Whooping cough or pertussis is a contagious respiratory infection. Whooping cough treatment includes medication and healthy eating. Read more at Meri Sehat.

Whooping Cough (Pertussis)

Overview

Pertussis is a highly contagious bacterial infection of the lungs. The symptoms start like the common cold and develop into a more severe cough. People with pertussis (also called whooping cough) gasp for air; long spells of cough can cause vomiting, and lead to broken blood vessels in the eyes or skin.

In most people, pertussis is marked by a severe hacking cough, followed by a high-pitched intake of breath that sounds like a whoop.

Whooping cough was said to be a disease affecting children before the development of the vaccine. Children who are very young to complete a full course of vaccinations are also affected by whooping cough, along with teenagers and adults with faded immunity.

Fatality associated with whooping cough is rare, but it commonly occurs in infants. Therefore, women who are pregnant and others who are in proximity to an infant should be vaccinated against whooping cough. 
&nbsp;

Clinical pertussis has three stages: catarrhal, paroxysmal, and convalescent.

The symptoms of pertussis develop in five to ten days post-exposure; however, sometimes it can be longer. It has an insidious onset with catarrhal symptoms. Moreover, this stage cannot be distinguished from minor infections of the respiratory tract.

The intermittent cough can become paroxysmal, followed by post-tussive vomiting. However, the symptoms of paroxysmal cough can be absent in children and adults who have been vaccinated for pertussis previously.

The paroxysms of cough occur at night and increase in severity when the illness progresses. Even after the paroxysmal cough subsides, non-paroxysmal cough continues for two to six weeks or longer. 
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Signs And Symptoms

When you become infected with whooping cough, it takes seven to ten days for the appearance of signs and symptoms. However, it can take longer. The symptoms are mild in the beginning and resemble the common cold:

<ul>
	<li>Cough</li>
	<li>Runny nose</li>
	<li>Nasal congestion</li>
	<li>Red, watery eyes</li>
	<li>Fever</li>
</ul>

&nbsp;

The signs and symptoms worsen after one week or two weeks. The airway accumulates thick mucus, which causes uncontrollable coughing. Severe, prolonged coughing attacks can trigger the following symptoms:

<ul>
	<li>Vomiting</li>
	<li>Red or blue face</li>
	<li>Causes extreme fatigue</li>
	<li>A high-pitched whoop sound when the infected person breathes after coughing</li>
</ul>

&nbsp;

Many people do not present with the characteristic whoop sound breathing. Hence, sometimes persistent hacking cough is the only sign seen in adolescents and adults who have whooping cough. Moreover, infants don&rsquo;t cough at all. Instead, they struggle to breathe and in some cases, may stop breathing temporarily. 
&nbsp;

Causes

Bordetella pertussis is a bacterium that causes whooping cough. It is transmitted from one person to another when the infected person sneezes, laughs, or coughs. The small droplets with the bacteria are airborne, and you may end up getting sick if you breathe in the droplets.

When the bacteria enter the airways, they attach to the tiny hair that is found in the linings of the lungs. This causes swelling and inflammation, which can lead to dry, and long-lasting cough.&nbsp;

Anyone at any age can get sick with whooping cough. It can last from three to six weeks. 
&nbsp;

Testing is performed with PCR from nasopharyngeal specimens, which are taken within three weeks of the onset of cough. PCR provides accurate results for up to four weeks. However, the bacterial DNA vanishes after the fourth week of cough, which can lead to false-negative results.

A blood test is also used for the detection of pertussis antibodies (IgG, IgA, IgM) produced by the immune system in response to past B. pertussis infection. However, it is not usually performed.&nbsp; 
&nbsp;

Diagnosis

The symptoms of whooping cough are a lot like the common cold, flu, or bronchitis. Therefore, early-onset diagnosis is difficult. Your physician will be able to tell you about it by the sound of your cough. However, tests will confirm it.

&nbsp;

<ul>
	<li>
	<h5>Nose Or Throat Culture</h5>
	</li>
</ul>

A simple swab is taken from the area where your nose and throat meet for the diagnosis of whooping cough.

&nbsp;

<ul>
	<li>
	<h5>Blood Test</h5>
	</li>
</ul>

A high WBC count means that your body is fighting an infection. However, it does not signify that it is specifically whooping cough.

&nbsp;

<ul>
	<li>
	<h5>Chest X-Ray</h5>
	</li>
</ul>

A chest X-ray can show whether you have fluid or inflammation in your lungs, which can be a sign of pneumonia.

&nbsp;

<ul>
	<li>
	<h5>Culture And PCR</h5>
	</li>
</ul>

The diagnosis of pertussis is made by isolating B. pertussis in culture. In addition, a polymerase chain reaction (PCR) can also be performed.

<ul>
	<li>The culture specimen should be obtained within the first two weeks of the cough through a deep nasopharyngeal aspiration.</li>
	<li>Nasopharyngeal specimens should be taken two weeks following the onset of the cough for PCR testing.</li>
	<li>The CDC recommends culture and PCR assay together if the patient is suffering from a cough for more than three weeks<a href="#accordion">[1]</a>.</li>
	<li>Early serial monitoring of WBC counts is necessary. 
	&nbsp;</li>
</ul>

Treatment

The goals of treatment for whooping cough are the following:

<ul>
	<li>The number of paroxysms should be limited.&nbsp;</li>
	<li>The severity of the cough should be observed, and the right assistance should be provided when necessary.</li>
	<li>Maximise resting and healthy eating for optimal recovery.</li>
</ul>

&nbsp;

<h5>Pharmacologic Therapy</h5>

<ul>
	<li>B. pertussis is eradicated faster with antimicrobial agents and antibiotics, preventing the spread.</li>
	<li>The preferred agents are erythromycin, clarithromycin, and azithromycin for patients one month and older.</li>
</ul>

&nbsp;

<h5>Immunization</h5>

Immunization is the best prevention and defense against pertussis. CDC recommends the vaccination as follows:

<ul>
	<li>DTaP vaccine is recommended for the ages 2, 4, 6, and 15-18 months, in addition to 4-6 years. It is not recommended in children who are older than 7 years.</li>
	<li>Tdap vaccine is recommended in children between 7-10 years who are not vaccinated fully. It is given to adolescents between 11-18 years as a single dose and for adults above the age of 19, in addition to pregnant women, regardless of their vaccination history. This also includes repeating the dose of vaccinations in subsequent pregnancies. 
	&nbsp;</li>
</ul>

Whooping cough is dangerous in children, especially those who are younger than six months, because it prevents them from getting sufficient oxygen. This can cause the following:

<ul>
	<li>Brain damage and bleeding in the brain</li>
	<li>Seizures</li>
	<li><a href="https://www.merisehat.pk/disease/pneumonia" target="_blank">Pneumonia</a></li>
	<li><a href="https://www.merisehat.pk/disease/sleep-apnea-91" target="_blank">Apnea</a></li>
	<li>Convulsions</li>
</ul>

If you think your infant may be suffering from pertussis, consult a physician right away. Moreover, children under the age of 18 months should be always under supervision if they have whooping cough. The reason is that coughing can make them stop breathing and young babies with severe symptoms may require hospital care as well. Protect your child by making sure any adults around them are fully vaccinated.&nbsp;

 
Whooping cough in teens and adults can lead to <a href="https://www.merisehat.pk/disease/pneumonia" target="_blank">pneumonia </a>and severe cough can cause the following complications:

<ul>
	<li>Abdominal hernias</li>
	<li>Bruises in the ribs</li>
	<li>Broken blood vessels</li>
	<li>Trouble controlling when you are peeing</li>
	<li>Insomnia</li>
</ul>

Teenagers recover from whooping cough without any problems and the same applies to adults. The complications are due to the side effects of strenuous coughing, which are:

<ul>
	<li>Bruising or cracked ribs</li>
	<li>Hernias in the abdomen</li>
	<li>Broken blood vessels in the sclera of your eyes or blood vessel</li>
</ul>

&nbsp;

<h5>Infants</h5>

Infants under the age of 6 months have the most severe complications of whooping cough, which are:

<ul>
	<li>Slow breathing</li>
	<li>Stopped breathing</li>
	<li><a href="https://www.merisehat.pk/disease/pneumonia" target="_blank">Pneumonia</a></li>
	<li>Dehydration</li>
	<li>Eating difficulties leading to weight loss</li>
	<li>Seizures</li>
	<li>Brain damage</li>
</ul>

Since infants and babies are at the highest risk of whooping cough, they get treated in a hospital. Furthermore, the complications can be fatal for infants over the age of 6 months. 
&nbsp;

The whooping cough vaccine that children receive eventually wears off. This causes susceptibility to the bacterium in adolescence and adulthood.&nbsp; Hence booster doses are recommended.&nbsp;

Infants who have never been vaccinated and are under the age of 12 months are at the highest risk of infection which in some cases can prove to be fatal.&nbsp; 
&nbsp;

The DTaP vaccine can prevent children from getting whooping cough. Infants should get one dose every month for six months and another between fifteen to eighteen months, Furthermore, the last one should be given between 4 to 6 years of age.

Children who are older and adults need the Tdap vaccine and a booster every ten years since immunity wavers with time. It is advisable for pregnant women to get a booster for the protection of their newborn.

Another prevention method is to protect the people around you. If someone is suffering from whooping cough in your house, make sure they cover their mouth while coughing or wear a mask. It prevents the bacteria from spreading. You should also wash your hands regularly.

&nbsp;

<h5>Outlook Of Whooping Cough</h5>

When you get treatment for whooping cough, you start feeling better after four weeks. However, you may continue coughing for three to six months.&nbsp;

&nbsp;

<h5>Get Vaccinated</h5>

The best prevention method for whooping cough is the pertussis vaccine, which is recommended by doctors in combination with two other vaccines diphtheria, and tetanus<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

The vaccine comprises a series of five injections that are usually given to children at the following ages:

<ul>
	<li>2 months</li>
	<li>4 months</li>
	<li>6 months</li>
	<li>15 to 18 months</li>
	<li>4 to 6 years 
	&nbsp;</li>
</ul>

There has been a 91% decrease in the cases of pertussis between December 2021 to May 2022. However, the number of cases increased in May compared to the previous month, and it was less than the 5-year average<a href="#accordion">[3]</a>. 
&nbsp;

Key Points

<ul>
	<li>Pertussis is also called whooping cough, and it is a highly contagious disease of the respiratory system.</li>
	<li>The causative bacterium is called Bordetella pertussis.</li>
	<li>Pertussis is commonly known as a respiratory disease characterized&nbsp;by uncontrollable coughing that can lead to breathing difficulties.</li>
	<li>It is mainly a toxin-mediated disease.</li>
	<li>The initial symptoms include a runny nose and fever, which are also symptoms of the mild flu. The differentiating factor is the sound of the cough, which is like a whoop.</li>
	<li>Whooping cough is a notification priority disease in Pakistan, and relevant local authorities should be contacted immediately.</li>
</ul>

[1] Centers for Disease Control and Prevention, 2017. Best practices for healthcare professionals on the use of polymerase chain reaction (PCR) for diagnosing pertussis.

[2] Di Mattia, G., Nicolai, A., Frassanito, A., Petrarca, L., Nenna, R. and Midulla, F., 2019. Pertussis: New preventive strategies for an old disease. Paediatric respiratory reviews, 29, pp.68-73.

[3] Gopal, D.P., Barber, J. and Toeg, D., 2019. Pertussis (whooping cough). bmj, 364.

[4] Langer, E.J. and Piper, A.I., 1987. The prevention of mindlessness. Journal of personality and social psychology, 53(2), p.280.

[5] Kilgore, P.E., Salim, A.M., Zervos, M.J. and Schmitt, H.J., 2016. Pertussis: microbiology, disease, treatment, and prevention. Clinical microbiology reviews, 29(3), pp.449-486.