(Whooping cough)

Pertussis is a highly contagious, usually in children and adolescents occurring disease caused by Bordetella pertussis. is caused. It comes initially to complaints in the sense of non-specific infection of the upper respiratory tract, followed by paroxysmal or spasmodic coughing fits, which usually end in a prolonged, high, “jubilant” Inspiration (panting). The diagnosis is made by the cultural detection of pathogens from the nasopharyngeal, PCR and serological tests. The sessions are held with macrolides.

Pertussis is endemic worldwide. Its incidence varies in the US cyclically every 3-5 years. Pertussis occurs only in humans; there are no animal reservoirs.

Pertussis is a highly contagious, usually in children and adolescents occurring disease caused by Bordetella pertussis. is caused. It comes initially to complaints in the sense of non-specific infection of the upper respiratory tract, followed by paroxysmal or spasmodic coughing fits, which usually end in a prolonged, high, “jubilant” Inspiration (panting). The diagnosis is made by the cultural detection of pathogens from the nasopharyngeal, PCR and serological tests. The sessions are held with macrolides. Pertussis is endemic worldwide. Its incidence varies in the US cyclically every 3-5 years. Pertussis occurs only in humans; there are no animal reservoirs. The transfer gschieht mainly via aerosols of B. pertussis (a small, immobile, gram-negative coccoid rods) from infected patients, particularly during catarrhal and early paroxysmal stage. The infection is highly contagious and causes disease in ? 80% of close contacts. Transmission through contact with contaminated objects is rare. Patients are not infectious usually after the third week of paroxysmal phase. Pertussis is the only vaccine-preventable childhood disease that increases in frequency. In the US case rate in the 1980s at an all time low of about 1 / 100,000, which increased to about 10 / 100000-2014. The increase is due to the decrease in immunity previously vaccinated adolescents and adults and parents who refuse to vaccinate their children (anti-vaccination movement) due. Such unprotected patients can get sick; Moreover, unprotected youth and adults are an important reservoir for B. pertussis and therefore often the source of infection for vulnerable infants <1 year (which had the highest annual incidence increase and the highest fatality rate [1]). In the US, there were 32,971 pertussis cases and 13 deaths in 2014 (2). Deaths occurred in all age groups, but the incidence was in infants <6 months at the largest and most deaths (8 of 13) were <3 months in infants. Most deaths are caused by bronchopneumonia and cerebral complications. In Pertussis also occurs more severe curves in the elderly. Pertussis incidence by age, 2014 Age Number of cases (%) Incidence per 100,000 <6 months 3,330 (10.1) 169 875 6-11 months (2.7) 44.4 1-6 years 6,082 (18.5) 25.1 7-10 year 5,576 (16.9 ) 34 11 - 19 years old 11.159 (33.8) 29.6 ? 20 years 5,839 (17.7) 2.2 Unknown 110 (0.3) N / A Based on the National Center for Immunization and Respiratory Diseases Division of Bacterial Diseases: 2014 Final pertussis Surveillance Report. Centers for Disease Control and Prevention, 2015. A disease does not confer lifelong natural immunity, secondary infections and infections in previously unvaccinated adolescents and adults whose immunity is expired, but usually proceed more easily and are often not even noticed. Illnesses caused by herpes simplex virus respiratory complications, including asphyxia in infants, are most common. There is often otitis media. Bronchopneumonia (which is common in the elderly) can be fatal at any age. Seizures rarely occur in newborns relatively common, but in older children. Hemorrhagic bleeding in the brain, eyes, skin and mucous membranes can result from severe paroxysms and following on anorexia. Cerebral hemorrhage, cerebral edema and toxic encephalitis can cause (mental retardation) or other neurological disorders to a spastic paralysis, diminished intelligence. Sometimes a umbilical hernia or rectal prolapse. Parapertussis This disease is caused by B. parapertussis, and can not be distinguished clinically from a whooping cough, but usually runs easier and less often fatal. Notes 1.Centers for Disease Control and Prevention: The Pink Book: pertussis. 2015. 2. National Center for Immunization and Respiratory Diseases Division of Bacterial Diseases: 2014 Final Pertussis Surveillance Report. Centers for Disease Control and Prevention, 2015. Symptoms and signs The incubation period is an average of 7-14 days (maximum 3 weeks). B. pertussis infects the respiratory mucosa and leads to increased formation of an initially low-viscosity, viscous later and viscous mucus. there will be no complications, the disease lasts about 6-10 weeks and running in three stages from: Catarrhal Paroxysmal convalescent The stage catarrhale begins insidiously, generally with sneezing, tearing, or other signs of a common cold; Anorexia; Listlessness and an annoying staccato, nocturnal cough that slowly shifts to the time of day. Hoarseness may occur. Fever rarely occurs. After 10-14 days, the stage begins paroxysmal, the coughing attacks are more severe and occur more frequently. During a single expiration leads to repeated bouts of ? 5 rapidly consecutive strong coughing, followed by the typical wheezing, rapid, deep inspiration. During or after the spasmodic coughing tougher and viscous mucus can be coughed or blistered expelled from the nostrils. Characteristically, there is vomiting. In children, it can occur (with or without cyanosis) and instead of coughing frequently choking. Pertussis in a child without whooping cough. Pertussis causing paroxysmal cough; only about half of the patients, the classic whooping cough develops. In this recording, the child coughs without inspiration until his lungs are evacuated, it breathes. Between the attack and the inspiration it will be a short break. In severe whooping cough cases this break can be as long to be called apnea; Children can be cyanotic, and apnea can have a life-threatening condition. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'player..'); ko.applyBindings ({MediaUrl '/-/media/manual/professional/sounds/whooping_cough_paroxysm_de.mp3?la=de&thn=0&mw=350', Mime Type: 'audio / wav'}, playerPanel.get (0)); Whooping cough (paroxysm) Audio Recording courtesy of Doug Jenkinson, M.D. Pertussis in a child with whooping cough. Pertussis causing paroxysmal cough; only about half of the patients, the classic whooping cough develops. In this recording, the child coughs without inspiration until his lungs are evacuated, then it breathes one with a cough. The shouting is caused by vocal cord adduction during inspiration. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'player..'); ko.applyBindings ({MediaUrl '/-/media/manual/professional/sounds/whooping_cough_classic_whoop_de.mp3?la=de&thn=0&mw=350', Mime Type: 'audio / wav'}, playerPanel.get (0)); Whooping cough (classic, hi-tech wheezing) Audio Recording courtesy of Doug Jenkinson, M.D. Pertussis in adults with whooping cough. In this recording, the child coughs without inspiration until his lungs are evacuated, then it breathes one with a Rufgeräusch (whoop). The Rufgeräusch caused by adduction of the vocal folds during inspiration. var player panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'player..'); ko.applyBindings ({MediaUrl '/-/media/manual/professional/sounds/whooping_cough_adult_patient_de.mp3?la=de&thn=0&mw=350', Mime Type: 'audio / wav'}, playerPanel.get (0)); Pertussis (adults) Audio Recording courtesy of Doug Jenkinson, M.D. With the start of stage decrementi (usually within 4 weeks after onset of symptoms) the symptoms disappear. The average disease duration is approximately 7 weeks (3 weeks to 3 months or longer). Spasmodic coughing attacks may recur for months, usually induced by an irritation of the respiratory tract due to infection of the upper airways. Diagnosis Nasopharyngeal cultures PCR test The stage catarrhale is often difficult from a bronchitis or influenza to be distinguished. It should also be thought of an infection with adenoviruses or tuberculosis. catarrhale in stage and can paroxysmal early stage B. pertussis are detected in 80-90% of cases culturally in nasopharyngeal secretions. The laboratory should be informed of the suspected pertussis, as special growth media and prolonged incubation are required. Pertussis can be relatively reliably detected in smears of Nasopharynxsekret also using specific antibodies, but this is not as sensitive as the culture. The PCR test from nasopharyngeal samples is the most sensitive and most preferred test. The white blood cell count is usually between 15,000 and 20,000 / ul, but can also inconspicuous, or up to 60,000 / ul be increased, mostly with a 60 to 80% concentration of small lymphocytes. Parapertussis is detected by culture, immunofluorescence antibody test or PCR. Therapy Supportive treatment erythromycin or azithromycin in severely ill children with a hospital stay of airborne insulation is recommended. The insulation is maintained, were given to antibiotics for five days. In children, the aspiration of excess mucus from the nasopharynx can be lifesaving. Occasionally, the administration of O2 and a tracheostomy or nasotracheal intubation is required. Mucolytic agents, antitussives and slight sedation have only a minimal effect. Because even minor disturbances can cause severe paroxysmal cough attacks with anoxia, seriously ill children should transferred to a dark, quiet room and be disturbed as little as possible. Outpatients should be advised of the need for isolation measures for at least 4 weeks after the onset of the disease until the disappearance of symptoms, in particular they should stay away from susceptible children. In stage catarrhale given antibiotics, the symptoms ease. Is it already come to spasmodic coughing, antibiotics, however, are usually not clinically effective, however, still recommended to prevent further spread of the disease. Preferred agents are erythromycin 10-12.5 mg / kg p.o. every 6 hours (max. 2 g / day) for 14 days or azithromycin 10-12 mg / kg p.o. once daily for 5 days. Trimethoprim / sulfamethoxazole, in patients ? 2 months who are intolerant or hypersensitive to macrolide antibiotics, be replaced. Antibiotics should even in the presence of bacterial complications such. As bronchopneumonia and otitis media are given. Prevention The active pertussis vaccination against whooping cough is part of routine childhood vaccinations. It will be administered five doses of acellular pertussis: aged 2, 4 and 6 months (usually combined with diphtheria and tetanus vaccine [DTaP]) as well as a booster dose 15-18 months and 4-6 years. Significant adverse effects from the pertussis component of the vaccine include encephalopathy within 7 days attack with or without fever within 3 days Sustained, heavy, inconsolable crying or wines for ? 3 h collapse or shock within 48 h temperature ? 40.5 ° C within 48 h Immediate severe or anaphylactic reaction These reactions are a contraindication for the continued application of Pertussisimpfstoffs; a combined diphtheria and tetanus vaccine (DT) is also available without the pertussis component. The acellular vaccine is better tolerated than the vaccine previously used, which contains numerous cell components and is the currently available formulation. Neither vaccination nor natural disease confer lifelong protective immunity against pertussis or reinfection. The immunity tends 5 to 10 years after the last dose of vaccine was administered to decrease. A single booster dose of Tdap (includes lower doses of diphtheria and pertussis components as the childhood DTaP) instead of Td for all adults after the age of 19 years (including derjeniger> 65 years) and recommended before pregnancy; the vaccine should be administered during each pregnancy after 20 weeks gestation (preferably between the 27th and 36th week of pregnancy). These newer recommendations are intended to reduce the risk of spread of pertussis of susceptible adolescents and adults to unprotected infants. After a course of infection is made immunity for about 20 years. A passive vaccination is not reliably effective and is not recommended. Close contacts <7 years who have received less than 4 doses of vaccine should be vaccinated. All other contact persons, vaccinated or not, a 10-day antibiotic prophylaxis with erythromycin 500 mg po should 4 times daily or 10 to 12.5 mg / kg p.o. get four times daily. The important points Pertussis is a respiratory infection that can occur at any age, but especially in infants is fatal in children most often and most likely <6 months. A stage catarrhale with URI symptoms is (panting) followed by a paroxysmal stage with repeated bouts of rapid, a consecutive coughing, followed by a rapid, deep inspiration. The illness lasts about 7 weeks, but the cough may last for months. The diagnosis is made with PCR tests or nasopharyngeal cultures; Special media are required. The treatment is carried out with a macrolide antibiotic to the disease to alleviate minimize (in the catarrhal stage) or the transmission (over the paroxysmal stage and later). The disease is prevented with the use of the vaccine against acellular pertussis as part of a planned immunization (including refresher for adults) and close contacts are treated with erythromycin. Neither the disease have yet to be vaccinated provides life-long protection, although a subsequent disease tends to be easier.

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