PT causes lymphocytosis
Clinical manifestations
3 stages catarrhal,
paroxysmal,
convalescent stages, each lasting 2 wk.
incubation period from 312 days,
catarrhal symptoms of congestion and rhinorrhea,
low-grade fever,
sneezing, lacrimation, and conjunctival suffusion.
coughing begins -intermittent, paroxysms that are the hallmark of pertussis.
infant begins to choke, gasp, and flail extremities, eyes watering and bulging, face
reddened.
Whoop (forceful inspiratory gasp) - chin and chest held forward, tongue protruding
maximally, eyes bulging and watering, face purple, - loud whoop follows as inspired air
traverses the still partially closed airway.
Post-tussive vomoting is common -clue to the diagnosis
Post-tussive exhaustion
Immunized children also have similar phases
Findings on physical examination
Conjunctival hemorrhages and petechiae on the upper body
Diagnosis
pure or predominant complaint of cough,
fever, malaise or myalgia, exanthem or enanthem, sore throat, hoarseness, tachypnea,
wheezes, and rales ARE ABSENT
young infants with afebrile pneumonia,
B. pertussis is associated with staccato cough (breath with every cough),
cough of 14 or more days' duration
paroxysms, whoop, or post-tussive vomiting
contact with pertussis,
Apnea or cyanosis (before appearance of cough) is a clue in infants younger than 3 mo.
Some times - sudden infant death.
1. Adenoviral infections = fever, sore throat, and conjunctivitis.
2. Mycoplasma = episodic coughing, history of fever, headache, and systemic
symptoms, rales on auscultation of the chest.
3. Chlamydia trachomatis = purulent conjunctivitis, tachypnea, rales or wheezes
4. respiratory syncytial virus = predominant lower respiratory tract signs
Patients are placed in isolation for at least 5 days after initiation of erythromycin therapy.
Whole-Cell Vaccine
Diphtheria and tetanus toxoids combined with whole-cell pertussis (DTP) vaccine prepared from suspension of inactivated B. pertussis bacterial cells-7090% effective in
preventing pertussis disease.
adverse effects
local (e.g., erythema, swelling and pain at the injection site),
fever,
systemic events (e.g., fretfulness, drowsiness, and anorexia).
serious systemic events (e.g., seizures and hypotonic hyporesponsive episodes)
occur in 1/1,750 doses
Acute encephalopathy 1-10 cases in 1 million doses administered
Acellular Vaccine
diphtheria and tetanus toxoids combined with acellular pertussis (DTaP) vaccines
fewer adverse reactions.
Pertussis Toxin is detoxified either chemically or using molecular genetic techniques.
Mild local and systemic adverse effects - high fever, persistent crying of 3 hr or longer
duration, hypotonic hyporesponsive episodes, and seizures occurred less in those who
received DTaP compared with DTP vaccine
Acellular pertussis vaccines are used only upto 6 yr of age.