laboratory confirmation isn’t necessary to make a diagnosis but only to confirm it
- 15. Diagnosis • Lab testingis beneficial in patients without exposure history and for public health considerations Labs • Complete blood count- leukocytosis from lymphocytosis (15,000- 100,000 cells/uL) Chest radiograph may be normal or have subtle abnormalities e.g. atelectasis Nasopharyngeal swabs for PCR and/or culture should be obtained Serologic tests for IgG
- 16. Differential diagnosis Catarrhal stage •Viral upper respiratory tract infection (e.g. adenovirus) • High fever suggests alternative diagnosis Paroxysmal stage • Cough causes (chronic obstructive pulmonary disease, allergic rhinitis etc.) • Mycoplasma pneumoniae • Neonatal chlamydia pneumoniae • RSV bronchiolitis
- 17. Differential diagnosis Convalescent stagewith persistent cough •Asthma •Gastroesophageal reflux •Allergic rhinitis •tuberculosis
- 18. management Admit if<4 months,apneic, seizures, pneumonia, respiratory distress goals • Limit number of paroxysms • Observe severity of cough and provide assistance when necessary • Maximize nutrition, rest Supportive management is the mainstay of B.pertussis management • Fluids and nutrition- frequent paroxysms of cough cause increased fluid and energy needs that should be monitored and met • IV hydration, Nasogastric feeding may be required
- 19. management •Cough- known triggersfor coughing paroxysms (exercise, cold temperatures, nasopharyngeal suctioning) should be avoided •Avoid symptomatic therapies e.g. bronchodilators, corticosteroids •Airway management - during paroxysms of cough, place child in recovery position to prevent inhalation of vomitus •Clear secretions from nose and throat with
- 20. management Pharmacologic therapy • Infantsyounger than 1 month- azithromycin(5 days) is preferred over erythromycin (14 days). Clarithromycin(7 days) isn’t recommended • azithromycin & erythromycin increase risk of infantile hypertrophic pyloric stenosis in Infants younger than 2 weeks • Infants older than 1 month- any of the macrolides can be used • Trimethoprim-sulfamethoxazole is an alternative in
- 21. management Immunization •Prevention through Immunization remainsthe best defense in the fight against pertussis •DTap vaccine : children aged 2, 4, 6,and 15-18 months and at age 4-6 years; its not for children aged 7 or older •Tdap vaccine; children aged 7-10 years who aren’t fully vaccinated ; as a single
- 22. Complications • Infants lessthan 6 months are at the highest risk for complications, • hospitalization • Apnea • Pneumonia (25%) • Seizures • Encephalopathy • Death (1% of infants <2 months) • Atelectasis • Emphysema • Ear infections
- 23. Complications Due to severecoughing spasms • Cough fracture (4% rib fracture) • Pneumothorax • Epistaxis • Subconjunctival hemorrhage • Hernia • Rectal prolapse • Subdural hemorrhage
- 24. prevention •Pertussis vaccine ispart of DPT vaccine •All household contacts should get erythromycin (14 days). •Close contacts <7 yrs should get a booster •Hygiene- cover your mouth and nose with tissue when you cough or sneeze •Put used tissue in the waste basket •Good hand washing practices
- 25. prognosis •Most people infectedwith pertussis fully recover, although usually after a prolonged illness of months •Infants and older adults tend to have the highest mortality and morbidity, respectively •Infant death rate is about 2% of the cases and accounts for 96% of deaths related to
- 27. references • Nelson textbookof pediatrics • Up-to-date • World Health Organization. Pertussis guidelines