Pertussis is a dangerous 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 changes in the larynx.
Etiology of a whooping cough.
The causative agent of a whooping cough is Bordetella pertussis, which is a stick with rounded ends that is not resistant to external influences. The source of infection is a sick person, the infection is transmitted by airborne droplets. The disease reaches its greatest contagiousness in the catarrhal and in the first week of the spasmodic period 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 up to 5-8 years. After the transferred disease, persistent immunity remains.
Frequent coughing attacks contribute to impairment of cerebral and pulmonary circulation, which leads to an insufficient saturation of blood with oxygen, a shift in the acid-base equilibrium towards acidosis. Increased excitability of the respiratory center persists for a long time after recovery.
Symptoms and clinical course of a whooping cough.
The incubation period of a whooping cough is 2-15 days, usually 5-9 days.
There are periods of pertussis disease:
- Catalytic (3-14 days)
- Spasmic, or convulsive (2-3 weeks)
- Period of recovery
The main symptoms that characterize pertussis develop in the spasmodic period: a 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 chasm, accompanied by a reprise, i.e. Whistling sound. After this, a new series of coughing 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 a cough, 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 recapitulation, 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, expressed fatigue, disruption of blood circulation and trophism in them, which is manifested by relaxation and paresis of vocal folds. These phenomena (dysphonia, hoarseness, incontinence due to the weakness of the constrictive function of the larynx) can persist for weeks and months after recovery.
Complications in a whooping cough: pneumonia, acute pulmonary edema, peribronchitis, lung atelectasis, signs of cardiovascular insufficiency, increased blood pressure, spasm of peripheral and cerebral vessels, hypoxic damage to the central nervous system. Death can come from asphyxiation when the glottis is completely closed due to spasm of the larynx musculature during a fit of coughing.
Diagnosis of pertussis.
The diagnosis is based on clinical and epidemiological data. Specific bacteriological diagnosis consists in isolating the causative agent from droplets of mucus settling on coughing at the back wall of the pharynx. To identify those who have recovered from epidemic outbreaks, a serological survey is conducted.
Treatment of a whooping cough.
The treatment consists of the proper care of the patient, the appropriate diet, staying in the fresh air. Feed your baby in small portions soon after a fit of coughing. Food should be high in calories and easily digestible, contain vitamins and, if possible, correspond to the child's wishes. 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 VDP 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. To alleviate spastic phenomena and coughing attacks, neuroleptic and sedatives are indicated. Of great importance is the use of oxygen therapy, especially in the form of hyperbaric oxygenation of the body. Assign also anxiolytics, sedatives and hypnotics (bromizoval), amphenicols (chloramphenicol), macrolides and azalides (josamycin, midekamycin, oleandomycin), penicillins (amoxicillin, ospamox), tetracyclines (doxycycline), antitussives (butamirate), secretolitics and stimulants of motor Functions 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. The use of modern methods of treatment, including the tracheotomy, dramatically reduces complications and mortality in a whooping cough.
Prevention consists in the routine vaccination of children with adsorbed pertussis-diphtheria-tetanus vaccine. Carry out activities aimed at excluding the contact of the sick with healthy children; Adults caring for a sick child should use personal protective equipment when dealing with them, and it should be borne in mind that infection by airborne droplets in a whooping cough occurs only if the unprotected person is at a distance of the patient closer than 10 feet.