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Whooping cough: photo, symptoms, pertussis treatment

Content:

Whooping cough is an acute infectious pathology caused by the parasitization of a specific bacterium in the human respiratory tract and characterized by bouts of pronounced dry cough. Cases of this infection are recorded everywhere, more often children, especially at the age of 3-6 years, are susceptible to its development. Today, the incidence of pertussis is reduced almost to a minimum, thanks to vaccinations introduced in the mandatory schedule of human vaccination in most countries of the world.



The reasons

The bacterium, Bordetella pertussis, which has a rod-shaped, small size, leads to the development of whooping cough. This bacterium does not form spores and capsules, therefore it is unstable in the external environment and dies in it within a few hours. The main feature of the bacterium of the pertussis pathogen is the production of a number of biologically active substances that determine the characteristic course of the disease:
Whooping cough

  • Pertussis toxin (lymphocytosis stimulating factor) - plays a major role in the development of paroxysmal cough.
  • Agglutinogens are specific compounds on the surface of a bacterial cell that contribute to its adhesion (attachment) to the airway mucosa.
  • Adenylate cyclase toxin - blocks a number of enzymatic systems of epithelial cells of the respiratory system, this compound determines the virulence (the ability to lead to the development of the disease) subspecies of whooping cough bacteria.
  • Tracheal cytotoxin is a specific protein compound that leads to the destruction of the epithelial cells of the trachea and bronchi with their subsequent desquamation.
  • Hemolysin is a bacterial toxin that is capable of causing red blood cell death, and is mainly involved in the development of an inflammatory reaction in the area of ​​parasitism of pertussis bacteria in the respiratory tract.
  • Endotoxin is a lipopolysaccharide that is released during the death of a bacterial cell and causes the development of general intoxication of the body.
  • Histamine sensitizing factor is a substance that leads to activation of allergic reactions during the development of pertussis infection.

All these substances and compounds determine the pathogenicity (the ability to lead to the development of the disease) of the pertussis pathogen.


Epidemiology

Whooping cough refers to anthroponotic infections. The main reservoir of the pathogen in nature and the source of infection is the human body. In epidemiological terms, more dangerous are people with an atypical form of the course of infection, in which there are no specific symptoms, the person is not isolated and continues to actively release the pathogen into the environment. The pertussis bacterium is a highly contagious pathogen, which means its ability to quickly spread and infect a large number of people. This epidemiological feature can especially often cause an epidemic in organized children's groups (kindergarten, school). The contagiousness index of bordetella reaches 75-100% - that is, if there is a source of infection, a contact person (assuming no immunity) falls ill in 100% of cases. The incidence of pertussis is higher in childhood (3-6 years), with autumn-winter seasonality and a periodic increase in the incidence with a frequency of 2-4 years. The way of infection is airborne - the bacterium is released from a sick person or a carrier (infected person, without clinical manifestations of whooping cough) into the environment during cough with tiny droplets of sputum that are suspended for up to several hours (up to several hours). When inhaling such air, bordetella enters the respiratory tract of a healthy person and leads to its infection.

Development mechanism of whooping cough

The entrance gate (the point of entry into the body) of infection is the mucosa of the upper respiratory tract. Bacteria attach to epithelial cells (surface cells of the mucous membrane) and then descend through the bronchi to the lower respiratory tract, where they multiply with the release of toxins and waste products. The main factor in the pathogenesis of the infectious process and disease is exogenous pertussis toxin, which causes the development of a number of reactions in the body:

  • Increased systemic arterial pressure due to spasm of the arteries and vessels of the microvasculature.
  • Inhibition of the functional activity of the immune system (secondary immunodeficiency) - pertussis bacteria toxins primarily inhibit cellular immunity (T-lymphocytes).
  • Constant irritation of the nerve endings of the respiratory tract mucosa, which is the primary link of the cough reflex - this irritation leads to the formation of a persistent dominant focus of arousal in the cough center of the medulla, which causes the development of characteristic cough.

The main feature of the pathogenesis of pertussis is the development of a dominant focus of excitation in the cough center, which is characterized by the following features:

  • Summation - the development of cough when exposed to the mucous membrane of the respiratory tract even minor irritants (dry air).
  • The response of the cough center to irritants that are not specific - a coughing fit may develop as a result of exposure to a loud sound, tactile or painful irritation of the skin;
  • Irradiation (distribution) of the nerve impulse to neighboring centers of the brain - vasomotor (increased blood pressure), vomit (development of vomiting) and skeletal (appearance of convulsions) center at the height of a coughing fit.
  • Persistence of excitement - the preservation of the focus in the cough center after the release of the body from pertussis bacteria.
  • Inertness - the formed focus may periodically disappear (with no coughing episodes), followed by renewal.
  • The possibility of transition to the state of parabiosis - extreme excitation in the cough center leads to the cessation of the formation of impulses in the respiratory center, which explains the cases of respiratory failure in children at the height of a coughing fit.

The pathogenesis of pertussis, associated primarily with the effects of pertussis toxin on the human body, determines the clinical manifestations of the disease.

Pertussis symptoms

Whooping cough photo Depending on the presence and severity of characteristic symptoms, a typical and atypical form of whooping cough is isolated. For the clinical course of whooping cough is characterized by periods that differ in their manifestations. These include:

  • Incubation period.
  • Pre-convulsive period.
  • The period of attacks of convulsive cough.
  • The period of the reverse development of symptoms.
  • The period of recovery (recovery).

Incubation period

This is the period from the time a person becomes infected with whooping cough to the appearance of the first symptoms of the disease. Its duration in this case is from 3 to 14 days (on average, about a week). In the incubation period, there are practically no symptoms of the disease, the person feels normal and does not present any complaints.

Pre-conviction period

The main symptom of this pertussis period is the appearance and gradual increase of dry cough, on the background of normal body temperature and the absence of signs of general intoxication and other phenomena accompanying acute respiratory disease (rhinitis, nasal discharge, sore throat). In the pre-convulsive period, a person rarely seeks medical help, but attempts to symptomatically treat dry cough with expectorant drugs or mucolytics do not bring results. The duration of this period is 3-14 days.

Period of paroxysmal cough

This is a clinical and pathogenetic peak of the disease, in which a dominant focus of excitation is formed in the cough center of the medulla oblongata. The main manifestation of this period is the development of a coughing fit, which has several main characteristic features:

  • Reprise is a condition at the height of a coughing fit, characterized by a series of several cough tremors on the exhale followed by a whistling breath. Reprize is a characteristic symptom indicating the development of whooping cough.
  • Discharge of a large amount of viscous clear sputum at the end of a coughing fit. Sometimes an attack of convulsive cough ends with vomiting (the result of the irradiation of the excitation focus to the emetic center of the medulla oblongata).
  • The development of an attack is usually preceded by an aura, which is accompanied by a feeling of anxiety, fear, sneezing or a sore throat.
  • During a coughing attack, a person has a characteristic appearance — reddening of the face with its subsequent cyanosis (bluish color due to deterioration of venous blood outflow), swelling of the jugular veins, tongue protruding during its entire length, and the tip of the tongue rises upwards.
  • An tear or ulcer of the frenulum of the tongue is characteristic only for whooping cough (pathognomonic) symptom.

The duration of a cough with whooping cough is 2-4 minutes, as the pathology develops, the duration of the attack may be longer. During the interictal period, the face of the person becomes puffy, due to swelling of its tissues, the skin becomes pale with cyanosis around the mouth. On the sclera may develop small hemorrhages in the form of red spots. The duration of the convulsive paroxysmal cough is from 2-3 to 6-8 weeks, depending on the severity of pertussis. The number and duration of convulsive coughs increase with severe pathology up to 25-30 times a day.

The period of reverse development of whooping cough

This period is also called early convalescence (recovery). It lasts from 2 to 6 weeks. At the same time, the frequency and duration of attacks of convulsive cough decrease gradually. The attack itself is easier; the general condition and well-being of the person also improves.

The recovery period (recovery)

This is the longest period in the clinical course of whooping cough, which lasts from 2 months to six months. At this time, the cough is practically absent, but a periodic return of attacks of convulsive cough is possible, due to the preservation of the very focus of arousal in the cough center of the medulla oblongata.

Symptoms of atypical pertussis

Atypical form of whooping cough is characterized by non-specific symptoms of the disease or its absence. Depending on this, there are several types of atypical forms of whooping cough:

  • Abortive view - the period of attacks of convulsive cough is not long, on average, after a week goes into a period of early recovery.
  • The worn out form - during the whole illness a strong, dry cough is present, but the development of its convulsive seizures is absent.
  • Asymptomatic form - characterized by a complete absence or minimal development of cough during the course of all periods of whooping cough.
  • Bacterial Carrier - getting into the upper respiratory tract of bacteria without developing the disease and their subsequent destruction by the immune system.

The development of an atypical form of pertussis is characteristic of people vaccinated against whooping cough, when a significant amount of the pertussis pathogen enters the pulmonary system.

Diagnostics

The diagnosis of pertussis is made only on the basis of a positive result of a specific study, which includes:

  • Bacteriological study by planting material on a nutrient medium with the subsequent cultivation and identification of the pathogen.
  • Serological diagnosis based on the determination of an increase in antibody titer to pertussis bacteria using an agglutination reaction (RA) or an enzyme immunoassay (ELISA).

To determine the structural changes and the presence of hypoxia (insufficient oxygen supply to the blood and body tissues), additional instrumental and laboratory research methods are used:

  • Radiography of the lungs or computed tomography.
  • Determination of blood oxygen saturation (determination of the presence of hypoxia).
  • General blood and urine tests.
  • Blood chemistry.

Such diagnostic methods allow to assess the degree of structural and functional disorders in the body, which will help determine the further treatment tactics.

Complications of whooping cough

Whooping cough is a pathology with a severe course and the development of a number of specific and nonspecific complications that often develop in severe form of pathology with frequent and prolonged attacks of convulsive cough. Specific complications related directly to the pathogenesis of pertussis include:

  • Emphysema of the lungs - is characterized by stretching of the alveoli due to cough and their increased airiness.
  • Emphysema of the mediastinum or subcutaneous tissue in the chest - the result of the rupture of the airway with the accumulation of air in the tissues.
  • Severe respiratory failure with its delay of up to 30 seconds or stopping (apnea) for a period of time longer than 30 seconds.
  • Bleeding from the nose, hemorrhages in the skin of the face and head, the sclera of the eyes, the brain and the spinal cord can develop as a result of disturbed outflow of blood from the upper half of the body during an attack of convulsive cough.
  • Hernia of the anterior abdominal wall (umbilical, inguinal hernia) or rectal prolapse, associated with an increase in intra-abdominal pressure during coughing.

Nonspecific complications of pertussis develop as a result of the addition of a secondary bacterial infection against the background of a decrease in the functional activity of the immune system. At the same time, pneumonia (pneumonia), bronchitis , tracheitis, tonsillitis , lymphadenitis (an infectious process in the lymph nodes) or otitis (inflammation of the middle ear) can develop. Also, even without the development of complications, after suffering whooping cough, residuals (residual effects) may persist in the form of chronic bronchitis or pneumonia, various speech disorders, children may develop enuresis (nighttime incontinence), impaired vision and hearing, paralysis of certain muscle groups.

Pertussis treatment

With severe and moderate course of the disease, treatment of whooping cough is carried out only in a medical hospital, in which it is possible to ensure the minimal impact of various factors provoking the development of an attack of convulsive cough. Also, children from organized groups should be hospitalized to prevent the spread of infection. Pertussis therapy includes several obligatory groups of therapeutic measures - gentle regimen, etiotropic therapy, pathogenetic and symptomatic therapy.

Sparing treatment and general activities

During treatment, the effects on the body of factors that can provoke an attack of convulsive cough — noise, harsh sounds, dry air, and emotional stress — are limited. Also, general recommendations include a diet rich in proteins, carbohydrates and vitamins. Eating fatty foods is not recommended. The relative humidity of the air at the level of 60% is required to be kept indoors.

Etiotropic therapy

This therapy is aimed at destroying the pertussis pathogen, for which antibiotics of the macrolide group (azithromycin, roxithromycin) or semi-synthetic penicillins ( amoxicillin ) are prescribed from the first days after diagnosis. The course of antibiotic therapy is about 7-10 days. In the case of a severe course of the disease with frequent bouts of coughing and vomiting, antibiotics are introduced into the body parenterally - intramuscularly or intravenously in the form of injections.

Pathogenetic therapy

The main group of therapeutic measures that are carried out in order to reduce the severity of the excitation focus in the cough center of the medulla oblongata. Drugs of the group of neuroleptics (aminazin) and anticonvulsant drugs (seduxen, phenobarbital) are used in age dosages. Additionally used antitussive drugs group (pertussin, pakseladin), antispasmodics (no-spa). In pathogenetic therapy include dehydration (removal of fluid from the body) to reduce edema (furosemide).

Symptomatic therapy

This is an additional treatment that reduces the severity of the main manifestations of the pathology. It includes the removal of mucus from the upper respiratory tract, aerosol therapy, breathing humidified air, oxygen therapy (breathing air saturated with humidified oxygen). Immunomodulators (methacyl, sodium nucleinate, Eleutherococcus) are used for the prevention of secondary bacterial infection.

Prevention

The ingestion of pertussis bacterium antigens causes the formation of resistant immunity (subsequent immunity to reinfection). Therefore, for the prevention of the disease, in all countries mandatory vaccination against pertussis has been introduced (the introduction of bacterial wall antigens into the body in order to induce the formation of immunity). Vaccination against whooping cough is performed several times in life, gives a high result in terms of immunity to infection. Even in the case of the development of an infectious process, in vaccinated people, the disease proceeds in a mild form without developing coughing fits.

Актуальность коклюша на сегодняшний день остается значительной, что связано с его тяжелым течением, периодическим подъемом заболеваемости через 2-4 года и преимущественным поражением детей в возрасте 3-6 лет.


21 Июнь 2015 | 4 002 | Инфекционные заболевания
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A Monroe: What he failed to mention is THE REASON we are ASYMPTOMATIC CARRIERS is BECAUSE that's EXACTLY what the vaccine does. It makes you an ASYMPTOMATIC CARRIER. 🤦🤬 So you are literally getting the vaccine and then passing it. Idiots.

Valhalla1: 0:49 "we still have millions of children dying every year due to pertussis". Blatant lie! The CDC reports 160,700 deaths per year globally across adults and children. Ask yourself why this doctor is lying about this!

Faith Jones: Im a kid...... i have a bad cough....but not whopping cough.....but a kid at my school had the whopping cough.....so im woried

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