Pertussis in children

Pertussis is an acute infectious disease characterized by gradually increasing attacks of a spasmodic cough and a number of pathoanatomical manifestations on the part of the respiratory system, including the larynx. With signs of whooping cough in a sick child, parents often turn to an ENT specialist for help, whose competence in this area should not cause them doubts.

The severe forms of whooping cough (currently found only in infants of the first months of life) can be complicated by bilateral pneumonia, pleurisy, acute respiratory insufficiency of the third degree and leading to death.

ICD-10 code

• A37.0 Pertussis caused by Bordetella pertussis.
• A37.1 Pertussis caused by Bordetella parapertussis.
• A37.8 Pertussis caused by another specified pathogen of the species Bordetella.
• A37.9 Pertussis, unspecified.

Epidemiology of whooping cough in children

The source of infection is the patient and the carrier. Infection of the patient is especially great in the initial catarrhal and the entire convulsive period. The index of contagiosity is 0.7-0.8. The incidence is greatest in children from 2 to 5 years. In recent years, adolescents, adults and children of the first months of life are among the diseased. Transplacental transplantable antibodies from the mother do not protect against the disease.

Pertussis is accompanied by a lesion of the mucous membrane of the upper respiratory tract, in which catarrhal inflammation develops, which causes a specific irritation of the nerve endings. Frequent coughing attacks contribute to impairment of cerebral and pulmonary circulation, which leads to insufficient saturation of blood with oxygen, changes in CBS towards acidosis. The increased excitability of the respiratory center persists for a long time after recovery.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of pertussis in children

The pertussis causative agent is Bordetella vulgaris, which is a rod with rounded ends that is unstable to the effects of the external environment. The source of infection is a sick person. The infection is transmitted by airborne droplets during a cough. The disease reaches its greatest contagiousness in the catarrhal and the first week of the spasmodic periods of the disease. A patient with pertussis ceases to be contagious to others 6 weeks after the onset of the disease. Children are more often ill at the age of several months to 8 years. After the transferred disease, there is a persistent immunity.

In the pathogenesis of respiratory disorders, the long-term irritation of the nerve endings of the bronchial mucosa exerted by pertussis exotoxin, and the formation of a stagnant hot spot in the respiratory center of the brain, according to the dominant type (according to Ukhtomsky), are of major importance. This leads to the fact that a fit of coughing arises against the background of the convulsive state of all the respiratory musculature; Cough jerks, following one after another, occur only on exhalation. A coughing attack without inhalation can last more than a minute, which is accompanied by increasing brain hypoxia. The inhalation is performed against the backdrop of muscle cramps in the larynx, so it is accompanied by a loud whistle (wheezing) or a stop of breathing (in children of the first months of life). Outside a fit of cough, children usually feel relatively well, can eat, play. In severe form, coughing attacks become very long (3-5 minutes), their frequency exceeds 25 per day, sleep is disturbed, circulatory disorders and hypoxic brain damage occur.

What causes whooping cough?

[10], [11], [12], [13], [14], [15], [16]

Symptoms of whooping cough

The incubation period lasts 2-15 days, usually 5-9 days. Distinguish the following periods of the disease: catarrhal (3-14 days), spasmodic, or convulsive (2-3 weeks), and a period of recovery. The main symptoms of pertussis develop in the spasmodic period: paroxysmal convulsive cough that occurs suddenly or after a period of harbingers (anxiety, tickling in the throat, a feeling of pressure in the chest). After a series of convulsive coughing tremors, a deep breath arises through the spastic narrowed vocal chink, accompanied by a so-called reprise, that is, a whistling sound. After this, a new series of coughing followed followed by a wheezing breath. In severe pertussis, the number of such attacks can reach 30 per day or more, accompanied by signs of oxygen deficiency (agitation, cyanosis of the face and lips, swelling of the veins of the neck and head, hemorrhages under the skin and conjunctiva). With frequent attacks of coughing, the face becomes puffy. With a strong cough, the child's tongue protrudes from the mouth and presses the bridle toward the lower incisors, which leads to her injury and ulceration. In children of the first year of life, coughing attacks occur without reprisals, often accompanied by a cessation of breathing and convulsions, loss of consciousness due to hypoxemia.

Coughing jerks, accompanied by a spasm of the glottis and a large mechanical strain on the vocal folds, lead to their overstrain, severe fatigue, impaired blood circulation in them and trophic disorders manifested in myogenic relaxation and paresis. These phenomena can persist for weeks and months after recovery, which is manifested by dysphonia, hoarseness, incontinence due to weakness of the larynx constrictor function.

Complications: pneumonia, acute pulmonary edema, peribronchitis, lung atelectasis, symptoms of cardiovascular damage, increased blood pressure, spasm of peripheral and cerebral vessels, hypoxic CNS damage. Death can come from asphyxiation when the glottis is completely closed due to spasm of the larynx musculature during a fit of coughing, as well as from stopping breathing and seizures.

Symptoms of whooping cough

Classification of whooping cough in children

There are typical and atypical forms of pertussis. Typical cases include cases with spasmodic cough. Atypical consider erased and subclinical forms. With erased forms, a cough is common, without recapitulation, and in subclinical cases, whooping cough is manifested only by immunological changes in the blood and, more rarely, by hematological changes.

Typical forms can be mild, moderate and heavy. The criteria are the frequency of spasmodic cough per day, the number of reprises during one attack, apnea.

• With a mild form, the frequency of attacks is up to 10-15 per day, and no more than 3-5 reprises. The general condition is not broken, vomiting is rare.
• With a moderate form, the number of coughing attacks reaches 15-25, and the number of reprises is 10. The attack of a spasmodic cough is accompanied by a slight cyanosis, sometimes it ends with vomiting.
• In severe cases, the number of seizures is more than 25 per day, sometimes 40-50 or more, and there are more than 10 reprises. Coughing attacks are accompanied by a general cyanosis with respiratory failure up to apnea. The child's state of health is sharply disturbed: he is irritable, does not sleep well, loses his appetite.

[17], [18], [19], [20]

Diagnosis of pertussis

The diagnosis of whooping cough is based on clinical and epidemiological data. Specific bacteriological diagnosis consists in isolating the pathogen from droplets of mucus settling on coughing at the back wall of the pharynx. To identify those who have recovered from epidemic foci, appropriate serological tests are carried out.

Diagnosis of whooping cough is based on a typical spasmodic cough with reprises, the withdrawal of viscous viscous sputum, often with vomiting at the end of the attack, and the puffiness of the face. You can identify a sore on the bridle of the tongue. Of great importance for diagnosis are the successive change in the periods of the disease: catarrhal, spasmodic, resolution and hematologic changes: pronounced leukocytosis and lymphocytosis with normal ESR.

For laboratory diagnostics, the selection of the causative agent is crucial. Material from the patient is taken using the "cough plate" method with a dry tampon or a tampon moistened with nutrient medium, and inoculated into elective media. The best sowing is when examined in the first 2 weeks from the onset of the disease. It is important and timely delivery of material to the laboratory (cooling delays the growth of the pathogen). Diagnosis of whooping cough also involves the detection of antibodies to Bordetella pertussis in the serum.

Diagnosis of pertussis

[21], [22], [23], [24], [25], [26], [27]

Treatment of pertussis

Hospitalization is required for young children, as well as for all patients with severe pertussis and complications. Treatment of whooping cough is mainly pathogenetic and symptomatic.

Throughout the disease, the patient is shown fresh cool air, which soothingly acts on the central nervous system and leads to a weakening and shrinking of spasmodic cough attacks. It is necessary to exclude external stimuli that cause an attack of spasmodic cough, avoid medical manipulations, oropharyngeal examinations, etc. If possible. It is necessary to provide a full vitaminized diet. For frequent vomiting, the child should be fed. If inflammation occurs, antibiotics must be prescribed in combination with probiotics (acipol).

Treatment of whooping cough is the proper care for the patient, the appropriate diet, stay in the fresh air. Feed your baby in small portions soon after a fit of coughing. Food should be highly energetic and easily digestible, contain vitamins and, if possible, match the tastes of the child. It is necessary to pay attention to the organization of the child's leisure, as children who are keen on playing or watching interesting video films have coughing attacks less often.

In severe disease and the presence of complications from the upper respiratory tract and lungs, bed rest and the use of broad-spectrum antibiotics are shown. To facilitate the departure of viscous sputum, chymopsy, chymotrypsin and other mucolytic enzymes are prescribed in aerosol inhalations. Neuroleptic and sedative agents are shown to relieve the spastic phenomena and coughing attacks. Of great importance is the use of oxygen therapy, especially in the form of HBO. Assign also anxiolytics, sedatives and hypnotics (Bromizovil), amphenicol (Chloramphenicol), macrolides and azalides (Jozamycin, Midekamycin, Oleandomycin, Erythromycin), penicillins (Amoxicillin, Ospamox), tetracyclines (Doxycycline), antitussives (Butamir), secretolytics and stimulants of the motor function of the respiratory tract (Tussamate, Thyme extract).

The prognosis is determined by the age of the child and the severity of the course of the disease. With the use of modern methods of treatment, including urgent tracheotomy, mortality in pertussis decreased, cases of death are observed mainly among children under 1 year in remote regions of the country in the absence of qualified medical care.

Treatment of pertussis

Prophylaxis of pertussis

Pertussis can be prevented with the help of adsorbed pertussis-diphtheria-tetanus vaccine. Measures are being taken to exclude the contact of the sick with healthy children, adults caring for a sick child should wear a gauze mask while communicating with them, and it should be borne in mind that infection by airborne droplets in pertussis occurs only if an unprotected person is at a distance of 3 m from the patient.

To create active immunity, whole cell and acellular vaccines are used. In our country, a whole-cell vaccine is used as part of DTP and pertussis monovalentine. Acellular (acellular) vaccines include pertussis anatoxin, filamentous hemagglutinin and pertactin. The pertussis component of the domestic DTP vaccine consists of killed pertussis pathogens.

How to prevent whooping cough?

The first vaccination against pertussis DTP vaccine is administered to children aged 3 months three times by 0.5 ml with an interval of 30-40 days, revaccination after 1.5-2 years. The vaccine is injected subcutaneously into the scapula area. Pertussis monovaccine is used in a dose of 0.1 ml subcutaneously to children previously immunized against diphtheria and tetanus.