Whooping cough in children
The content of the article:
- Causes and risk factors
- Symptoms of whooping cough in children
- Diagnostics
- Whooping cough treatment in children
- Potential consequences and complications
- Forecast
- Prevention of pertussis in children
Pertussis in children is an infectious disease characterized by a spasmodic, paroxysmal cough that persists for a long time. The most vulnerable are children in the first year of life. Unlike most other drip infections in children, whooping cough affects even newborns. As a rule, by 4-5 years of age, stable immunity is formed, due to either a previous infection or vaccination.
Causes and risk factors
Pertussis in children is caused by the gram-negative bacillus Bordetella pertussis, which is very unstable in the external environment. When exposed to disinfectants in normal concentration, it dies almost instantly. Direct sunlight destroys its vitality after 60 minutes.
Source: medaboutme.ru
Pertussis is a typical anthroponous infection. Its source is sick people and bacteria carriers. Whooping cough in older children and adults usually occurs in an erased form, which poses a serious epidemiological danger. Patients are contagious to others from 1 to 25 days of the disease. With antibiotic therapy, the duration of the infectious period may be shortened.
The spread of infection occurs exclusively by airborne droplets during coughing (through an aerosol of infected sputum). In view of the extreme instability of the bacillus Bordetella pertussis in the environment, the contact-household route of infection is not observed. Given that the infected aerosol spreads over a short distance (no more than 2 meters), children become infected with whooping cough only when they are in close enough contact with patients.
The susceptibility to whooping cough in children is high. After the transferred disease, stable immunity is formed, usually for life. However, in old age, the tension of the immune system can weaken, which explains the sometimes observed cases of repeated illness.
When infected, whooping cough enters the mucous membrane of the upper respiratory tract and affects the cells of the ciliated epithelium of the bronchi and larynx. The pathogen does not penetrate into deeper tissues and does not spread throughout the body. In the process of life, it produces toxins that cause the development of a local inflammatory reaction.
After the death of pertussis rods and the destruction of their membranes, endotoxin is released, which provokes attacks of spasmodic cough. Later, in children, a focus of excitation is formed in the medulla oblongata, and the cough acquires a central genesis. As a result, a coughing attack can be triggered by various stimuli, for example, prolonged conversation, strong laughter, pain, touch. Excitation from the center of the cough can also go to the neighboring centers of the medulla oblongata. Therefore, after a cough attack, vascular spasm, increased blood pressure, reflex vomiting are sometimes observed. With a severe attack of coughing, children often have clonic or tonic seizures.
The endotoxins of pertussis bacillus and the enzyme adenylate cyclase produced by it contribute to the weakening of the immune system, which, in turn, increases the risk of the formation of a long-term carrier of bacteria or the addition of a secondary infection.
Symptoms of whooping cough in children
The incubation period for whooping cough in children lasts from 3 to 15 days. In the clinical picture of the disease, there are several successive periods:
- catarrhal (prodromal);
- spasmodic (convulsive) cough;
- permissions.
The prodromal period lasts from 2 to 10 days. It is characterized by a runny nose with pronounced mucous rhinorrhea and a moderate dry cough. The general condition remains satisfactory, no signs of intoxication are observed. Gradually there is an increase in cough, it takes on a paroxysmal nature and intensifies at night.
The main symptom of whooping cough in children is a convulsive cough. Its appearance indicates the transition of the disease to the next stage. Coughing attacks become frequent and intense, become spastic in nature.
Older children report symptoms that are precursors of an impending attack:
- anxiety;
- chest discomfort;
- sore throat.
Spastic narrowing of the glottis becomes the cause of the appearance of an elongated wheezing breath, the so-called reprise. In fact, an attack is an alternation of reprises and convulsive cough exhalations. It ends with the discharge of vitreous mucous viscous sputum or reflex vomiting.
Attacks are more likely to occur at night and early in the morning. Due to significant tension on the conjunctiva, the mucous membrane of the oropharynx and the skin of the face, small hemorrhages (petechiae) appear.
Body temperature remains within normal limits. If its increase occurs, this is evidence of the addition of a secondary bacterial infection.
The period of convulsive cough lasts 3-4 weeks, after which pertussis in children gradually enters the resolution phase. The attacks gradually lose their spasmodic character, become shorter, the gap between them lengthens and after a while they completely stop. The duration of the authorization period ranges from several days to several months. This is due to the fact that even after the main symptoms subside, general asthenia and increased nervous excitability of the cough center persist for a long time.
In vaccinated persons, the disease can proceed in an erased form. In this case, a long-lasting cough that is practically not amenable to therapy becomes a sign of pertussis in children. The spastic character of the cough is weak. Vascular spasms, vomiting and reprisals are absent.
During a medical examination, cases of a subclinical course of whooping cough in children can be detected in the focus of infection, a symptom of which is only a recurrent cough.
With the abortive form, whooping cough in children stops at the stage of catarrhal manifestations. There are no fits of convulsive cough, the regression of clinical signs occurs very quickly.
Diagnostics
Diagnosis of pertussis in children is based on a characteristic clinical picture. Confirmation of the diagnosis is carried out by laboratory diagnostic methods based on the detection of whooping cough or its antigens:
- sowing mucus from the throat on selective media (casein-coal agar or glycerin-potato agar with the addition of blood) - sowing should be carried out in the first days of the disease before starting antibiotic therapy;
- detection of pertussis bacillus antigens in pharyngeal mucus by the RIF method;
- detection of antibodies to pertussis antigen (RSK and passive hemagglutination, ELISA);
- reaction of latex microagglutination in the child's saliva samples.
With whooping cough in children, there are also certain changes in the general blood test, which indicate an infectious process in the body (lymphocytic leukocytosis, a slight increase in ESR).
On the roentgenogram of the chest organs, an increased transparency of the lung fields (a sign of emphysema), a flattening of the dome of the diaphragm and an increase in the pulmonary pattern with the appearance of reticulation are determined.
Pertussis in children requires differential diagnosis with other respiratory diseases (ARVI, bronchitis, tracheitis, pneumonia).
Whooping cough treatment in children
Pertussis treatment in children in most cases is carried out on an outpatient basis. Hospitalization is indicated only for severe disease and secondary infection.
The patient should be isolated in a separate room, where wet cleaning is carried out several times a day and ventilated.
Children of the first year of life remain breastfed. At an older age, a dietary table No. 13 according to Pevzner is prescribed. The goals of diet therapy are:
- increasing the body's resistance to infection;
- stimulation of protective forces;
- reduction of intoxication;
- creating optimal conditions for the immune system.
The diet includes:
- dried white bread, uncooked cookies;
- weak fish and meat broths, vegetable and meat puree soups, slimy cereal soups;
- steam cutlets, meat souffle, meatballs;
- steam fish cakes, aspic from fish;
- fermented milk products (fermented baked milk, acidophilus, kefir, cottage cheese, sour cream);
- cheese and feta cheese;
- protein steam omelet, soft-boiled eggs;
- semi-liquid viscous porridge;
- berries and fruits (soft, ripe and sweet);
- some types of sweets (honey, jam, jam, meringue, mousse, jelly, marshmallow, marmalade);
- vegetable and butter;
- tea with lemon, rosehip infusion.
- compotes, fruit drinks, diluted fruit and vegetable juices;
Exclude from the diet:
- fresh rye and wheat bread, baked goods;
- strong and fatty broths;
- fatty meats and fish, sausages, smoked meats;
- legumes;
- canned food, pickles and marinades;
- spicy cheeses, cream, whole milk;
- hard-boiled eggs, scrambled eggs;
- porridge made of corn, barley, yak and millet;
- vegetables with coarse fiber (mushrooms, rutabagas, cabbage, radish, radish, turnip);
- cakes and pastries;
- cocoa and chocolate.
In the catarrhal period, pertussis treatment in children is carried out with antibiotics (macrolides, aminoglycosides) in a weekly course at an average therapeutic dosage. In the early days of the disease, specific anti-pertussis gamma globulin may be prescribed to children simultaneously with antibiotics.
To suppress paroxysmal cough, it is recommended:
- long stay of the child in the fresh air (in calm weather and air temperature not lower than -10 ° С;
- the appointment of sedatives and antihistamines.
For severe coughing attacks, antipsychotics may be prescribed.
The use of antitussives with a central mechanism of action is contraindicated. Mucolytics and expectorants are ineffective, so they are also not prescribed. Banks and mustard plasters are contraindicated, their use can provoke a strong cough attack.
Source: extempore.info
During the period of convulsive cough, HBO (hyperbaric oxygen therapy) has a good therapeutic effect. In addition, physiotherapy is widely used, for example, inhalation of proteolytic enzymes.
In severe pertussis with apnea, theophylline and corticosteroids are prescribed in a short course. With prolonged apnea, chest massage and artificial lung ventilation are performed.
Potential consequences and complications
Severe whooping cough in children can be complicated by hemorrhages under the mucous membranes, in the thickness of the tissues of the internal organs and the brain, as well as the development of emphysema, pulmonary atelectasis, pneumothorax. Described as isolated cases of rupture of the tympanic membrane, hemorrhoids, prolapse of the rectum and rupture of the muscles of the anterior abdominal wall.
Other complications of pertussis in children are associated with the addition of a secondary infection: bronchitis, pleurisy, pneumonia, purulent otitis media.
Forecast
The outlook is generally favorable. Death is extremely rare and only in children with a significantly weakened immune system. With the addition of complications, the course of the disease lengthens. In children of the first years of life, whooping cough can cause the development of chronic lung diseases, including bronchiectasis.
Prevention of pertussis in children
Specific prophylaxis of pertussis in children is carried out by routine vaccination. The course consists of three intramuscular injection of DPT vaccine with an interval of 45 days. The first vaccination is given at three months, revaccination is carried out once every 1.5-2 years. Children over three years of age are not vaccinated against whooping cough.
Active immunoprophylaxis of whooping cough is prescribed for children under 6 years of age who have been in close contact with the patient. Immunoglobulin is injected once, regardless of the time elapsed from the moment of contact.
General prevention of pertussis in children is based on early detection and isolation of cases. If children attending children's organized groups or adults working in preschool or medical institutions have a cough that lasts for more than 5-7 days, then they must be examined for whooping cough.
Source: lechimdetok.ru
Children with whooping cough are isolated for 25 days. If it is not possible to provide a sick child with a separate room, then his bed is covered with a screen that prevents the spread of an infected aerosol in the room when coughing. After the isolation of the patient, the children's team is quarantined for 14 days. In the focus of infection, a thorough current disinfection is carried out.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
