Pertussis and paraakkossh in children and adults - acute infectious diseases, clinically little distinguishable from each other. Important signs of disease: damage to the respiratory tract, central nervous system, cyclic flow.
The main symptom : bouts of a convulsive barking cough that ends with a loud hissing and the release of viscous viscous sputum, and sometimes vomiting. And yet, there is a difference between whooping cough and the parakoklushem. With pertussis, the leading clinical symptom is a spasmodic cough, paracoccosis is similar, but it is much easier.
Causes, prognosis, causative agent of
Pertussis for a long time was one of the most common and severe diseases in children and ranked among the first among other airborne infections in terms of morbidity and mortality. So it was before the introduction of active immunization, which became an important historical stage in the fight against pertussis infection.
Pertussis for young children is very dangerous, often leads to severe impairment of the respiratory and nervous systems. It is in this age group that there are more lethal outcomes.
The causative agent of whooping cough is a pertussis stick that is not resistant to environmental influences, is not highly volatile, does not spread from one room to another, remains in sputum for no more than two hours, quickly dies during drying, ultraviolet irradiation, under the influence of disinfectants.
The viability of a paracutaneous microbe in contrast to a pertussis microbe is large, it early develops resistance to antibiotics. Clinical manifestations of paraconiae resemble the light forms of pertussis and can have not only sporadic, but also epidemic character.
The absence of congenital immunity to whooping cough combined with a high susceptibility index( up to 60-90%) contributes to pertussis disease in young children, including newborns and prematurity, i.e.susceptibility to pertussis is almost absolute and from birth.
The source of the infection is a sick person. Infectiousness is greatest at the very beginning of the disease. For newborns, the greatest epidemiological importance is for adults. Currently there is an increase in the incidence of whooping cough in adults, but the correct diagnosis is made only with a targeted epidemiological and laboratory study.
Recently, cases of pertussis infection of children from mothers, fathers, grandmothers, grandfathers, nurses have become more frequent. As sources of infection play a role and patients with erased forms, as for years of specific prevention, light and erased forms of the disease( 95%) began to predominate. A third of the patients do not consult a doctor, since there is no significant impairment of health. It has now been established that carriers of pertussis( 1-1.5%) and paracolous( 10-15%) rods after 10 years can be identified in the foci of infection among vaccinated children( and whooping with whooping cough).
Transmission of the infection occurs by airborne droplets. Infection is possible only with direct and more or less prolonged communication with the patient. Infection through things and third parties due to the low stability of the pathogen in the external environment is of no practical importance.
The highest incidence of pertussis is observed in children under the age of 9 years and older. Paracocchemia is more common in children 3-6 years of age.
After the transferred disease, lifelong immunity remains. It is produced after vaccination, but less stable, in some cases does not protect against the disease, so for its maintenance, revaccination is carried out. Pertussis occurs in these cases in the form of light and erased forms.
Seasonality for whooping cough is not typical - it can occur at any time of the year. Paraculation is characterized by pronounced seasonal increases in incidence in autumn and winter.
Forms of whooping cough: symptoms and coughing in a child and adult
Identify typical, atypical( erased) forms of pertussis and bacteriocarrier.
Typical species include diseases with a spasmodic cough.
Within a typical pertussis, four periods are distinguished:
- spasmodic cough;
- solution, or reverse development.
The incubation period varies from 2 to 14 days( an average of 5-8 days).
Cough with whooping cough: the main symptom - a fit of cough
The catarrhal period lasts from 7 to 21 days, an average of 10-18 days. Begins whooping cough with a cough that is not much different from coughing with catarrh of the respiratory tract, any etiology. Cough is usually dry, obtrusive, occurs more often at night or before bedtime. The temperature remains normal or within a few days - subfebrile. The state of health, as a rule, does not suffer. Cough gradually intensifies, acquires an increasingly stubborn, obtrusive character, and then paroxysmal. The disease passes into the second period.
In the period of spasmodic cough, a cough-like cough appears, symptomatology reaches its maximum development. The paroxysmal cough is characterized by a series of rapidly exhaling tremors followed one after the other, followed by a convulsive sibilant inspiration-reprise. During a cough, the child's face becomes red or cyanotic, the veins of the neck are dilated, the tongue protrudes from the mouth, often the bridle of the tongue is injured. The attack ends with the release of viscous vitreous sputum, sometimes at the end of the attack, vomiting occurs. During the attack the child is nervous. There may come a stop in breathing followed by asphyxiation. There may be a hemorrhagic syndrome of varying severity. Appears puffiness of face and eyelids.
The period of a convulsive cough lasts 3-4 weeks, then the attacks become less frequent and disappear, although the "usual" cough lasts another 2-3 weeks( the resolution period).
There are light, medium and heavy forms. The severity of whooping cough is determined at the height of the convulsive period by the number of seizures. The severe form is usually in the non-vaccinated children of the first half of life.
To the mild forms of typical pertussis include diseases in which the number of coughing attacks does not exceed fifteen per day and the general condition is not disturbed or is disrupted to a small extent. With the mild form of modern pertussis, the number and severity of seizures are reduced. More often they do not exceed 10, almost half of the sick people - 5 times a day, less often - up to 15 times.
Reprises are observed only in half of patients, vomiting - not at all and only at separate attacks of a cough, an easy cyanosis of a nasolabial triangle - at units. More moderate puffiness of face and eyelids is more constant. Hemorrhagic syndrome is observed rarely in the form of individual petechiae on the skin.
Pathological manifestations on the part of the respiratory system can be limited to emphysema of the lungs, there are no rales.
Changes in blood, characteristic for whooping cough, are minimal - a slight tendency to increase the number of leukocytes and lymphocytes and for diagnostic purposes they do not help.
Spasmodic period with mild form is long - an average of 4.5 weeks, the resolution period is 1-2 weeks. Cough in the period of resolution loses its typical character, becomes less frequent and easier.
When the form is moderate, the number of seizures increases to 16-25, they are longer, with more reprises. Sometimes seizures may be more rare, but severe, with frequent reprises and a marked deterioration in the general condition( excitability, irritability, lethargy, sleep disturbance).The long period is shorter( 7-9 days), the spasmodic period is 5 weeks and longer. Coughing attacks are protracted( with cyanosis of the face), weakening the child. Respiratory failure may persist outside of coughing attacks. The puffiness of the face is almost constant, the signs of hemorrhagic syndrome are more evident.
In the lungs dry and variegated moist wheezing is heard, which can disappear after a fit of cough and after a short time again appear. With this form, changes on the part of the blood are more constant( absolute and relative increase in lymphocytes with normal or decreased ESR).
In severe cases, coughing attacks increase to 30 or more per day, they last for several minutes, accompanied by many reprises, cyanosis of the face. Patient's state of health is sharply disrupted, marked respiratory failure is observed. In the lungs, a large number of differently-moist, wet wheezes are usually heard. More common symptoms are cardiovascular disorders, puffiness of the face, sometimes swelling of the hands and feet, petechiae on the face and upper body, bleeding in the sclera, nosebleeds, increased blood pressure. It is possible to raise the temperature to high figures. Changes in the peripheral blood expressed - hyperleukocytosis, the specific weight of lymphocytes can be 70-90%.
In children with central nervous system damage and with the combination of pertussis with influenza, there may be encephalic disorders with spasms of clonic and clonic-tonic nature, depression of consciousness, sometimes development of coma. Prolonged respiratory arrest and severe encephalic disorders are the most dangerous manifestations of whooping cough, which can lead to death.
Atypical form is characterized by a dry, not typical for whooping cough, observed mainly at night, the absence of a consistent change in the periods of the disease. The temperature rises rarely, catarrhal phenomena are poorly expressed. Duration of cough from 7 to 50 days, on average - 30 days.
Bacteriosis in pertussis occurs in 1-2% of children after 10 years of age who are vaccinated against whooping cough or who have recovered from this infection. Its duration does not exceed two weeks. In young children, bacteriocarrier is very rare.
Pertussis in newborns and infants
Children of the first months of life have a number of features of pertussis:
- incubation and catarrhal periods can be reduced to 3-5 days;
- spasmodic cough does not always have characteristic reprises and consists of attacks of short, but persistent coughing jerks accompanied by cyanosis;
- in connection with the overexcitation of the respiratory center and the spastic condition of the respiratory musculature, respiratory arrest may occur-apnea, usually short-term. They occur more often and can be prolonged in premature infants and in children with central nervous system damage. Following the onset of asphyxia, convulsions may occur with the subsequent development of encephalopathy;
- the course of the disease is characterized by great durability and undulation;
- more often there are complications from the lungs and the central nervous system.
In severe pertussis may be various complications:
- nosebleeds, conjunctival hemorrhage, retina, sometimes in the brain with the development of central paralysis;
- from the side of the lungs - emphysema, atelectasis;
- in case of cerebral circulation disorders - seizures and encephalopathies;
- in the layering of the coccal flora - bronchitis, bronchiolitis, pneumonia, pleurisy.
Diagnosis of typical pertussis
In adults, complications are rare. To diagnose typical pertussis, it is possible to use disputable diagnostic features:
- contact with sick whooping cough, the presence of long-coughing faces in the environment;
- dry, persistent, persistently increasing cough at normal temperature and absence of other catarrhal phenomena;
- recurrent vomiting after cough;
- characteristic "sunsets" with reprises( pathognomonic sign);
- leukocytosis with an increase in the number of lymphocytes;
- attacks of apnea in children of the first months of life.
When diagnosing erased forms, it is necessary to consider:
- epidemiological data;
- obsessive nature of cough, its increase in the second - third week;
- cough suppression at night;
- duration of cough in the absence of temperature, catarrh of the upper respiratory tract and bronchopulmonary changes that could explain the persistence of coughing;
- detection of pertussis microbes in crops.
Treatment of pertussis and paracottitis in children and adults
Hospitalization of the child
Hospitalization is primarily for children in the first half of the year with severe illness due to the risk of developing apnea and serious complications. Hospitalization of older children is carried out in accordance with the severity of the disease and for epidemic reasons. In the presence of complications, indications for hospitalization are determined by their severity, regardless of age. It is necessary to protect patients from superinfection.
Severe manifestations of pertussis infection( deep respiratory distress and encephalic syndrome) require resuscitation because they can be life threatening.
The Chinese call pertussis a "one hundred-day cough", which indicates the duration of this disease. Cough can last more than three months. Attempts to treat fantastic patients with pertussis by fantastic means( transport in open cars through railway tunnels, lift on an airplane, placement in a pressure chamber) did not in all cases facilitate the disease.
At all times in the treatment of patients with whooping cough, clinicians paid much attention to the general hygiene principles - regimen, care and nutrition.
The erased forms of whooping cough do not require treatment. It is sufficient to eliminate external stimuli to ensure peace and a longer sleep with sick pertussis.
With mild forms, you can limit yourself to long-term exposure to fresh air and a small amount of symptomatic measures at home. Walking should be daily and long.
The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees.
What to do if you have a coughing fit in a child
During a fit of a cough, you have to take the baby in your arms, slightly lowering his head.
When mucus accumulates in the mouth, the child's mouth should be released with a finger wrapped in clean gauze.
It is recommended to feed the patient often and gradually. The food should be high-grade and high-calorie and fortified. With frequent vomiting, the child should be fed 20-30 minutes after vomiting.
Antibiotics are indicated in young children, with severe and complicated forms of pertussis, with concomitant diseases in therapeutic doses for 7-10 days. The best effect is provided by ampicillin, gentamicin, erythromycin. Antibiotic therapy is effective only in the early periods of uncomplicated pertussis, in catarrhal and not later than the 2nd-3rd day of the convulsive period of the disease.
The appointment of antibiotics in the spasmodic period of whooping cough is indicated by the combination of pertussis with acute respiratory viral diseases, bronchitis, bronchiolitis, and chronic pneumonia. One of the main tasks is the fight against respiratory failure.
Treatment of newborns and infants
The most important therapy for severe pertussis in children is the first year of life. Oxygen therapy is necessary with the systematic supply of oxygen, cleaning the respiratory tract from mucus and saliva. When you stop breathing - sucking off mucus from the respiratory tract, artificial ventilation. When signs of brain disorders( tremors, short-term convulsions, worsening anxiety) are prescribed seduxen and for dehydration - lasix or sulfurous magnesia. Intravenously injected from 10 to 40 ml of a 20% solution of glucose with 1-4 ml of a 10% solution of calcium gluconate, to reduce pressure in the small circle of circulation and to improve the bronchial patency - euphyllin, children with neurotic disorders - bromide preparations,luminal, valerian.
In the treatment of whooping cough, antihistamines( dimedrol, suprastin, tavegil), inhalation aerosols of proteolytic enzymes( chymotrypsin, chymotrypsin), which facilitate the passage of viscous sputum, mucaltin, are used.
From non-traditional therapies the following composition can be used: 500 g of peeled and crushed onion, 50 g of honey, 400 g of sugar cooked in one liter of water over low heat for three hours. Liquid cool and pour into a clogged bottle. Take 4-6 tbsp.l.in a day.
Paracolitic treatment is symptomatic.
Pertussis: coughing in a child
In the video, you will see a fit of coughing in a small child.
Whooping cough: childhood illnesses in adults: symptoms and treatment
Whooping cough is an infectious disease, the main symptom of which is a violent cough lasting for weeks, often resulting in vomiting, is traditionally considered a childish illness. In the next issue of the heading "About medicine", the presenters will tell you why adults are more often affected by whooping cough, how dangerous this disease is, and how to prevent infection.
How to treat cough with whooping cough in a child?- Dr. Komarovsky
Doctor Komarovsky will tell you how to treat cough with whooping cough and how to relieve the child's condition.
About paracut and pertussis Komarovsky EO: symptoms and treatment in children
Dr. Komarovsky will talk about such childhood diseases as whooping cough and parakoklysh. About pertussis Komarovsky EO
What cough is with whooping cough?- Doctor Komarovsky
Doctor Komarovsky will describe and show what kind of cough is typical for whooping cough.
Source: "Encyclopedia of Traditional and Alternative Medicine", electronic version of the site Librarian.ru