PERTUSSIS

DEFINITION
• Also known as “whooping cough” but first known
as “chin cough”
• Inflammation of Respiratory Tract
• Repeated attacks of spasmodic cough
• Series of explosive expirations, typically ending
in a long- drawn forced inspiration which
produces a “whoop” sound, usually followed by
vomiting.
• Whooping Cough is the most common name for
pertussis
 Etiology
• Bordatella pertussis- non- motile, Gram
negative, non-spore forming coccobacillus
that may form in capsules
• The Haemophilus pertussis bacillus of Bordet
and Gengou
• B. parapertussis
• B. bronchiseptica
• Aerobic but in some conditions may be
anaerobic
• Easily destroyed by light, heat and drying
 Source of Infection
• Secretions from nose and throat/mucus
membranes of respiratory system
• Droplet
• Discharges from laryngeal and bronchial mucus
membranes
 Mode of Transmission
• Direct contact with infected persons
• Portal of entry is the mucous membranes of the
respiratory system
• Articles freshly soiled with discharges from the
laryngeal and bronchial mucus membrane
• Cough droplets
• Direct contact
 Pathology
• After incubation period, large numbers of B.
pertussis are confined to the tracheobronchial
mucosa, entangled in the cilia where it produces
progressively tenacious mucus.
• This mucus is irritating to the mucosa and
initiates coughing.
• Whooping cough follows a classic six-day
course of 3 stages, each of which lasts 2 wks.
• It is believed that coughing is initiated by the
direct toxic effect of the organism on the central
nervous system.
• Toxins are absorbed in the trachea and act
upon the CNS to produce the cough.
• The organism is formed in large number,
entangled in the cilia of the bronchial
epithilium
 Incubation Period
• As short as 24 hrs or as long as 10 days
• Clinical signs appear between 3 and 5 days
 Course of the Disease
Catarrhal Stage
- Catarrhal symptoms of the nose and throat
- Dry hacking, irritating, nocturnal cough
- Coryza
- Sneezing
- Lacrimation
- Mucoid Rhinoria
- Most Communicable stage
-1-2 weeks
- Slightly elevated temperature
- Individual may be listless and irritable
- Cough gradually becomes severe esp. at
night
- End of Catarrhal stage, increased number of
lymphocytes (15,000-30,000)
 Course of the Disease
Spasmodic Stage
- Can be recognized clinically
- Series of short, rapid, sputtering coughs,
explosive bursts, between which there is no
inspiration
- follows sudden deep inspiration through
tense vocal cords
- producing whoop sound
-5-10 successive forceful cough
- 7th to 14th day
- face is cyanotic
- veins of neck and head become swollen
- tongue hangs from mouth
- eyeballs protrude
- strings of mucus hang from nostrils
- 3- 10 whoops
- Relief from expectorating tenacious amount
of mucus & vomiting
- As soon as the plug of mucus is expelled, the
paroxysm ends.
• Epistaxis
• Hemorrhage of the anterior chamber of the eye
• Periorbital edema
• Conjuctival hemorrhage
• Increased venous pressure
Repeated paroxysms may cause
* loss of breath
* whooping
* vomiting
* exhaustion to the patient
* perspiration
* dazing
* Anxious
* Congested facies
* Clutch at surrounding objects for support
 - Epistaxis
- Hemorrhage
- Duration of paroxysmal stage is 4-6 weeks
- May vary from 1-8 weeks
6-8 weeks
 Course of the Disease
Convalescence
- decrease in paroxysmal coughing
- no more vomiting
 Type of Disease
• Bacterial Disease- non- motile, Gram negative,
non-spore forming coccobacillus that may form in
capsules
 Complications
• Bronchopneumonia • Epistaxis
• Hernia • Lacrimation
• Hemorrhages • Otitis Media
• Rectal prolapse • Marasmus
• Convulsions • Atelectasis
• Ulcer of the frenum

Sequelae
- TB
- Bronchitis - Bronchiectasis
 Differential Diagnosis
• May be suggested by accompanying
a. Bronchitis
b. Enlarged thymus
c. Enlarged tracheobronchial lymph nodes
Caused by:
- TB
- Laryngismus stridulus- sudden spasm of the
larynx that occurs in children especially in rickets
and is marked by difficult breathing with
prolonged noisy inspiration
 Diagnostic Procedure
• Nasopharyngeal Swabs
• Sputum Culture
• CBC analysis
• Bordet- Gengu test
• Agar plate
• Cough Plate
 Period of Communicability
• Onset of catarrhal symptoms until whoop
appears (7-14 days)
 Treatment
• Fresh air
• Sunshine
• Adequate Nourishing Food
• Phenobarbital (15 mins. before meals)
• Cod-liver oil- General tonic
• Vit. C
• Anoxia
• Sulfadiazine
• Penicillin
• Streptomycin
• Nasal drops
• Areosporin
• Chloromycetin
• Tetracycline
• Chloramphenicol
• Sulfixoazole
 Method of Control
• Cases of Pertussis shall be reported at once
• Preimmunized children should be given
reinforcing injection
• Isolation of 4-6 wks
• Report subclinical or unreported cases
• Public education fro active immunization
 Nursing Diagnosis
• Ineffective airway clearance
• Altered Nutrition: Less than body requirements
• Risk for infection/complication
• Sleep pattern Disturbance
• Alteration in comfort
 Nursing Care
• Isolation
• Comfort of the patient – humidity of 50%
• Fowlers position
• Support patient by placing hand on patient’s
stomach
• Administer Antibiotics
• Care of mouth
• During a paroxysm the patient should not be left
alone
• Ready suctioning equipment at all times
• Sunshine and fresh air are important
• The child should be kept still and quiet
• Provide warm baths and keep bed dry from
soiled linens
• Monitor intake and output closely
• Diet- milk, vegetables, citrus fruits
• Avoid very hot and cold foods, highly
seasoned, spicy
• SOLIDS SHOULD ALWAYS BE GIVEN FIRST
• Refeed patient after vomiting