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Pediatric Pertussis

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by

Christine Tafoya

on 19 April 2011

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Transcript of Pediatric Pertussis

Case Study
A 5-month-old boy was admitted to the hospital with severe cough.
Symptoms began about two weeks earlier with the onset of upper respiratory tract congestion and a milder cough.
Primary provider had assessed him at this time, did no tests and prescribed symptomatic treatment.
The cough worsened to the point of causing some post-tussive emesis and brief loss of breath with cyanosis.
Past Medical History
Pre/post natal history unremarkable
No history of conjuctivitis
Otherwise healthy infant with no past history of illness or surgery
No allergies
No medicines except the over-the-counter decongestant given during his first visit
No immunizations
18-year-old mother has had a coughing illness for several weeks. Examination
Temperature: 37.9°C
Pulse, Respiratory Rate, and Oxygen levels within normal limits
Marked upper airway congestion
Breath sounds revealed moist, bilateral rhonchi with minimal wheezing
Began coughing, > 30 seconds
Mild cyanosis Tests
WBC: 34,000 with 85% lymphocytes
Chest X-ray: non-specific, diffuse bilateral perihilar pattern
Rapid strep test: negative
Rapid influenza antigen test: negative
Rapid RSV: negative
Nasopharyngeal swab: pending (7-10 days)
Polymerase Chain Reaction: pending (1-2 days)
Blood cultures: pending (3 days) Pediatric Pertussis
"Whooping Cough"
by Christine Tafoya Etiology
"Bordetella pertussis"
-very small gram-negative rod, looks similar to a coccobacillus
-aerobic
-fastidious
filamentous hemagglutinin (FHA) Pathogenesis
-Toxin-mediated disease
-The bacteria attach to cilia of the respiratory tract, and produce toxins which paralyze the cilia, leading to respiratory tract inflammation
-This inflammation makes it very difficult for the child to “clear” their pulmonary secretions Stage 1: Catarrhal
-From word, “catarrh”, meaning inflammation of the mucous membranes, especially in the nose and throat
-Begins gradually, initially presenting as a minor respiratory tract infection
-Lasts 1 to 2 weeks
-Characterized by:
•Coryza (runny nose)
•Low-grade fever
•Mild, occasional cough (which gradually becomes more severe)
Stage 2: Paroxysmal
-From word, “paroxysm”, meaning a sudden attack, recurrence, or intensification of a disease .
-Usually lasts 1-6 weeks, but can last up to 10 weeks
-Intermittent cough becomes paroxysmal, terminating with inspiratory whoop followed by posttussive vomiting.
-The violent coughing spasms can result in bursting of blood vessels in the eyes, vomiting, and rarely, seizures due to hemorrhages in the brain.
-Cyanosis (during an attack): the skin appears blue/purple due to decreased oxygen (hypoxia)- also seen in chronic bronchitis (“blue bloaters”) Paroxysmal attacks:
-Frequently at night
-Average: 15 attacks/24 hours.
-Increase in frequency during the first 1-2 weeks
-Remain at the same frequency for 2-3 weeks
-Gradual decrease Stage 3: Convalescent phase:
-Convalescence: gradual recovery of health and strength after an illness
-Usually lasts 7 to 10 days, but can range from 4 to 21 days.
-Less persistent, paroxysmal coughs
-Paroxysms often recur with subsequent respiratory infections for many months Risk Factors
-Anyone who has not been previously immunized
-Adolescents and adults who received the vaccine as children, but have not been re-vaccinated
-Babies 6 months and under Transmission and Epidemiology
-Transmitted via respiratory droplets.
-Highly contagious during catarrhal and paroxysmal stages.
-Most infants are infected by older siblings, parents, or caregivers, who do not know they have the disease.
-About 25% of infections occur in older children and adults
-Results in 300,000-500,000 deaths annually worldwide
Recent Outbreaks
-2010: 9477 cases in California, including 10 infant deaths
-2010: 1519 cases in Michigan
-2010: 964 cases in Ohio
-Arizona reports an average of 200-300 cases each year Complications
-Serious and sometimes life-threatening complications in infants and young children
-In infants younger than 1 year of age who get pertussis, more than half must be hospitalized.
Of those hospitalized:
•1 in 5 get pneumonia
•1 in 100 will have convulsions
•Half will have apnea
•1 in 300 will have encephalopathy
•1 in 100 will die Diagnostics
-Distinctive clinical symptoms
-Cultures: Typically a pertussis culture and PCR test will both be ordered, as early in the illness as possible.
-Can take 2-3 weeks for a culture to grow. Treatment
Mainly supportive care:
-Admission to the hospital
-Intravenous (IV) fluids
-Oxygen
-Breathing support from a ventilator
-Prevention of secondary infections
-Antibiotics (azithromycin, erythromycin, clarithromycin, trimethoprim-sulfamexazole)
-Possible steroids
-Beta2-agonists Vaccination is the best way to prevent Pertussis .
-Infants/Children: protects children against 3 diseases: diphtheria, tetanus, and pertussis. For maximum protection against pertussis, children need 5 DTaP shots.
-Preteens: 11 or 12 years should get a dose of Tdap, a booster for tetanus, diphtheria, and pertussis.
-Parents to be and those around infants: Tdap
-If an outbreak of Pertussis in the community occurs, there is a chance that a fully vaccinated person may contract the disease Differential Diagnosis for
"whoop-like cough"

A. Bordetella pertussis
B. Chlamydia trachomatis
C. Adenovirus
D. Bordetella parapertussis
References
Brady, M. (2009). Pertussis. In C. Burns, A. Dunn, M. Brady, N. Barber Starr, & C. Blosser, Pediatric Primary
Care (pp. 778-779). Saunders Elsevier: St. Louis.
Cowan, M., & Talaro, K. (2006). Microbiology: A Systems Approach. New York: McGraw-Hill.
Infectious Disease Epidemiology Program. (n.d.). Retrieved April 8, 2011, from Arizona Department of Health and Human Services: http://www.azdhs.gov/phs/oids/epi/disease/pert/pertussis_g.htm
Jassim, H. (n.d.). Bordetella pertussis. Retrieved April 10, 2011, from
http://web.mst.edu/~microbio/BIO221_2001/bordetella_pertussis.html
Pertussis (Whooping Cough). (n.d.). Retrieved April 9, 2011, from Centers for Disease Control and
Prevention: http://www.cdc.gov/pertussis/index.html
Pertussis: The Test. (n.d.). Retrieved April 9 2011, from Lab Tests Online:
http://www.labtestsonline.org/understanding/analytes/pertussis/test.html
Ratnapalan, S., Parkin, P., & Allen, U. (2005, April). Case 1: The deadly danger of pertussis. Paediatrics &
Child Health, 10(4), 221-222.
Schoenstadt, A. (n.d.). Whooping Cough Treatment. Retrieved April 9, 2011, from eMedTV:
http://diseases.emedtv.com/whooping-cough/whooping-cough-treatment.html
Whooping Cough Risk Factors. (n.d.). Retrieved April 9, 2011, from Mayo Clinic:
http://www.mayoclinic.com/health/whooping-cough/DS00445/DSECTION=risk-factors
Whooping Cough: Management and Diagnosis of Pertussis. (2011, March). Pediatric Emergency
Medicine Reports: PEMR. Retrieved April 10, 2011, from ProQuest Health and Medical Complete. (Document ID: 2297496471). Normal CXR
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