Whooping Cough

Pertussis

Symptoms and Complications

The disease has three stages. The first stage begins about 10 days after infection and causes symptoms like a common cold - sneezing, watery eyes, tiredness, and loss of appetite. There's also a dry hacking cough.

The second stage occurs after 10 to 14 days and is signaled by a rapid increase in the frequency and severity of coughing. It's this cough that gives the disease its name. Half a dozen or more rapid coughs follow each other in quick succession, followed by a "whooping" sound as the person inhales deep and fast. It may happen hundreds of times in a single day. The coughing may produce large amounts of thick mucus. Sometimes infants swallow it, but it may exit through the nostrils, often forming bubbles. Frequent coughing and mucus can cause vomiting, and choking is a risk in infants. Infants are actually less likely to make the whooping sound than are older children, but they're more likely to have a choking spell. Infected adults rarely whoop - they just cough frequently and spasmodically.

After a month, most people start to look and feel better and cough less. This is the third stage - a gradual recovery taking a few weeks or occasionally a few months. The usual total course of the disease lasts 6 to 10 weeks.

The risk of complications is highest in infants under one year old. There's also potential danger to seniors and those with chronic ill health. Complications include pneumonia, encephalitis (inflammation of the brain), seizures, apnea (brief periods when breathing stops), and hemorrhages (bleeding) in the eye.

Making the Diagnosis

Whooping cough is usually easy to diagnose. A cotton swab on the end of a wire is inserted through the nostril into the nasopharynx (the breathing tube behind the nose), and then cultured or analyzed using laboratory tests to look for bacteria.

Most of the time, the bacteria will show up on this test. This means a few cases won't be diagnosable in the early stages, but once it gets to the second stage, the symptoms will make the nature of the condition obvious. In some cases, the disease runs a milder course and the later symptoms do not develop.

People who have been immunized can still get whooping cough, but they will have much milder symptoms. Chest X-rays may also be taken to check for the presence of fluid or mucus in the lungs.

Treatment and Prevention

Although bacteria cause whooping cough, antibiotics aren't especially effective in treating it unless they're given in the first stage. Very often, the disease isn't recognized until it enters the second stage. Nevertheless, antibiotics such as erythromcyin*, clarithromycin, azithromycin, or sulfamethoxazole - trimethoprim are given at this stage to reduce the possibility of complications, even if they don't cut the duration of the whooping cough itself. Antibiotics may also help to reduce the chances of spreading the infection to others.

Infants with pertussis are often hospitalized, especially those less than 6 months of age. Treatment is designed to minimize symptoms and the damage those symptoms can cause. In the case of heavy vomiting, fluids and electrolytes (e.g., potassium) must be replaced intravenously. In babies, it may be necessary to suck out mucus with a vacuum-like device or to install a nasal breathing tube to help breathing. Extra oxygen may also be necessary. Expectorant and cough-suppressing medications are generally not recommended. Babies with pertussis should be left to sleep as much as possible, since any disturbance or excitement is likely to trigger coughing. In older children, symptoms and risks are much milder, and hospitalization is hardly ever needed.

Most people know there's a vaccine against whooping cough; however, too many people know about it for the wrong reasons. Antivaccine groups and the media have focused on a one-in-a-million chance of encephalitis (severe brain inflammation) occurring in the hours or days after the vaccination, while not addressing the far larger risk of encephalitis and the other potentially severe problems caused by whooping cough in unvaccinated people.

The pertussis vaccination schedule is as follows: babies are given the DTaP (diphtheria - tetanus - pertussis) vaccine at 2 months, 4 months, and 6 months of age to establish basic immunity. They are then given boosters at 15 to 18 months and at 4 to 6 years of age. The DTaP vaccine is often given in conjunction with the polio vaccine and the Hemophilus influenzae type B or "Hib" vaccine (an anti-pneumonia vaccine), since these have a similar schedule as the DTaP vaccine.

Since immunity wears off after 5 to 10 years, a booster dose of Tdap is recommended around the 12th birthday. This will help reduce the chances of getting pertussis during teen and early adult years.

 


*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

John Goldenring, MD, MPH, JD, Pediatrics, Sharp Rees-Stealy Medical Group, San Diego, CA. Review provided by VeriMed Healthcare Network.

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