Whooping cough in adults

An infectious disease such as whooping cough can occur at any age. Although small children are more likely to have complications after this disease, some complications after whooping cough in adults can also occur.

Whooping cough in adults, despite the fact that this disease is considered a problem of long gone years, continues to be periodically encountered in clinical practice. This is an infectious disease, which usually occurs acutely, cyclically, and is characterized by specific symptoms.

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History and statistics of whooping cough in adults

There is no reliable data on how whooping cough affected the population of the ancient world, however, records from the 18th century speak of terrible statistics: an epidemic of the disease in the Scandinavian lands lasted more than 15 years, taking the lives of 2-3 thousand people annually. A century later in England, whooping cough took the lives of about 120 thousand people in seven years. In addition, those who survived the terrible epidemics often suffered from the consequences of cerebral hemorrhage, encephalitis, which were provoked by attacks of severe coughing and respiratory arrest. The most dangerous outbreaks occurred on the eve of the 20th century, when whooping cough began to spread throughout European countries, especially in poor working-class areas. Unsanitary conditions, large crowds of people, poverty and malnutrition contributed to the rapid infection of thousands of adults. There is data collected by Russian doctors of those years, which shows that in aristocratic families whooping cough in adults was 5-6 times less common than among the population of working-class neighborhoods.

Whooping cough was practically invincible also because the disease itself, despite its threatening prevalence, was little studied. Only at the beginning of the 20th century, Jules Bordet and his colleague Octave Gengou identified the true enemy - the causative agent of the disease, but the methods of treatment were ineffective and absolutely unsuitable for the fight against an infectious disease. Those who were struck by whooping cough were bled, leeches were applied, and mercury and opium-based drugs were prescribed. Only after the discovery of the first antibiotic during World War II, the mortality rate from whooping cough began to fall, and the first vaccination marked the beginning of a real victory over such a terrible disease as whooping cough in adults. In addition, the discovery of the era of antibiotics helped effectively fight scarlet fever, typhus, measles, tuberculosis and other ailments that took thousands of lives over many centuries. The fact that whooping cough in adults is becoming increasingly rare today is, of course, due to the normalization of sanitary conditions, the increase in the general standard of living of the population, in addition, it is believed that an adequate immune response has gradually accumulated to many diseases, transmitted genetically. It is interesting that by the time of the mass vaccination campaign in Russia in the middle of the 20th century, the mortality rate from whooping cough had practically disappeared.

Whooping cough in adults develops and proceeds cyclically, perhaps this feature is associated with a new surge in the disease, starting in 2000, whooping cough has become a fairly frequent "guest" in many developed countries, despite ideal sanitary, social conditions and even vaccination. Since the beginning of the 21st century, cases of whooping cough have been registered, and every year more and more often and in larger quantities, unfortunately, there are also fatal outcomes. The most vulnerable segment of the population again turned out to be children under two or three years old. Today, the main way to reduce the prevalence and risks of complications after such a serious disease as whooping cough in adults is timely vaccination. Even in case of infection, a person is in a much milder form, and immunity against whooping cough lasts throughout life.

Statistics show that whooping cough in adults (especially after age 50) is much more common than is commonly thought. For example, in the United States, from 2006 to 2012, the incidence of whooping cough among adults aged 50-65 more than doubled, and among those over 65, it tripled.

In adults, this infectious disease is often less pronounced, so patients - despite the fact that uncontrollable paroxysmal cough can last from three to six weeks - do not consult a doctor. Thus, identifying the pathogen - the bacteria Bordetella pertussis - is difficult. Therefore, according to infectious disease specialists, in about 2% of cases, prolonged paroxysmal cough in the elderly may be associated with whooping cough.

How does whooping cough develop in adults?

Whooping cough in adults is an infectious disease that manifests itself with a specific symptom - paroxysmal cough, which can cause spasms of the respiratory system.

Whooping cough in adults develops due to the penetration of a bacterium, the whooping cough bacillus, called Bordetella pertussis, into the body. The bacillus is quite vulnerable and is not viable in the external environment, thus, the infection is transmitted directly from an infected person to a healthy one. The initial period of the disease, the first two weeks, is especially dangerous in this sense. Until now, despite the huge number of medications and mass vaccination, whooping cough in adults is considered an extremely contagious disease. Early age (up to three years) or weakened immunity is almost 100% probability of infection with bordetella, subject to contact with a sick person. The disease is transmitted through the air, that is, by airborne droplets. The main characteristic symptom of whooping cough is a cough that is not cured by medication, which manifests itself in attacks. When coughing, the patient releases many bacilli into the environment, infecting those around him. Infection is usually possible through fairly close contact with an infected person, as Bordetella cannot spread more than two to three meters. Quite often, the source of infection is the parents themselves, who are sick with an atypical, latent form, believing that the cough is just a sign of a mild cold. Whooping cough is especially dangerous for newborns, who do not have an innate immune response to the disease. If the patient has steadfastly endured the infection, immunity is developed and maintained throughout life. Incubation of whooping cough lasts from 5 to 10 days, but there are forms of whooping cough, the incubation period of which is from three days to three weeks.

How does whooping cough manifest itself in adults?

The general course of the disease lasts about 5-6 weeks, divided into the following stages:

• Catarrhal period, which can last for two weeks. The beginning of the prodromal stage (the period between incubation and the disease itself) is manifested by a dry, persistent cough, with virtually no increase in temperature. It is at this time that diagnostic errors are most common, as a rule, the patient is diagnosed with ARVI or, in extreme cases, bronchitis. It turns out to be a dangerous combination - the patient, who is extremely contagious during the catarrhal period, spreads the infection, in addition, whooping cough in adults is much easier to stop at the very beginning of development, which does not happen. It should be noted that Bordenella lose activity every day and by the end of the 20-21st day they become completely weakened. However, even in two weeks, a huge number of people surrounding the sick person can become infected. As the disease develops, the symptoms increase, the cough becomes more intense and acquires a characteristic feature of whooping cough - attacks.
• Paroxysmal stage, which can last for two or even three months. This period is named after the name and characteristics of coughing fits, which are so specific that any experienced doctor, having barely heard them, immediately makes a diagnosis - whooping cough in adults. It is also quite easy to independently differentiate the characteristic cough, which is peculiar only to whooping cough. This is a series of coughs, consisting of 5-10 shocks, which follow one after another, almost without stopping. Since the patient has nothing to breathe during a coughing fit, immediately after it ends, he takes a breath, often with a specific whistling sound (reprise). Reprise is caused by narrowing, and sometimes spasm of the glottis. As soon as breathing is restored a little, the attack can be repeated. Such paroxysms are accompanied by the release of sputum, in children it often swallows and then vomits. The cough causes a strong reddening of the face, the tongue is stuck out so much that it can sometimes be injured. Whooping cough in adults at this stage literally weakens the patient, the general condition also worsens. The paroxysmal stage lasts quite a long time, up to three months, gradually the attacks become less frequent, the frequency of coughing shocks decreases. The most severe course of the disease is observed in children under one year old, in newborn babies paroxysms are rare, but during a strong cough breathing can stop for several minutes, this manifestation of whooping cough poses a serious threat to the life of the baby. Vaccinated people tolerate the paroxysmal stage of the disease much easier, in them whooping cough in principle proceeds more easily, often in an erased form.
• Recovery stage. In pediatric practice, it is believed that the recovery process begins from the second month of the disease, although coughing fits continue, they become less frequent, and the general well-being improves significantly.

What complications can whooping cough cause in adults?

According to the American Academy of Family Physicians and the US CDC, complications of whooping cough in young children in 60% of cases manifest as apnea (short-term cessation of breathing), more than 20% develop pneumonia, one child in a hundred experiences seizures, and 0.3% have cerebral disorders.

The most common complications of whooping cough in adults are:

• difficulty breathing (inspiratory dyspnea), which affects more than 90% of patients;
• weight loss due to exhaustion, which is caused by bouts of vomiting that occur with severe coughing (observed in almost a third of patients);
• loss of bladder control (urinary incontinence), which occurs in more than a quarter of patients;
• episodes of apnea and loss of consciousness (noted in 6% of cases);
• cracks and fractures of the ribs from severe coughing (detected in 4% of patients);
• inflammation of the lungs (pneumonia), developing due to a secondary infection in 2% of clinical cases.

In addition, complications after whooping cough in adults can manifest themselves as:

• sleep disturbance;
• vascular disorders leading to cerebral hemorrhages;
• bleeding from the nose or ears;
• otitis media (inflammation of the middle ear) due to secondary bacterial infection;
• the formation of a hernia (inguinal or umbilical) due to increased intracavitary pressure.

Damage to cerebral structures (encephalopathy) is also possible, which occurs due to periodic hypoxia (a decrease in the oxygen content in the blood) and deterioration of the trophism of brain tissue.

It is impossible to prevent complications in this case, but you can take steps to avoid contracting whooping cough. For more information, see How to Prevent Whooping Cough.

The most dangerous complications of whooping cough for babies under six months are apnea, secondary collapse of the lung (atelectasis), convulsive syndrome, pneumonia, encephalopathy. Bronchopneumonia, which is observed in 15-20% of all patients under one year of age, is also dangerous. Encephalopathy, which can provoke pathological changes in brain function, convulsions, bronchial obstruction (obturation), pathological changes in the functioning of the central nervous system due to hypoxia - all these complications pose a serious threat not only to human health, but sometimes to life.

Treatment of whooping cough in adults

Therapeutic actions in the fight against whooping cough are divided into two important stages:

1. The first stage is the most complete relief of the threatening symptoms that are characteristic of whooping cough: prevention of apnea syndrome, relief of convulsions, reduction of bronchial tree secretion obstruction. The prescription of antibacterial drugs and a special diet that restores the loss of nutrients due to vomiting is indicated.
2. The second stage is therapeutic measures to prevent possible complications and more threatening consequences (fatal outcome in children under one year of age). The appointment depends on the form of the disease, the severity of the patient's condition and laboratory test results.

How to treat whooping cough in adults?

• Mild whooping cough is treated with drugs from the macrolide group (azithromycin, roxithromycin, and others). Antispasmodic mixtures are prescribed for relaxation and relief of spasms, vitamin therapy is also effective, and antihistamines are prescribed for allergic symptoms.
• Whooping cough, occurring in the form of moderate severity, is also treated with antibacterial agents, but cephalosporins are added to macrolides to neutralize inflammatory processes in the bronchopulmonary system. The entire therapeutic complex is aimed at activating mucociliary transport (clearance) of mucus and bronchial secretions, reducing swelling of the mucous membranes. The following drugs are prescribed: Lazolvan, Bromhexine, Sinekod, Euphyllin in dosages corresponding to the age and weight of the patient.
• Severe whooping cough is treated in hospital, if the patient is a child under one year of age, outpatient treatment is unacceptable. Severe forms of the disease are also treated with a complex of drugs - macrolides, cephalosporins. Aerotherapy or oxygen therapy is indicated, which is carried out in a special incubator (heating bed), a tent supplied with oxygen. If there is a suspicion of complications from the central nervous system, drugs are prescribed to improve cerebral circulation.

What measures help prevent whooping cough in adults?

All children under three years of age are strongly recommended to undergo DPT vaccination. Vaccinations are carried out in three stages, when the vaccine is administered intramuscularly with a break of one and a half months. After all three stages have been completed, revaccination is carried out a year or a year and a half later to consolidate. Of course, there are complications after vaccinations, this is a completely understandable phenomenon. But neither a short-term increase in temperature nor other vaccination symptoms should be an obstacle to timely preventive vaccination. The consequences and complications that whooping cough brings to unvaccinated adults can be much more dangerous.