Whooping cough in children

Whooping cough is an acute infectious disease characterized by gradually increasing attacks of spasmodic cough and a number of pathological manifestations from the respiratory system, including the larynx. With signs of whooping cough in a sick child, parents often seek help from an ENT specialist, whose competence in this area should not cause them to doubt.

Severe forms of whooping cough (currently found only in children in the first months of life) can be complicated by bilateral pneumonia, pleurisy, acute respiratory failure of the third degree and lead to death.

ICD-10 code

• A37.0 Whooping cough due to Bordetella pertussis.
• A37.1 Whooping cough due to Bordetella parapertussis.
• A37.8 Whooping cough due to other specified Bordetella species.
• A37.9 Whooping cough, unspecified.

Epidemiology of whooping cough in children

The source of infection is the patient and the carrier. The infectiousness of the patient is especially high in the initial catarrhal and the entire convulsive period. The contagiousness index is 0.7-0.8. The incidence is highest in children aged 2 to 5 years. In recent years, adolescents, adults and children in the first months of life have predominated among those infected. Transplacentally transferred antibodies from the mother do not protect against the disease.

Whooping cough is accompanied by damage to the mucous membrane of the upper respiratory tract, in which catarrhal inflammation develops, causing specific irritation of the nerve endings. Frequent coughing attacks contribute to the disruption of cerebral and pulmonary circulation, which leads to insufficient oxygen saturation of the blood, a change in the acid-base balance towards acidosis. Increased excitability of the respiratory center persists for a long time after recovery.

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Causes of Whooping Cough in Children

The causative agent of whooping cough is Bordetella pertussis, which is a rod with rounded ends, unstable to environmental influences. The source of infection is a sick person. The infection is transmitted by airborne droplets during coughing. The disease reaches its greatest contagiousness in the catarrhal and first week of the spasmodic periods of the disease. A patient with whooping cough ceases to be contagious to others after 6 weeks from the onset of the disease. Children aged from several months to 8 years are most often ill. After the disease, persistent immunity remains.

In the pathogenesis of respiratory disorders, the leading role is played by prolonged irritation of the nerve endings of the bronchial mucosa caused by the whooping cough exotoxin and the formation of a stagnant excitation center of the dominant type (according to Ukhtomsky) in the respiratory center of the brain. This leads to the fact that a coughing fit occurs against the background of a convulsive state of the entire respiratory muscles; coughing impulses, following one after another, occur only on exhalation. A coughing fit without inhalation can last more than a minute, which is accompanied by increasing hypoxia of the brain. Inhalation occurs against the background of a spasm of the laryngeal muscles, therefore it is accompanied by a loud whistle (whistling inhalation) or respiratory arrest (in children of the first months of life). Outside of a coughing fit, children usually feel relatively well, can eat, play. In severe cases, coughing fits become very long (3-5 minutes), their frequency exceeds 25 per day, sleep is disturbed, circulatory disorders and hypoxic brain damage appear.

What causes whooping cough?

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Symptoms of whooping cough

The incubation period lasts 2-15 days, most often 5-9 days. The following periods of the disease are distinguished: catarrhal (3-14 days), spasmodic, or convulsive (2-3 weeks), and the recovery period. The main symptoms of whooping cough develop in the spasmodic period: paroxysmal convulsive cough, which occurs suddenly or after a period of precursors (anxiety, sore throat, feeling of pressure in the chest). After a series of convulsive coughing impulses, a deep breath occurs through a spasmodically narrowed glottis, accompanied by the so-called reprise, i.e. a whistling sound. This is followed by a new series of coughing impulses followed by a whistling breath. In severe cases of whooping cough, 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 in the conjunctiva). With frequent coughing attacks, the face becomes puffy. With a strong cough, the child's tongue sticks out of the mouth and is pressed by the frenulum to the lower incisors, which leads to its injury and ulceration. In children of the first year of life, coughing attacks occur without reprises, often accompanied by respiratory arrest and convulsions, loss of consciousness caused by hypoxemia.

Cough shocks, accompanied by a spasm of the glottis and a large mechanical load 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 of the voice, air incontinence due to the weakness of the constrictor function of the larynx.

Complications: pneumonia, acute pulmonary edema, peribronchitis, pulmonary atelectasis, symptoms of cardiovascular damage, increased blood pressure, spasm of peripheral and cerebral vessels, hypoxic damage to the central nervous system. Death may occur from asphyxia with complete closure of the glottis due to spasm of the laryngeal muscles during a coughing fit, as well as from respiratory arrest and convulsions.

Symptoms of whooping cough

Classification of whooping cough in children

There are typical and atypical forms of whooping cough. Typical cases include cases of the disease with a spasmodic cough. Atypical forms are considered to be erased and subclinical. In erased forms, the cough is normal, without reprises, and in subclinical forms, whooping cough manifests itself only by immunological shifts in the blood and, less often, hematological changes.

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

• In mild forms, the frequency of attacks is up to 10-15 per day, and reprises are no more than 3-5. The general condition is not disturbed, vomiting is rare.
• In moderate cases, the number of coughing attacks reaches 15-25, and the number of reprises is 10. An attack of spasmodic cough is accompanied by slight cyanosis, sometimes ending in vomiting.
• In severe cases, the number of attacks is more than 25 per day, sometimes 40-50 or more, with more than 10 reprises. Coughing attacks are accompanied by general cyanosis with respiratory failure up to apnea. The child's well-being is sharply impaired: he is irritable, sleeps poorly, and loses his appetite.

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Diagnosis of whooping cough

The diagnosis of whooping cough is based on clinical and epidemiological data. Specific bacteriological diagnostics involves isolating the pathogen from mucus droplets that settle on the back of the throat when coughing. To identify those who have recovered from the disease, appropriate serological studies are conducted in epidemic foci.

Diagnosis of whooping cough is based on a typical spasmodic cough with reprises, discharge of viscous sputum, often with vomiting at the end of the attack, puffiness of the face. An ulcer on the frenulum of the tongue can be detected. Of great importance for diagnosis are the successive change of periods of the disease: catarrhal, spasmodic, resolution and hematological changes: pronounced leukocytosis and lymphocytosis with a normal ESR.

For laboratory diagnostics, isolation of the pathogen is of crucial importance. Material from the patient is taken using the "cough plates" method with a dry swab or a swab moistened with a nutrient medium, and inoculated onto elective media. The best inoculation is achieved during examination in the first 2 weeks from the onset of the disease. Timely delivery of the material to the laboratory is also important (cooling delays the growth of the pathogen). Diagnostics of whooping cough also involves detection of antibodies to Bordetella pertussis in the blood serum.

Diagnosis of whooping cough

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Treatment of whooping cough

Young children and all patients with severe whooping cough and complications are subject to hospitalization. Treatment of whooping cough is mainly pathogenetic and symptomatic.

Throughout the illness, the patient is shown fresh cool air, which has a calming effect on the central nervous system and leads to weakening and decreasing attacks of spasmodic cough. It is necessary to exclude external irritants that cause an attack of spasmodic cough, if possible, avoid medical manipulations, examinations of the oropharynx, etc. It is necessary to provide a complete vitamin-rich diet. If the child vomits frequently, it is necessary to feed him additionally. If inflammatory phenomena occur, antibiotics in combination with probiotics (Acipol) are necessarily prescribed.

Treatment of whooping cough consists of proper care of the patient, a proper diet, and being in the fresh air. The child should be fed in small portions soon after a coughing fit. The food should be high-energy and easily digestible, contain vitamins and, if possible, match the child's tastes. Attention should be paid to organizing the child's leisure time, since children who are engrossed in games or watching interesting videos are less likely to have coughing fits.

In severe cases of the disease and complications in the upper respiratory tract and lungs, bed rest and broad-spectrum antibiotics are indicated. To facilitate the expectoration of viscous sputum, chymopsin, chymotrypsin and other mucolytic enzymes are prescribed in aerosol inhalations. Neuroleptic and sedatives are indicated to relieve spastic phenomena and coughing fits. Oxygen therapy, especially in the form of HBO, is of great importance. Anxiolytics, sedatives and hypnotics (Bromizoval), amphenicols (Chloramphenicol), macrolides and azalides (Josamycin, Midecamycin, Oleandomycin, Erythromycin), penicillins (Amoxicillin, Ospamox), tetracyclines (Doxycycline), antitussives (Butamirate), secretolytics and stimulants of the motor function of the respiratory tract (Tussamate, Thyme extract) are also prescribed.

The prognosis is determined by the child's age and the severity of the disease. With the use of modern treatment methods, including urgent tracheotomy, the mortality rate for whooping cough has decreased; deaths are observed mainly among children under 1 year of age in remote regions of the country in the absence of qualified medical care.

Treatment of whooping cough

Prevention of whooping cough

Whooping cough can be prevented with the adsorbed diphtheria-tetanus-pertussis vaccine. Measures are taken to prevent contact between sick people and healthy children; adults caring for a sick child should wear a gauze mask when communicating with him/her, while it should be borne in mind that airborne infection with whooping cough occurs only if an unprotected person is closer than 3 m from the sick person.

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

How to prevent whooping cough?

The first vaccination against whooping cough with DPT vaccine is given to children aged 3 months three times at 0.5 ml with an interval of 30-40 days, revaccination - after 1.5-2 years. The vaccine is administered subcutaneously in the shoulder blade area. The pertussis monovalent vaccine is used in a dose of 0.1 ml subcutaneously to children previously immunized against diphtheria and tetanus.