Also known as whooping cough, killer cough or canine cough, this infection is responsible for a persistent cough, which, in the central phase of the infection (paroxysmal phase), becomes the protagonist of real tussive crises.
Whooping cough is an "infection that - when it affects infants and very young children - can cause serious complications, even death; in adults, however, it rarely causes severe consequences.
The treatment of pertussis varies according to the age of the patient and the stage in which the diagnosis of the infection occurs.
The most effective method to prevent the disease is to resort to vaccination, vaccination which, in Italy, has been mandatory for some years now.
, which affects the airways and lungs.
Whooping cough owes its name to the symptom that most characterizes it: cough.
In infected patients, the cough disorder is so persistent that it can last up to 10 weeks; this explains, among other things, why whooping cough is also called the "100-day cough".
Other Synonyms of Pertosse
In addition to "100 day cough", other synonyms for whooping cough are: canine cough, whooping cough and killer cough.
Epidemiology: how common is whooping cough?
With the advent of the vaccine (1940s), whooping cough went from "being a" widespread infection throughout the world and the main cause of death among children, to representing a health problem of primary importance only in countries in the developing world, where vaccination programs are still overdue.
In other words, the creation of the pertussis vaccine represented an epochal turning point, enormously reducing the cases of pertussis in the most industrialized countries of the globe.
Worldwide, today, whooping cough is an infectious disease that affects approximately 16 million people annually and causes 58,700 deaths to sufferers.
Some numbers on whooping cough:
- According to a 2008 statistic, pertussis is the cause of death for 195,000 people worldwide.
- According to some estimates, about 90% of all cases of pertussis occur in developing countries.
- In a country like the United States, the number of annual cases of pertussis has gone from just over 178,000 units, in the period before the vaccine was made, to just under 21,000 units in 2015 (ie almost 70 years after the advent of vaccination).
When it infects a human, Bordetella Pertussis s "settles in the epithelial cells of the lungs and colonizes them; the colonizing action of this bacterium impedes the movement of the cilia (which cover the pulmonary epithelium and have the important function of eliminating debris entering the lungs, through the inhaled air).
Hence, the impediment to the movement of the eyelashes, by Bordetella Pertussis, causes the accumulation of debris along the airways and in the lungs of the host, and this is responsible for part of the symptoms of whooping cough.
To complete the infectious process of Bordetella Pertussis it is the inhibitory action that this bacterium has on the host's immune system; going into more detail, the weapon he uses Bordetella Pertussis to attack the immune system is its exotoxin, simply called pertussis toxin.
Pertussis: Incubation Times
The incubation period that characterizes Bordetella Pertussis (ie the time that must pass from the first exposure to the bacterium until the first symptoms appear) has an average duration of 9-10 days; it is good, however, to specify that its range goes from a minimum of 6 to a maximum of 20 days.
Whooping cough: the Contagion
How is Bordetella Pertussis transmitted?
The transmission of whooping cough (and of Bordetella Pertussis) to a new host occurs exclusively through the inhalation of droplets of infected saliva, emitted by a carrier of the infection, when sneezing, coughing or speaking.
The degree of infectivity of the containing droplets Bordetella Pertussis it is particularly high; According to some medical studies, the probability these droplets have of transmitting whooping cough to a susceptible individual (who clearly inhales them) is over 90%.
Did you know that ...
In the medical field, this route of transmission just mentioned, which assigns the role of vehicles for whooping cough to the droplets of saliva emitted by patients, is called aerosol.
Infectious diseases transmissible by aerosol make overcrowded places ideal environments for the spread of the triggering pathogen.
Whooping cough: who is most at risk of getting sick?
Whooping cough can affect anyone who has not obtained the vaccine; however, statistics in hand, he has a predilection for infants and very young children, on whom, moreover, he can have the worst consequences.
and phlegm, associated with a slight rise in body temperature).
The catarrhal phase is followed, after 1-3 weeks, by the so-called paroxysmal phase (or accessional phase), in which, especially at night, there is an "exacerbation (sudden aggravation) of the cough, which gives rise to real crises .
The paroxysmal phase lasts from 2 to 6 weeks; after that, the last phase of whooping cough begins, that is the phase of convalescence.
Characterized by a gradual cessation of severe cough, typical of the previous pathological phase, the convalescence phase or period has a variable duration, which can range from one to even 3 weeks.
Whooping cough: Symptoms of the Catarrhal Phase
The characteristic symptoms of the catarrhal phase of whooping cough are:
- Catarrhal cough. Resistant to common sedatives, with the passing of the days, it becomes more and more irritating and frequent;
- Fever;
- Runny nose (runny nose)
- Fever;
- Nasal congestion;
- Sore throat;
- Red and watery eyes;
- Weakness and general malaise.
Together with the incubation period, the catarrhal phase of pertussis represents the pathological period in which infectivity (or contagiousness) is maximum.
Pertussis: Symptoms of the Paroxysmal Phase
The paroxysmal phase of whooping cough begins when there is so much mucus accumulating in the respiratory tract that the body's need to free the airways produces real coughing fits (readers are reminded that cough it is a defensive reflex, implemented by the body to protect the airways and make them open).
More frequent during the night, the cough crises of the paroxysmal phase have a canonical duration of a few minutes and are characterized by short and contiguous coughs.
Their repetition in a close sequence - the latter phenomenon which is decidedly very common - has a tendency to end with a retching or expectoration of dense, vitreous and stringy mucous material; in addition, it is responsible for:
- Red or blue face (if blue, it is called cyanosis)
- Sense of intense fatigue;
- Production of a typical shrill rattle at the first inspiratory act following the end of the cough crisis.
The number of cough fits over the "span of a" full day can range from 5 to as much as 40.
As the paroxysmal phase takes its course, the patient's level of contagiousness gradually decays, until it disappears.
Whooping cough: Symptoms of the Convalescence Phase
In whooping cough, the convalescence phase represents the moment in which the symptoms of the paroxysmal phase begin to progressively diminish, until they completely disappear.
In other words, the patient with whooping cough who enters the convalescent phase sees his state of health progressively improving and can be considered on the road to recovery.
Pertussis Symptoms in the Infant and Young Child
In the newborn with whooping cough, the seizures are decidedly more lenient than in the child or in the older person; however, in the sick newborn, it is possible to witness apnea phenomena more likely, which can, in the most unfortunate cases, result in serious complications.
Symptoms of Pertussis in Older Child, Adolescent and Adult
The more the patient with whooping cough is an adult, the more likely it is that cough is the only symptom present.
In other words, in older children and adolescents it is easier to observe a complex symptomatological picture, compared to what happens in adults, who, generally, exhibit only a cough.
The newborn with whooping cough who develops any of these complications needs immediate hospitalization.
Whooping cough: Complications in Big Child and Adult
In adolescents and adults with good immune systems, whooping cough tends to resolve without problems.
However, in some situations, coughing fits have such an intensity as to cause:
- A broken rib
- The formation of an "abdominal hernia;
- Episodes of nosebleeds;
- The rupture of some blood vessels present on the ocular sclerae.
Whooping cough: when to see a doctor?
The presence of a persistent cough, which causes retching, red face, cyanosis, episodes of apnea and shrill rales during inhalation represents a more than valid reason to consult a doctor.
a thorough culture of a nasopharyngeal (or nasopharyngeal) swab and blood tests.
Physical examination and anamnesis
The physical examination and the anamnesis usually represent the first step in the process leading to the diagnosis of pertussis.
Briefly, they consist in the observation and critical evaluation of the symptoms manifested by the patient.
In some situations (eg when pertussis is in the paroxysmal phase), they may be sufficient for a correct diagnosis; in other circumstances (eg when pertussis is in the catarrhal stage), they can only provide incomplete information.
Did you know that ...
Whooping cough is an infectious disease which, when it is in its onset phase (catarrhal phase), is difficult to diagnose, as it produces the same symptoms as a simple cold.
Things change completely when the aforementioned infection is in its acute phase (paroxysmal phase): in these situations, the symptoms are so to speak unequivocal and the diagnosis is very simple.
Culture Examination on Nasopharyngeal Swab
The culture test on a nasopharyngeal swab - that is, on a sample of tissue coming from the nose and throat - represents the confirmation diagnostic test, as it allows to trace Bordetella Pertussis and show that the current infection is whooping cough.
Blood analysis
Blood tests show that there is an "infection with Bordetella pertussis, as this bacterium triggers the production, by the infected organism, of particular antibodies found in the bloodstream.
, hospitalization of a newborn with whooping cough or a person with a severe form of whooping cough includes:- The administration of fluids intravenously, for the purpose of preventing / treating dehydration. The use of the intravenous route is related to the fact that the patient may have difficulty in ingesting liquids;
- Periodic monitoring of respiratory function. This allows doctors to intervene promptly if the patient needs breathing support (mechanical ventilation) and treatment such as oxygen therapy.
- An "adequate antibiotic therapy, in order to eliminate the bacterium responsible for the infection from the infected organism."
- Mechanical ventilation and oxygen therapy. They are used when breathing difficulties become critical.
Whooping cough: Home Remedies and Medicines for Therapy
Intended for all non-newborn patients with normal symptoms, the home treatment of pertussis includes: the use of antibiotics (according to the methods described above), a period of absolute rest, the consumption of plenty of water to avoid dehydration and the use of paracetamol or ibuprofen to reduce fever.
Whooping cough antibiotics: what are they?
Among the most suitable antibiotics for the treatment of pertussis are: erythromycin, clarithromycin and azithromycin.
For further information: Medicines for the treatment of whooping coughWhooping cough: What to do to avoid infecting other people?
To avoid infecting other people, an individual with whooping cough should:
- Avoid frequenting crowded places and any circumstances that lead him to come into contact with other people (school, work, etc.). This recommendation lapses after 48 hours from the beginning of any antibiotic therapy or after 3 weeks from the beginning of the infection.
- Cover the mouth and nose with a paper tissue or with the crook of the elbow when sneezing, coughing. For the little ones, this recommendation is more difficult to put into practice.
- Dispose of / wash any tissue used to cover mouth and nose as soon as possible.
- Wash your hands with warm soapy water.
Antibiotic prophylaxis for whooping cough: who is it for?
According to the doctors, it is a good idea for anyone who lives in close contact with a pertussis patient (in general, family members) to resort to "adequate antibiotic prophylaxis, in order to protect themselves from any contagion.
Whooping cough: are cough medicines useful?
Cough medications are generally contraindicated in children and infants, while they may find use in adults.
In any case, with regard to this topic, it is better to rely on the indications of the attending physician.
Benefits of Pertussis Vaccine
The advent of vaccination against pertussis has helped to reduce not only the morbidity of the disease in question, but also its lethality related to complications such as pneumonia, encephalitis, suffocation asphyxiation, etc.
Pertussis vaccine: how long does the protection last?
Immunity induced by the pertussis vaccine tends to diminish with the passage of time (5-10 years). This means that, after a certain period of time, those who have obtained the vaccination can get sick in the same way as a person who has never been vaccinated .
This same possibility (immune protection against whooping cough which diminishes over time) also applies to people who have become ill with whooping cough and have developed a "natural immunity."
Whooping cough vaccine: is it mandatory?
With the decree law on vaccination prevention for minors from zero to 16 years, approved on 28/07/2017, vaccination against pertussis has become mandatory.
In the little ones, this vaccination involves three dosages, spread over the first year of life, after which it involves periodic boosters, set at specific ages.
The pertussis vaccine is given together with other vaccinations: there are five others (anti-diphtheria, anti-tetanus, anti-hepatitis B, anti-Haemophilus influenzae type B and anti-poliomyelitis), as happens in the vaccine Infanrix Hexa, the so-called hexavalent vaccine; there can be four others (anti-diphtheria, anti-tetanus, anti-hepatitis B and anti-poliomyelitis), as happens in the Infanrix Penta preparation; there may be three others (anti-diphtheria, anti-tetanus and anti-hepatitis B), as happens in the Tritanrix HepB preparation.
We remind you that compulsory vaccinations such as that for whooping cough are a requirement for admission to kindergarten and preschools (for children from 0 to 6 years old) and that the violation of the vaccination obligation entails the application of significant financial penalties.
For more information on mandatory vaccines in children see this article.
Pertussis Vaccine in Pregnancy
The pertussis vaccine is also one of the vaccinations that can be carried out and recommended during pregnancy, to protect the mother and especially the child in the first months of life, when the vaccine on the latter is still not executable.
For further information: Anti Pertussis Vaccine in Pregnancy: Why and When to Do It?
