WHOOPING COUGH

Koklyush is an acute infectious disease characterized by a paroxysmal spasmodic cough .

The causative agent is Gram-negative bacillus Bordetella pertussis. The pertussis causative agent is unstable in the environment, quickly dies under the influence of high temperature, sunlight, drying and disinfectants.

The source of the causative agent is a patient with whooping cough, especially at the onset of the disease before the onset of spasmodic coughing. Special epidemiological danger is represented by patients with erased and subclinical forms of pertussis, in which a characteristic spasmodic cough is absent. Duration of infectious period 4 - 5 weeks. The causative agent of whooping cough is transmitted by airborne droplets when coughing, sneezing, talking at a distance of up to 3 m. Children who are pertussis of all ages, including newborns and adults, suffer from pertussis.

Clinical picture . The incubation period is from 3 to 15 (usually 5 to 8) days. A typical form of pertussis is characterized by a slow cyclic course, in which three periods are distinguished: catarrhal, spasmodic and resolution period. In the catarrhal period there is a dry, gradually intensifying cough , sometimes there is a slight runny nose, subfebrile body temperature. The general condition of the patient is usually not violated. The duration of the catarrhal period, as a rule, is 1.5 to 2 weeks. In children in the first months of life, the catarrhal period is weak and lasts 5 to 7 days. The next spasmodic period lasts 2 weeks and is characterized by a paroxysmal cough, differences. A sign of which is a series of coughing jerks, quickly following on exhalation one after another. After coughing, a whistling breath (reprise) occurs. Then again follows a series of coughing jerks, ending with reprises. The attack ends with a coughing up of viscous sputum and, often, vomiting. At the beginning of the spasmodic period, coughing spells are rare, then they become more frequent and more severe. The maximum severity of coughing attacks is reached at the 2nd -3rd week from the onset of the spasmodic period of the disease. During the spasmodic cough, the patient's face turns red, in severe cases the veins turn blue, the veins of the neck swell, the eyes are watered, as if "pouring blood", the head is stretched forward, the tongue protrudes to the limit. At the same time, the bridle of the tongue in children with teeth is injured by the lower incisors, and a sore can appear on it.

With a mild pertussis, the general condition of the patient is not disturbed, body temperature is usually normal, coughing short, without disturbance of respiratory function, their frequency does not exceed 10-15 per day.

With a moderate form of whooping cough, the patient becomes irritable, sluggish, sleep, appetite is disturbed. Body temperature can remain normal, sometimes increases to 38 ° C. Coughing attacks increase to 20-30 times a day, prolonged, accompanied by cyanosis, and in young children - general cyanosis. Dry and wet wheezing is heard in the lungs.

The severe form of pertussis is characterized by a significant deterioration in the patient's condition. Body temperature rises to 38 ° C and above. There are disorders of sleep, lack of appetite, indifference to the environment, sharp pallor of the skin, puffiness of the face, puffiness of the eyelids. In the lungs, a large number of dry and moist raznochalibnyh rattles are heard. Coughing attacks are frequent (up to 40 - 50 per day), heavy, prolonged. The respiratory function is sharply disrupted, there is a general cyanosis , sometimes in children of the first year of life there comes a stop of respiration of various duration (apnea). During an attack, nasal bleeding, hemorrhages to sclera, involuntary urination and defecation are often observed.

In some cases, with severe disease in children before the attack, there is a period of harbingers, during which children over 1 year old become restless, interrupt the game, jump up, sometimes run to adults, as if seeking protection; Children of the first year of life wake up, begin to cry.

Gradually the disease passes into the next stage - the resolution period lasting 2-4 weeks. During this period, spasmodic coughing attacks become less frequent and shorter, recurrences disappear, sputum is easier to go away. In general, the duration of the disease is from 1.5 to 2 months.

With a worn out form of pertussis, there is no coughing fit, only a slight cough is observed for a long time (4 to 6 weeks), the general condition is not disturbed, the body temperature remains normal.

In vaccinated children whooping cough occurs in an erased form, in adults - in mild or (more often) in an erased form.

The diagnosis is based on epidemiological history and a characteristic clinical picture of the disease. Of the laboratory methods, the most valuable is the bacteriological study that allows to identify the causative agent: using a tampon moistened with a nutrient medium, take nasopharyngeal mucus or sputum of patients and sow on elective nutrient media. This study should be conducted in the first weeks after the onset of the disease.

Treatment . Children of an early age, as well as all patients with severe pertussis and complications are subject to hospitalization. Of great importance are properly organized treatment and care for the patient.

Bed rest is indicated only at elevated body temperature and the development of severe complications. In other cases, it is useful to stay in the open air at any time of the year, this improves lung ventilation and oxygen exchange, coughing attacks become less frequent and weaker. It is necessary to frequently ventilate the room in which the patient is. It is important to rationally organize the leisure time of a sick child (children who are keen on playing, less cough). The food should be high-grade, vitaminized. It should be possible to exclude unpleasant external stimuli, including examination of throat.

Antihistamines are indicated (eg, dimedrol , suprastin). In the catarrhal period, antibiotics (levomycetin, ampicillin , gentamicin) are recommended for 7 to 10 days at doses appropriate to age. Children of the first three months of life prefer to prescribe ampicillin at 100 mg / kg per day 3 times a day intramuscularly, levomycetin is contraindicated. In the spasmodic period, antibiotics are ineffective, therefore, mainly pathogenetic and symptomatic therapy with neuroleptics, antihistamines and anticonvulsants is carried out.

The prognosis is favorable in most cases - full recovery is coming. Children of the first year of life with severe pertussis, accompanied by cramps and apnea, may be fatal.

Prevention - the routine vaccination of children with adsorbed pertussis-diphtheria-tetanus vaccine, preventing the contact of newborns and children of the first months of life with sick whooping cough. In the focus of infection, general preventive measures (airing, disinfection of dishes and care items) are necessary, final disinfection is not carried out.