WHOOPING COUGH

  

Whooping cough

 This is due to respiratory droplet infection caused by bordetella pertussis. The disease most commonly affects infants, fifty percent cases occurring before the age of two years . Incubation period is 7-17 days. Classically there are three stages.

Catarrhal stage:

This is chracterised by anorexia, malaise, lacrimation and cough more at night, followed by paroxysmal stage. The infectivity is greatest during this stage..

Paroxysmal stage:

This appears 10-14 days later characterized by bouts of cough ending in a whoop. Vomiting is common during paroxysmal attacks. Paroxysms may vary from 1-2 to 40-50 per day. The cojunctiva are deeply engorged. Epistaxis is common. Subconjunctival haemorrhage and periorbital oedema may develop. Infants may be cyanotic.

Physical signs of bronchitis may be found in the chest .

Stage of convalescence:

One to several weeks later cough becomes less frequent and sputum less tenacious.

Complications include bronchopneumonia, segmental or lobar collapse, bronchiectasis, subconjunctival or periorbital haemorrhage, prolapse of the rectum.

Bordetella pertussis may be isoloated by culture of nasal swabs or cough plates in 50% cases nasopharyngeal swabs yield higher result.

Treatment

1. Nursing is best carried out by mother.

2. During spasm:

           (a)  Lift the child immediately from the cot.

           (b) Hold the baby in head down position.

           (c) Put the back till the spasm is over.

3. Feed should be small and frequent preferably immediately after the spasm. This should mainly consist of milk. Sticky food should be avoided.

4. Drugs:

   (a) Tr. belladonna and syr. Codeine phos may be given in       
        appropriate doses for the control of spasm.

          

   (b) Erythromycin or ampicillin, 50mg/kg daily orally for 14

         days. Erythromycin is preferable.

         

    (c) Azithromycin 500 mg 1^st day then 250 mg/d for 5 days

    (d) Clarithromycin 250 mg/d for 5 days or

          

    (e) Dirythromycin 500 mg single dose.

          

    (f) For complications like bron chopneumonia,erythromycin

         ampicillin should be given or the drug should be decided
         apon bacterial sensitivity report.

         

    (g) For penicillin resistant staphylococcus use cloxacillin,
         50mg/kg in 6 hourly divided  doses.

5. Postural drain age and physiotherapy for atelectasis .