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دانشجویان پزشکی 87 کرمان
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دانشجویان پزشکی 87 کرمان

 Pertussis Syndrome


ETIOLOGY

 

  • Bordetella pertussis and certain other infectious agents. 
  • Classic pertussis, whooping cough syndrome, is caused by B. pertussis, a gram-negative pleomorphic bacillus with fastidious growth requirements
  • infect only humans
  • transmitted person to person by coughing.
  • Adenoviruses have been associated with pertussis syndrome


EPIDEMIOLOGY

 

  • The mean incubation period is 6 days.
  • Patients are most contagious during the earliest stage.
  • The peak age is less than 4 months of age-among infants too young to be completely immunized and most likely to have the complications of pneumonia and severe infection that are associated with a high mortality rate 


CLINICAL MANIFESTATIONs

 

children between 1 and 10 years of age:

  • catarrhal stage is marked by nonspecific signs (injection, increased nasal secretions, and low-grade fever) lasting 1 to 2 weeks.
  • paroxysmal stage is the most distinctive stage of pertussis and lasts 2 to 4 weeks. Coughing occurs in paroxysms during expiration, causing young children to lose their breath. The forceful inhalation against a narrowed glottis that follows this paroxysm of cough produces the characteristic whoop. Post-tussive emesis is common.
  • convalescent stage is marked by gradual resolution of symptoms over 1 to 2 weeks. Coughing becomes less severe, and the paroxysms and whoops slowly disappear. Although the disease typically lasts 6 to 8 weeks, residual cough may persist for months

 

Infants:

  • may not display the classic pertussis syndrome. The first sign in the neonate may be episodes of apnea. Young infants are unlikely to have the classic whoop, more likely to have central nervous system (CNS) damage as a result of hypoxia, and more likely to have secondary bacterial pneumonia.

Adolescents:

  • and adults with pertussis usually present with a prolonged bronchitic illness with persistent, nonproductive cough that often begins as a nonspecific upper respiratory tract infection.

 

LABORATORY

 

 

    • lymphocytosis is present in 75% to 85%.

    • WBC may increase from 20,000 cells/mm3 to more than 50,000 cells/mm3

    • It is not unusual for physical and radiographic signs of segmental lung atelectasis to develop during pertussis, especially during the paroxysmal stage. Perihilar infiltrates are common and are similar to what is seen in viral pneumonia


 

DIFFERENTIAL DIAGNOSIS

 

For a young child with classic pertussis syndrome, the diagnosis based on the pattern of illness is quite accurate.

 The paroxysmal stage is the most distinctive part of the syndrome.

  • infants :Respiratory viruses such as RSV, parainfluenza virus, and Chlamydophila pneumoniae can produce bronchitic.
  • In older children and young adults: Mycoplasma pneumoniae may produce a prolonged bronchitic illness that is not distinguished easily from pertussis in this age group.

 

TREATMENT

 

Erythromycin, clarithromycin, or azithromycin are recommended for children under 1 month of age.

Azithromycin should be used in neonates due to the association of erythromycin treatment and the development of pyloric stenosis.

Treatment is not effective in the paroxysmal stage.

COMPLICATIONS

 

hypoxia, apnea, pneumonia, seizures, encephalopathy,  malnutrition. Pneumonia Atelectasis . pneumomediastinum, pneumothorax, or interstitial or subcutaneous emphysema; epistaxis; hernias; and retinal and subconjunctival hemorrhages. Otitis media.

 

Most permanent disability is a result of encephalopathy


PREVENTION

 


  • Close contacts under 7 years of age who have received only four doses of vaccine should receive a booster dose of DTaP (unless a booster dose has been given within the preceding 3 years) and a macrolide antibiotic for 10 to 14 days.
  • Close contacts 7 years of age and older should receive prophylactic macrolide antibiotic for 10 to 14 days and Tdap, although the effectiveness of this strategy has not yet been determined.

 




طبقه بندی: پزشکی، 
[ پنجشنبه 10 بهمن 1392 ] [ 01:15 بعد از ظهر ] [ گرند راند ]
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