Pertussis in adults

Such an infectious disease, like whooping cough, can be at any age. And although small children are more likely to have complications after this disease, but there may be some complications after whooping cough in adults.

Pertussis in adults, despite the fact that this disease is considered a problem for many years, continues to meet periodically in clinical practice. This is an infectious disease, which, as a rule, is acute, cyclic, characterized by specific symptoms.

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History and statistics of whooping cough in adults

There is no reliable data on how the population of the ancient world was affected by pertussis, however, the records of the XVIII century speak of terrible statistics: the epidemic of the disease in the Scandinavian lands lasted more than 15 years, taking annually 2-3 thousand inhabitants. A century later in England for seven years whooping cough killed about 120 thousand people. In addition, those who survived the terrible epidemics, often suffered from the effects of cerebral hemorrhage, encephalitis, which were provoked by bouts of violent coughing and stopping breathing. The most dangerous outbreaks occurred on the eve of the 20th century, when pertussis began to spread across all European countries, especially in poor working areas. Unsanitary conditions, large numbers of people, poverty and malnutrition contributed to the rapid infection of thousands of adults. There are data collected by Russian doctors of those years, which show that in aristocratic families pertussis in adults was found 5-6 times less frequently than among the population of working quarters.

Pertussis was virtually invincible, and for the reason that the disease itself, despite its menacing prevalence, was studied little. Only at the beginning of the 20th century, Jules Bordet and his colleague Octave Zhangu identified the true enemy - the causative agent of the disease, but the methods of treatment were ineffective and absolutely not suitable for the fight against an infectious disease. Those who were affected by pertussis did bleeding, put leeches, prescribed drugs based on mercury and opium. Only after the discovery of the first antibiotic during World War II, death from pertussis began to fall, and the first inoculation marked the beginning of a real victory over such a formidable disease as whooping cough in adults. In addition, the opening of the era of antibiotics helped effectively fight against scarlet fever, typhoid, measles, tuberculosis and other ailments that have claimed thousands of lives for many centuries. The fact that pertussis in adults is becoming more and more rare today is, of course, the merit and normalization of sanitary conditions, the increase in the general standard of living of the population, in addition, it is believed that many diseases gradually accumulated an adequate immune response that is transmitted genetically. It is interesting that by the mid-20th century mass vaccination campaign in Russia, lethality from whooping cough had practically disappeared.

Pertussis in adults develops and proceeds cyclically, possibly with this feature a new outbreak of the disease is associated, since 2000, whooping cough has become quite a frequent "guest" in many developed countries, I dismiss ideal sanitary, social conditions and even vaccination. Since the beginning of the 21st century, cases of pertussis have become registered, and every year more and more often, and in large numbers, there are also fatal outcomes. The most vulnerable layer of the population were again children up to two or three years old. To date, the main way to reduce the incidence and risk of complications after such a serious illness as whooping cough in adults is timely vaccination. Even in case of infection, a person is more in a much lighter form, and immunity against pertussis persists throughout his life.

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

In an adult, this infectious disease is often less pronounced, so patients - despite the fact that an uncontrolled convulsive cough can last from three to six weeks - do not go to the doctor. Thus, the detection of the pathogen - the bacteria Bordetella pertussis - is difficult. Therefore, according to infectious disease specialists, approximately 2% of cases of prolonged paroxysmal cough in elderly people can be associated with whooping cough.

How does pertussis develop in adults?

Pertussis in adults is an infectious disease that manifests itself as a specific symptom - a paroxysmal cough that can cause respiratory system spasms.

Pertussis in adults develops due to the penetration into the body of bacteria, pertussis called Bordetella pertussis - Bordetella. The wand is quite vulnerable and in the external environment is not viable, so transmission of infection is carried out directly from the infected person to the healthy one. Especially dangerous in this sense is the initial period of the disease, the first two weeks. Until now, despite the huge number of medications and mass vaccinations, whooping cough in adults is considered an extremely contagious disease. The early age (up to three years) or the weakened immunity is practically 100% of the probability of infection by the bordetalla under condition of contact with the sick person. The disease is transmitted through the air, that is, by airborne droplets. The main characteristic of pertussis symptoms is a non-cure medication cough that manifests itself paroxysmally. When a patient coughs, the patient emits many wands into the environment, infecting those around him. Basically, infection is likely with close contact with an infected person, since the Bordetella is not capable of spreading more than two or three meters. Quite often the source of infection is the parents themselves, sick atypical, worn out form, believing that coughing is just a sign of an easy cold. Particularly dangerous for whooping cough for newborns, who have no innate immune response to the disease. If the patient persistently suffered an infection, immunity is developed and maintained throughout life. Pertussis incubation lasts from 5 to 10 days, but there are forms of pertussis whose incubation period ranges from three days to three weeks.

How does pertussis appear 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 interval between the incubation and the actual disease) is manifested by a dry, constant cough, practically without a rise in temperature. It is at this time that most often there are diagnostic errors, as a rule, the patient is diagnosed with acute respiratory viral infection or, in extreme cases, bronchitis. It turns out a dangerous combination - a 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 the Bordenelles lose their activity every day and by the end of the 20th-21st day they become quite weakened. However, in two weeks, it is possible to infect a huge number of people surrounding a sick person. With the development of the disease, the symptoms increase, the cough becomes more intense and acquires a characteristic sign of pertussis-seizures. 
• Paroxysmal stage, which can last for a long two or even three months. This period is named after the name and characteristics of coughing attacks, which are so specific that any experienced doctor, hardly hearing them, immediately makes a diagnosis - whooping cough in adults. It is also independent enough to differentiate a characteristic cough peculiar only to whooping cough. This is a series of coughs, consisting of 5-10 tremors, which follow one after another, almost without stopping. Since the patient has nothing to breathe during a coughing attack, immediately after his cessation, he takes a breath, often with a specific whistling sound (reprise). A reprise is caused by a constriction, and at times a cramp of the vocal cicle. As soon as the breath is restored a little, the attack can repeat. Such paroxysms are accompanied by sputum secretion, babies often swallow it and then vomit. Cough causes severe redness of the face, the tongue is pushed out so that sometimes it can be traumatized. Pertussis 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 impulses decreases. The most severe course of the disease is observed in children under the age of one year, in newborn babies paroxysms are rare, but during a violent cough, breathing can stop for several minutes, this manifestation of pertussis poses a serious threat to the life of the baby. Vaccinated people are much easier to tolerate the paroxysmal stage of the disease, they have pertussis in principle easier, often in an erased form. 
• Stage of recovery. In pediatric practice, it is believed that the process of recovery begins with the second month of the disease, although coughing attacks continue, but they become increasingly rare, overall well-being improves significantly.

What complications can pertussis in adults?

According to the American Academy of Family Physicians and the US CDC, complications of whooping cough in young children show up in apnea (short-term respiratory arrest) in 60% of cases, more than 20% develop pneumonia, one child has a hundred cramps, and 0, 3% - cerebral disorders.

The most common complications after whooping cough in adults:

• difficulty breathing (inspiratory dyspnea), which affects more than 90% of patients;
• a decrease in body weight due to exhaustion, which leads to attacks of vomiting that occur with a strong cough (observed in almost a third of patients);
• loss of bladder control (urinary incontinence), occurring 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 cough (detected in 4% of patients);
• pneumonia (pneumonia), which develops due to secondary infection in 2% of clinical cases.

In addition, complications after whooping cough in adults can be manifested:

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

It is also possible to damage the cerebral structures (encephalopathy), which occurs due to periodic hypoxia (lowering the oxygen content in the blood) and worsening trophism of the brain tissues.

Warn the development of complications in this case is impossible, but you can take steps to not catch pertussis. For details, see - How to prevent whooping cough.

The most dangerous complications of pertussis for babies up to six months - apnea, secondary lung decay (atelectasis), convulsive syndrome, pneumonia, encephalopathy. Also, the danger is bronchopneumonia, which is observed in 15-20% of the total number of patients under the age of one year. Encephalopathy, which can provoke pathological changes in the functions of the brain, convulsions, bronchial blockage (obturation), pathological changes in the central nervous system due to hypoxia-all these complications pose a serious threat not only to human health, but sometimes to his 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 maximum complete relief of the menacing symptomatology, which is characteristic of whooping cough: prevention of apnea syndrome, cramping of seizures, reduction of occlusion by the secretion of the bronchial tree. It shows the appointment of antibacterial drugs, a special diet that restores the loss of nutrients due to vomiting. 
2. The second stage - therapeutic measures to prevent possible complications and more menacing consequences (death in children under the age of one year). The appointment depends on the form of the course of the disease, the severity of the patient's condition and the testimony of laboratory tests.

How to treat whooping cough in adults?

• Pertussis, which occurs in mild form, is treated with drugs from the macrolide group (azithromycin, rooxithromycin and others). Relaxation and relief of spasms are prescribed for antispasmodic action, vitamin therapy is also effective, antihistamines are prescribed for allergic symptoms. 
• Pertussis, which occurs in the form of moderate severity, is also treated with antibacterial agents, but cephalosporins are also added to macrolides to neutralize inflammatory processes in the broncho-pulmonary system. The entire therapeutic complex is aimed at activating mucociliary transportation (clearance) of mucus and bronchial secretion, to reduce swelling of the mucous membranes. Assign drugs - Lazolvan, Bromhexin, Sinekod, Euphyllin in dosages, corresponding to the age and weight of the patient. 
• Pertussis in severe form is treatable under hospital conditions, if the patient is a child under the age of one year, outpatient treatment is unacceptable. Severe forms of the disease are also treated with a complex of drugs - macrolides, cephalosporins. Aerotherapy or oxygen therapy is shown, which is carried out in a special kuveze (a hot-water bottle), a tent supplied with oxygen. If there is a suspicion of complications from the central nervous system, funds are prescribed that improve the blood circulation of the brain.

What measures help to prevent whooping cough in adults?

It is strongly recommended that all children under the age of three are vaccinated with DTP. Vaccinations are carried out in three stages, when the intramuscular injection of the vaccine with a break in a month and a half. After all three stages have been completed, a year or a half later, a revaccination is carried out for fixation. Of course, there are complications after vaccinations, this is a fully understandable phenomenon. But neither a short-term rise in temperature, nor other vaccination symptoms should be an obstacle to timely preventive vaccination. It is much more dangerous to have consequences and complications, which brings pertussis in adults to unvaccinated people.