Whooping cough – the acute infectious disease of the bacterial nature which is shown in the form of the attacks of spasmodic cough accompanying catarrhal symptomatology. Infection with whooping cough occurs in the aerosol way at close contact with the sick person. The incubatory period makes 3-14 days. The catarrhal period of whooping cough reminds symptoms of sharp pharyngitis, then characteristic attacks of spasmodic cough develop. At imparted more often the erased clinical picture of whooping cough is observed. Diagnostics is based on identification of a koklyushevy stick in dabs from a pharynx and in a phlegm. Concerning whooping cough antibacterial therapy (aminoglycosides, macroleads), antihistamines with sedative effect, inhalations is effective.
Whooping cough – the acute infectious disease of the bacterial nature which is shown in the form of the attacks of spasmodic cough accompanying catarrhal symptomatology.
Characteristic of the activator
Whooping cough causes Bordetella pertussis – a small motionless aerobic gramotritsatelny coccus (though traditionally the bacterium is called "a koklyushevy stick"). The microorganism is similar on the morphological features to the causative agent of parawhooping cough (an infection with the similar, but less expressed symptomatology) - Bordetella parapertussis. The Koklyushevy stick produces thermolabile , thermostable endotoxin, and also trakhealny cytotoxin. The microorganism is a little steady against influence of the external environment, keeps viability at action of a direct sunlight no more than 1 hour, perishes in 15-30 minutes at a temperature of 56 °C, are easily destroyed by disinfectants. Several hours keep the viability in a dry phlegm.
The tank and source of a koklyushny infection is the sick person. The contagious period includes the last days of an incubation and 5-6 days later began diseases. The peak of transmissibility falls on the moment of most expressed clinic. Epidemiological danger is constituted by the persons suffering from the erased, clinically low-expressed infection forms. The carriage of whooping cough does not happen long and epidemiologically is not significant.
Whooping cough is transmitted through the aerosol mechanism in mainly airborne way. Plentiful allocation of the activator happens at cough and sneezing. In view of the specifics, the aerosol with the activator extends to insignificant distance (no more than 2 meters) therefore infection is possible only in case of close engagement with the patient. As in the external environment the activator does not remain is long, the contact way of transfer is not implemented.
People possess a high susceptibility to whooping cough. Most often children get sick (whooping cough is carried to children's infections). After transferring of an infection resistant lifelong immunity is formed, however the antibodies received by the child from mother transplatsentarno do not provide sufficient immune protection. At advanced age cases of a repeated disease of whooping cough are sometimes noted.
Pathogenesis of whooping cough
The Koklyushny stick gets on a mucous membrane of the top airways and occupies the resnitchaty epithelium covering a throat and bronchial tubes. Do not get into deep fabrics of a bacterium and on an organism do not extend. Bacterial toxins provoke local inflammatory reaction.
After death of bacteria endotoxin which causes spasmodic cough, characteristic of whooping cough, is released. With progressing cough gets the central genesis – the excitement center in the respiratory center of a medulla is formed. Cough reflex arises in response to various irritants (a touch, pain, laughter, a conversation, etc.). Excitement of the nervous center can promote initiation of similar processes in the neighboring areas of a medulla, causing reflex vomiting, vascular dystonia (increase HELL, a vascular spasm) after a kashlevy attack. At children spasms can be noted (tonic or clonic).
Whooping cough endotoxin together with the enzyme produced by bacteria – adenilattsiklazy promotes decrease in protective properties of an organism that increases probability of development of a secondary infection, and also - distribution of the activator, and in certain cases - a long carriage.
Whooping cough symptoms
The incubatory period of whooping cough can last from 3 days to two weeks. The disease proceeds with consecutive change of the next periods: catarrhal, spasmodic cough and permission. The catarrhal period begins gradually, there are moderate dry cough and cold (at children it can be quite expressed). Rhinitis is followed viscous separated mucous character. Intoxication and fever usually are absent, body temperature can rise to subfebrilny values, the general state patients recognize satisfactory. Over time cough becomes frequent, persistent, its attacks can be noted (in particular at night). This period can proceed from several days to two weeks. At children usually short-term.
Gradually catarrhal period passes into the period of spasmodic cough (differently – convulsive). Fits of coughing become frequent, become more intensively, cough gains convulsive spastic character. Patients can note attack harbingers – irritation in a throat, discomfort in breasts, concern. Because of spastic narrowing of a glottis before a breath the whistling sound (reprises) is noted. The fit of coughing represents alternation of such whistling breaths and, actually, kashlevy pushes. Weight of a course of whooping cough is defined by the frequency and duration of fits of coughing.
Attacks become frequent at night and morning hours. Frequent tension promotes that the face of the patient becomes hyperemic, edematous, small hemorrhages on face skin and a mucous rotoglotka, a conjunctiva can be noted. Body temperature remains in normal limits. Fever at whooping cough is a sign of accession of a secondary infection.
The period of spasmodic cough lasts from three weeks to one month then the disease enters a phase of recovery (permission): at cough the mucous phlegm begins to otkharkivatsya, attacks become more rare, lose spasmodic character and gradually stop. Duration of the period of permission can borrow from several days to several months (despite subsiding of the main symptomatology, nervous excitability, the tussiculation and the general adynamy can be noted at patients a long time).
The erased whooping cough form sometimes is noted at the imparted faces. At the same time spasmodic attacks are expressed more weakly, but cough can be more long and hardly give in to therapy. Reprises, vomiting, vascular spasms are absent. The subclinical form is found sometimes in the center of a koklyushevy infection at inspection of contact persons. Subjectively patients do not note any pathological symptoms, however it is quite often possible to note periodic cough. The abortive form is characterized by the termination of a disease at a stage of catarrhal signs or in the first days of the convulsive period and bystry regress of clinic.
Diagnosis of whooping cough
Specific diagnosis of whooping cough are made by bacteriological methods: allocation of the activator from a phlegm and dabs mucous the top airways ( on nutrient medium). The Koklyushevy stick is sown on Borde-Zhangu's circle. Serological diagnostics by means of RA, RSK, RNGA is made for confirmation of the clinical diagnosis as reactions become positive not earlier than the second week of the convulsive period of a disease (and in certain cases can yield negative result and in later terms).
Nonspecific diagnostic techniques note symptoms of an infection (lymphocytic in blood), slight increase of SOE is characteristic. At development of complications from respiratory organs consultation of the pulmonologist and carrying out a X-ray analysis of lungs is recommended to patients with whooping cough.
Whooping cough complications
Whooping cough most often causes the complications connected with accession of a secondary infection, diseases of respiratory system are especially frequent: bronchitis, pneumonia, pleurisy. As a result of destructive activity of koklyushevy bacteria development of emphysema is possible. The heavy current in rare instances leads to an atelektaz of lungs, pheumothorax. Besides, whooping cough can promote developing of purulent otitis. There is a probability (at frequent intensive attacks) a stroke, a rupture of muscles of a belly wall, eardrums, loss of a rectum, hemorrhoids. At children of early age whooping cough can promote development of a bronkhoektatichesky disease.
Treatment of whooping cough
Whooping cough treat on an outpatient basis, it is desirable for patient to breathe the moistened air rich with oxygen, room temperature. Food is recommended full, fractional (often small portions). It is recommended to limit influence not nervous system (intensive visual, acoustical impressions). In case of preservation of temperature within norm it is desirable to walk more in the fresh air (however at air temperature not less than -10 °C).
In the catarrhal period prescription of antibiotics (macroleads, aminoglycosides, ampicillin or a levomitsetin) in sredneterapevtichesky dosages to courses for 6-7 days is effective. In a complex with antibiotics in the first days quite often appoint introduction of specific protivokoklyushny gamma globulin. As pathogenetic means the patient appoint antihistaminic medicines with sedative action (, ). During the convulsive period for simplification of attacks it is possible to appoint spazmolitik, in hard cases – neuroleptics.
Protivokashlevy, expectorant cure and mucolytics for whooping cough are ineffective, protivokashlevy means with the central mechanism of action are contraindicated. Oxygenotherapy is recommended to patients, the good effect is noted at an oksigenobaroterapiya. Physiotherapeutic techniques, inhalations of proteolytic enzymes are successfully applied.
The forecast is favorable. Comes to an end letalno in exceptional cases at persons of senile age. At development of complications preservation of long consequences, chronic diseases of lungs is possible.
Prevention of whooping cough
Specific prevention of whooping cough is carried out according to plan. Vaccination of children is performed by means of introduction of vaccine AKDS. Vaccination against whooping cough is begun at the age of 3 months, the vaccine is entered three times at an interval of one and a half months. At the age of more than 3 years vaccination is not made. The general preventive actions include early identification of patients and control over the state of health of contact persons, preventive inspection of children in organized children's collectives, and also adults working in treatment-and-prophylactic both in preschool institutions and at schools at detection of long cough (more than 5-7 days).
Children (and adults from the above-stated groups), patients with whooping cough, are isolated for 25 days since the beginning of a disease, contact persons are discharged of work and visit of children's collective for 14 days from the moment of contact, undergoing double bacteriological test. In the center of an infection are made careful disinfection, the appropriate quarantine measures are carried out. The emergency prevention is made by means of immunoglobulin introduction. It is received by children of the first year of life, and also not imparted faces which had contact with sick whooping cough. Immunoglobulin (3 ml) is entered once regardless of the term which passed from the moment of contact.