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Whooping Cough (Pertussis) - Symptoms, Stages, Diagnosis, Treatment and Home Remedies of Whooping Cough

Pertussis, which means intensive cough, is an acute respiratory infection, seen more commonly in young children. The disease is also more serious in them. The term "whooping cough" is derived from the occurrence of progressive repetitive paroxysyms of cough followed by inspiratory whoop. Pertussis is caused by Bordetella pertussis which is highly infective. Bordetella parapertussis and B.bronchisepica are members of the same genus, rarely causing disease in man. Maximum incidence is seen in children below five years and the mortality is highest for children below 1 year of age. The organism are spread by droplet infection and the route of entry is the respiratory tract. The spectrum of disease varies from severe illness to a typical and mild illness without whoop. The Chinese call it a "Hundred Day Disease". It is a serious disease that can cause permanent disability in infants, and even death.

Before the vaccination against whooping cough was introduced, three out of four children caught the disease and some died every year. Today only a few get whooping cough. Currently, 25 percent of pertussis cases in the United States occur among adolescents and adults (often in nursing homes and on college campuses). In fact, adults and teenagers (who are not usually diagnosed as having pertussis) are now a major source for spreading pertussis to infants and children. High risk children were excluded from the study even though these categories of high-risk children are routinely vaccinated in the U.S

Symptoms / Stages of Whooping Cough/ Pertussis

The first symptoms of pertussis may be similar to those of a common cold, including nasal congestion, runny nose, sneezing, red and watery eyes, mild fever, and a dry cough. The patient will eventually cough up some phlegm and these attacks may well be followed by vomiting . Although it's likely that infants and younger children who become infected with B. pertussis will develop the characteristic coughing episodes with their accompanying whoop, not everyone will. At the end of a coughing spell, the child gasps for air with a characteristic "whooping" sound. B.pertussis produces a local infection; the organism is not invasive. It multiplies on the surface epithelium of the respiratory tract and causes inflammation and necrosis of the mucosa leading to secondary bacterial invasion. Three stages are described in the clinical course of the disease.

Three stages with there symptoms can be distinguished- catarrhal, paroxysmal and convalescent- each lasting up to 2 weeks so that the course of the disease extends to 6-8 weeks.

Catarrhal Stage :- this stage manifests with rhinorrhea, mild fever, and cough. During this stage, clinical recognition of the disease is difficult. This is the most infective stage.

Paroxysmal Stage :- in this stage cough starts, increases in severity and becomes repetitive and explosive. Each paroxysm is followed by a whoop produced by a sudden massive inspiratory effort through a narrowed glottis. During the paroxysms of cough the infant develops facial congestion, distention of neck and scalp veins, lacrimation, cyanosis and clouding of consciousness. The paroxysms ends with the onset of vomiting. The whoop may not be distinctly made out in younger infants, but they may become asphyxiated and develop anoxic convulsions. In the uncomplicated cases lung signs are usually absent.

Convalescence Stage :- it is marked by the decrease in frequency and severity of paroxysms. Vomiting subsidies and the patient's appetite improves. At this stage the child is very susceptible to develop super infections by other respiratory pathogens and this may lead to recurrence of the paroxysms of cough. When it occurs it may last for several months.

Complications in Whooping Cough/ Pertussis:-

While whooping cough is very unpleasant, there may also be other complications.

Respiratory:

• Otitis media, especially in infants
• Bronchitis
• Bronchopneumonia
• Atelectasis (segmental or lobar)
• Interstitial or subcutaneous emphysema or pneumothorax due to rupture of alveoli.
• Bronchiectasis
• Flare- up of tuberculosis.

Central nervous system:

• Convulsions (due to anoxia, encephalopathy, or rarely intracranial hemorrhage).

Gastrointestinal:

• Severe vomiting with dehydration, tetany ulceration of the tongue ( due to biting during a paroxysm), prolapse rectum, hernia.

Incubation period:-

• The incubation period is usually 7-14 days but may be prolonged to 20 days.
• In some children, the convalescent stage may last for months.

Mode of transmission :-

Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth

Whooping cough is spread mainly by droplet infection and direct contact. Each time the patient coughs, sneezes or talks, the bacilli are sprayed in the air. Once inside the airways, pertussis bacteria produce toxins that interfere with the respiratory tract's normal ability to eliminate germs. The bacteria also produce chemicals that cause inflammation, damaging the lining of the breathing passages. Most children contract infection from their playmates who are in the early stages of the disease, The role of fomites in the spread of infection appears to be very small, unless they are freshly contaminated. Infected people are most contagious during the earliest stages of the illness up to about 2 weeks after the cough begins. Anyone who has been vaccinated or has suffered from whooping cough will have a degree of immunity to the disease.

Diagnosis of Whooping Cough/ Pertussis :-

The disease has to be suspected clinically, particularly in an unimmunized child with known contact with the disease. Total leucocyte count is elevated to 20,000 to 50,000/cmm with absolute lymphocytosis. A leukemoid reaction may sometimes occur. Chest X-ray show perihilar infiltrates or segmental collapse. Bacteriological diagnosis is established by culturing the organism obtained from nasopharyngeal swabs. Fluorescent antibody staining of pharyngeal specimens provides a rapid and specific diagnosis.

Differential diagnosis : Whooping cough has to be differentiated from other conditions in childhood causing spasmodic cough .These are acute bronchitis, bronchopneumonia, aspiration of foreign bodies; extrinsic compression of trachea and bronchi by tuberculosis glands or other masses, obstructive airway disease, cystic fibrosis, congenital malformations of the upper respiratory tract. Infections with B. parapertussis ,B. bronchiseptica and adenovirus types 1, 2, 3 and 5 closely resemble whooping cough and cannot be clinically differentiated.

Treatment of Whooping Cough/ Pertussis:-

Pertussis is treated with antibiotics, usually erythromycin. Some experts believe that treatment is most effective when antibiotics are started early in the course of the illness.

Supportive care is important to maintain nutrition, prevent aspiration into the respiratory tract and maintain the airway. The airway is cleared by suction of the exudates. Anoxic convulsions are managed by administration of oxygen and anticonvulsants. Small , frequent feeds are tolerated if given soon after a paroxysm of cough. Intravenous fluids may be required if the child is dehydrated. In general, administration of antibiotics does not shorten the paroxysm stage, once it is established . Erythromycin 50mg/kg/day given for5-7 days will reduce the period of communicability. It may even abort or prevent the progress of the disease if given in the catarrhal stage. Ampicillin, chloramphenicol and cotrimoxazole may also be used as alternative drugs.

Antibodies are not transferred in the case of whooping cough. In most patients, a single attack confers life-long immunity.

Prevention of Whooping Cough/ Pertussis:-

Active immunization is achieved by the administration of the pertussis vaccine, usually given in combination with diphtheria and tetnus toxoids. Pertussis can be prevented with the pertussis vaccine which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization The DTaP vaccine contains a purified acellular version of the pertussis vaccine and has fewer B. pertussis toxins in it. DTaP immunizations are routinely given in five doses before a child's sixth birthday.. The initial dose is given at 2 months, with 2 more doses at 4 week intervals. The first booster is given 1 year later and the next one at school entry. Adverse reactions may develop after vaccination. These arelocal reactions, fever developing within 12 to24 hours of injection and rarely post-vaccination encephalitis. At present the benefits of vaccination far outweigh the risks and, hence vaccination should be recommended for all infants. The booster shot may help reduce the number of pertussis cases in adolescents and adults.

Persons with pertussis should stay home and avoid close contact with others until 5 days of antibiotic treatment for pertussis have been completed at which time they are no longer contagious. Prophylactic (preventive) oral antibiotics should be given to anyone who lives in the same household as someone with pertussis.

When should the doctor be called?

Call your doctor immediately if you suspect that your child has pertussis. Also, call your doctor if your child has been exposed to someone with pertussis, even if your child has already received all of his scheduled DTaP or DTP immunizations.

Call your doctor if your child has prolonged, severe coughing spells, especially if these spells make the child turn red or blue, are followed by vomiting, or occur together with a "whooping" sound when the child breathes in.

Home Remedies of Whooping Cough / Pertussis

• Take a wine glass of rum, and a little spirits of turpentine, shake well together, rub the child by the fire gently down the neck and chin, night and morning; in a few days the cough will be cured.
• Grind together equal amounts of basil leaves and black pepper and add a little honey so as to have a consistency to make small tablets. These tablets, sucked slowly, should be taken four times a day. In the case of dry cough, take a mixture of equal amounts of the juices of basil seeds, ginger and onion. In the case of loose cough, add candy sugar.
• Black cohosh also helps loosen and expel mucus. Take 3 cups of tea or 20 drops of tincture in water daily.
• Add fir infusion or 10 drops of thyme oil or tea tree oil to bath water to speed healing of damaged membranes.
• Use of ginger is another effective home made remedy for whooping cough treatment. A teaspoon of fresh ginger juice, mixed with a cup of fenugreek (methi) decoction and honey to taste, is an excellent diaphoretic. It acts as an expectorant in the whopping cough disease.
• Almond oil is valuable in whooping cough. Five drops of almond oil should be mixed with ten drops each of fresh white onion juice and ginger juice, and taken thrice daily for a fortnight. It will provide relief.
• The herb calamus is another valuable remedy for whooping cough. A pinch of the powder of the roasted herb should be given with a teaspoon of honey. Being antispasmodic, it prevents severe bouts of coughing. For smaller children, the dose must be proportionately smaller.
• A syrup prepared by mixing a teaspoon of fresh radish juice with an equal quantity of honey and a little rock salt is beneficial in the treatment of this disease. It should be given thrice daily.
• After further recovery, he can adopt a regular well-balanced diet, according to his age. The emphasis should be on fresh fruit, fruit and vegetable juices and milk. When the convalescent stage has been reached, the child should be encouraged to spend as much time as possible out of doors.