Whooping cough analysis transcript 1 20. Questions

Whooping cough is an acute infectious disease caused by B. pertussis, transmitted by airborne droplets and characterized by a cyclical course, as well as the presence of convulsive paroxysmal cough.

Many domestic pediatricians, including infectious disease specialists, view whooping cough as a problem of yesterday. And this is not surprising if we remember that back in the middle of the 20th century, the incidence of whooping cough in the USSR was 428 people per 100 thousand population with a very high mortality rate (0.25%). But decades later, thanks to the ongoing and ongoing vaccine prevention, the incidence decreased by 25 times, and the number of deaths by a thousand times. Subsequently, the dynamics of the disease became even, without sharp ups and downs. In recent years, the incidence of whooping cough has continued to decline further. Thus, in the Russian Federation in 2004, 11,099 people fell ill (7.7 per 100 thousand population), among them 10,315 children (44.6 per 100 thousand child population). In megacities such as Moscow and St. Petersburg, the number of registered cases of whooping cough is traditionally higher than in Russia as a whole. The incidence of whooping cough in 2004 in St. Petersburg was 29.1 cases per 100 thousand population and 214.4 per 100 thousand children. This is due to a number of objective reasons, including migration processes, high population density, which increases the intensity of the epidemic process with an airborne transmission mechanism. Noteworthy is the increase in the incidence of whooping cough in recent years among children aged 7-14 years (mostly mild and atypical forms), which are a source of infection for the younger age group. The epidemic alertness of doctors regarding this infection appears to be reduced, which leads to late diagnosis of whooping cough in both children and adults and aggravates both the immediate and long-term outcomes of the disease.

Whooping cough is caused by the aerobic, nonmotile, gram-negative bacterium Bordetella pertussis. The pathogen is fastidious, and it is cultivated on special media (casein-charcoal, potato-glycerin agar). On blood agar, bacteria grow slowly, forming small grayish shiny colonies by the 3rd day. Cephalexin is currently added to the medium to suppress the growth of competitive microflora.

B. pertussis It is very unstable in the external environment, so sowing on the medium must be done immediately after taking the material. Under influence disinfectants B. pertussis dies quickly, but can survive in dry sputum for several hours.

B. pertussis has eight agglutinogens, the leading of which is 1.2.3. Depending on the presence of leading agglutinogens, it is customary to distinguish four serotypes (1.2.0; 1.0.3; 1.2.3 and 1.0.0). Moreover, in the last decade, serovars 1.2.0 and 1.0.3 have been predominant, isolated from vaccinated children with mild and atypical forms of the disease. At the same time, serovars 1.2.3 are isolated from unvaccinated children primarily early age, in whom the disease occurs more often in severe and less often in moderate form.

The main components of the bacterial wall of the causative agent of whooping cough are: pertussis toxin - exotoxin, as well as filamentous hemagglutinin (FHA) and protective agglutinogens, adenylate cyclase toxin, tracheal cytotoxin, dermonecrotoxin, BrKa - outer membrane protein, endotoxin (lipopolysaccharide), histamine-sensitizing factor.

The reservoir and source of infection is a sick person who poses a danger from the end of the incubation period; The patient is maximally contagious from the moment the clinical manifestations of the disease develop. It is believed that in the preconvulsive period, as well as during the first week of spasmodic cough, 90-100% of patients secrete the causative agent of the disease. Subsequently, the frequency of excretion of the pathogen rapidly decreases and does not exceed 10% by the 3-4th week of the spasmodic period. Great danger for children's organized groups they represent children and adults who suffer from the disease in an erased form. Carriage of the causative agent of whooping cough is usually short-lived and does not have significant epidemiological significance.

The transmission mechanism is aerosol; transmission route is airborne.

Despite the massive release of the pathogen into the external environment, due to the coarse nature of the released aerosol, transmission of the microbe is possible only through close contact with the patient. In this case, infection occurs at a distance of no more than 2 m from the source of infection. Due to the instability of the pathogen in the external environment, transmission through household items, as a rule, does not occur.

Susceptibility to infection is high - the infectivity index ranges from 0.7 to 1.0. Whooping cough is characterized by an autumn-winter rise in incidence with a peak in December-January. Periodic ups and downs with intervals of 3-4 years are typical. Repeated cases are usually recorded in elderly people or are the result of erroneous diagnosis in children. The mortality rate is currently 1-2% in developing countries, and 0.04% in developed countries.

The entry point for infection is the mucous membranes of the respiratory tract. The pathogen colonizes the cells of the cylindrical ciliated epithelium of the larynx, trachea and bronchi. However, it does not penetrate cells and does not disseminate in the bloodstream. Exotoxin (its A and B components) and endotoxin (lipopolysaccharide) play a decisive role in the mechanism of respiratory tract damage. The last one formed after death B. pertussis, causes the development of spasmodic cough, causes lymphocytosis, hypoglycemia, and increased sensitivity to histamine. The decrease in the threshold of sensitivity to histamine persists much longer than the presence of the pathogen on the mucous membrane, which explains the development of bronchospasm over several weeks. The cough reflex is gradually consolidated in the respiratory center of the medulla oblongata, coughing attacks become more frequent and intense. This is due to irritation of the receptors of the afferent fibers of the vagus nerve, impulses from which are sent to the region of the respiratory center. All this leads to the formation in the region of the medulla oblongata of a stagnant focus of excitation, characterized by signs of a dominant (according to A. A. Ukhtomsky). The main signs of a dominant focus are: the possibility of irritation of excitation to neighboring subcortical autonomic centers (emetic, vasomotor and the center of tonic innervation of skeletal muscles), as well as the persistence of the focus of excitation with long-term preservation of activity and the likelihood of transition to a state of holding and stopping breathing.

Unlike other acute childhood infections, with whooping cough there is no primary toxicosis with a pronounced temperature reaction and clear primary signs of the disease. The disease is characterized by a slow cyclical course, reaching its climax only 2-3 weeks after the appearance of the first symptoms of the disease. It is customary to distinguish between typical and atypical forms of whooping cough. Typical variants of the disease include those in which the cough has a paroxysmal character, regardless of whether it is accompanied by recurrences or not.

Complications of typical whooping cough are as follows.

• Associated with pertussis infection:

  a) damage to the bronchopulmonary system:

  pneumopertussis; pulmonary atelectasis;

  b) damage to the cardiovascular system: cor pulmonale; subconjunctival hemorrhages; hemorrhage into the bottom of the fourth ventricle;

  c) encephalopathy.

• Associated with secondary flora:

  a) bronchitis and bronchiolitis;

  b) pneumonia.

The criteria and severity of typical whooping cough are reflected in .

Atypical are the forms in which whooping cough is not spastic in nature. These include abortive, erased and asymptomatic forms.

In typical cases, the following periods are distinguished: incubation, preconvulsant (catarrhal), convulsive (spasmodic), period of reverse development - early (2-8 weeks) and late (2-6 months) convalescence. The severity criteria for typical forms of whooping cough are:

• duration of the prodromal period;
• frequency of coughing attacks;
• presence of facial cyanosis when coughing;
• the appearance of facial cyanosis in the early stages of the disease (1st week);
• preservation of hypoxia phenomena outside of coughing attacks;
• disorders of the cardiovascular system;
• encephalic disorders.

Mild forms of typical whooping cough include diseases in which the number of coughing attacks does not exceed 15 per day, and the general condition is disturbed to a slight extent.

The incubation period lasts from 3 to 14 days (on average 7-8 days). The preconvulsant period begins unnoticed and gradually. Against the background of satisfactory condition and normal or low-grade fever a dry, obsessive cough appears, which intensifies before bedtime, in the first hours of the night, despite symptomatic therapy. The child’s well-being and behavior do not change significantly. Symptoms that suggest whooping cough during the catarrhal period include:

• cough - persistent, continuously progressing, despite symptomatic therapy;
• in the presence of a cough - hard breathing in the lungs, wheezing is not heard, percussion - slight tympanitis;
• pallor of the skin due to spasm of peripheral vessels, slight swelling of the eyelids;
• in peripheral blood there may be leukocytosis (15-40x10 9 / l), absolute lymphocytosis with normal ESR.

The duration of the preconvulsive period ranges on average from 3 to 14 days (on average 10-13 days), the longest in vaccinated children, the shortest in children in the first months of life.

During the period of spasmodic cough, paroxysmal cough becomes dominant, clinical symptoms reach their maximum development. Short coughing bursts follow one after another during one exhalation, followed by an intense and sudden inhalation, accompanied by a whistling sound (reprise). The number of such cycles in one period can vary from 2 to 15 or more. In these cases, the doctor is presented with a well-known bleak picture - the child’s position is forced, his face is red or becomes cyanotic, his eyes are “bloodshot”, watery, the tongue seems to be pushed out to the limit and hangs down, while its tip is bent upward. The veins of the neck, face, and head swell. As a result of traumatization of the frenulum of the tongue by the lower incisors (or gums), some children experience tearing and the formation of ulcers, which are symptoms pathognomonic for whooping cough. The attack ends with the discharge of viscous, thick, glassy mucus, sputum or vomiting. The combination of coughing attacks with vomiting is so typical that whooping cough should always be assumed even in the absence of recurrences. It is possible to concentrate coughing attacks over a short period of time, i.e., the occurrence of paroxysms. Reprises, considered in previous years as an obligatory symptom of typical whooping cough in children over one year of age, are currently recorded only in every second child. In the intervals between attacks, upon careful examination, the doctor pays attention to the puffiness and pastiness of the face, swelling of the eyelids, pallor of the skin, perioral cyanosis, and signs of pulmonary emphysema. Subconjunctival hemorrhages and petechial rash on the face and neck are possible. Typical is the gradual development of symptoms with a maximum increase and severity of convulsive coughing attacks in the 2nd week of the convulsive period. At the 3rd week, specific complications are observed, and at the 4th week, nonspecific complications are observed due to the development of secondary immunodeficiency.

During the convulsive period, changes in the lungs are most pronounced: a tympanic shade of percussion sound, its shortening in the interscapular space and lower sections, dry and moist (medium-, coarse-bubbly) rales are heard over the entire surface of the lungs. Characteristic changes in the lungs are the disappearance of wheezing after a coughing attack and reappearance after a short period of time over other pulmonary fields. X-rays reveal signs of pulmonary emphysema: horizontal position of the ribs, increased transparency of the pulmonary fields, low location and flattening of the dome of the diaphragm.

The period of reverse development (early convalescence) lasts from 2 to 8 weeks and is marked by the gradual disappearance of the main symptoms. The cough loses its typical character, occurs less frequently and becomes easier. The child’s well-being and condition improve, vomiting stops, the child’s sleep and appetite are normalized.

The period of late convalescence lasts from 2 to 6 months. During this period, the child remains hyperexcitable, and trace reactions are possible (“relapse” of convulsive paroxysmal cough with significant physical exertion and with the accumulation of intercurrent respiratory diseases).

Recently, atypical forms of the disease have become increasingly common.

Abortive form: the catarrhal period is followed by a short-term (no more than 1 week) period of convulsive cough, followed by recovery.

Erased form: characterized by the absence of a convulsive period of the disease. Clinical manifestations are limited to the presence of a dry, obsessive cough in children. It is observed in those who were previously inadequately immunized or who received immunoglobulin during the incubation period. This form is the most dangerous epidemiologically.

Asymptomatic form: characterized by the absence of all clinical symptoms, but at the same time there is a culture of the pathogen and/or a significant increase in titers of specific antibodies or IgM-associated antibodies are detected.

It must be emphasized that atypical forms of the disease are usually recorded in adults and vaccinated children.

Based on severity, it is customary to distinguish between mild, moderate and severe forms of whooping cough.

In addition, smooth and non-smooth course of the disease is distinguished. In the second case, the presence of complications, the layering of a secondary infection, and the exacerbation of chronic diseases are implied.

Features of whooping cough in young children

The high level of morbidity in young children and the severity of the disease dictate the need to dwell on the characteristics of clinical manifestations in this category of children.

• Severe and moderate forms of the disease predominate, with a high probability of death and severe residual effects (chronic bronchopulmonary diseases, delayed psychomotor development, neuroses, etc.).
• The incubation and catarrhal periods are shortened to 1-2 days and often go unnoticed.
• The period of convulsive cough is extended to 6-8 weeks.
• Coughing attacks may be typical; repeated episodes and protruding of the tongue are observed much less frequently and are not clearly expressed.
• In newborns, especially premature babies, the cough is weak and silent.
• Children in the first months of life are characterized not by typical cases of cough, but by their equivalents (sneezing, hiccups, unmotivated crying, screaming).
• When coughing, less mucus is produced because children swallow it as a result of incoordination. various departments respiratory tract. Mucus is thus released from the nasal cavities, which is often regarded as a manifestation of a runny nose.
• The vast majority of children have cyanosis of the nasolabial triangle and face.
• Hemorrhagic syndrome manifests itself as hemorrhages in the central nervous system, while subconjunctival and cutaneous manifestations, on the contrary, are less common.
• In the interictal period, the general condition of patients is disturbed: children are lethargic, suck less well, weight gain decreases, and motor and speech skills acquired at the time of the disease are lost.
• There is a high frequency of specific, including life-threatening complications (apnea, cerebral circulation), and both delay and cessation of breathing can occur outside of a coughing attack - often in sleep, after eating.
• The early development of nonspecific complications (mainly pneumonia, both viral and bacterial origin) is typical.
• Manifestations of secondary immunodeficiency are noted in the early stages - already from the 2-3rd week of spasmodic cough, they are more pronounced and persist for a long time.
• Peculiar hematological changes are clearly expressed and persist for a long time.
• More often, the seeding of the pertussis pathogen belonging to serotype 1.2.3 is observed.
• Serological changes are less pronounced and appear at a later date (4-6 weeks of the period of convulsive cough). In this case, the titer of specific antibodies may be lower than diagnostic (below 1:80 in RPGA).

Vaccinated children may have their own characteristics of whooping cough. Currently, the incidence among vaccinated children is 4-6 times lower than among unvaccinated children. Children vaccinated against whooping cough may become ill due to insufficient development of immunity or a decrease in its intensity. Thus, it has been established that the risk of developing the disease in a vaccinated child increases significantly 3 or more years after the last vaccination. Mild, including erased, forms of the disease are more common (at least 40%), moderate forms are recorded in less than 65% of cases. Severe forms of the disease, as a rule, do not occur among vaccinated children. Specific complications from the bronchopulmonary and nervous systems in vaccinated patients are observed 4 times less frequently than in unvaccinated patients, and are not life-threatening. No deaths are observed. In contrast to unvaccinated children, the incubation and catarrhal periods are extended to 14 days, and the period of spasmodic cough, on the contrary, is shortened to 2 weeks. Repetitions and vomiting are observed much less frequently. Hemorrhagic and edematous syndromes are not typical for previously vaccinated children (no more than 0.4%). In peripheral blood, only slight (“isolated”) lymphocytosis is detected. With bacteriological confirmation, serotypes 1.2.0 and 1.0.3 are more often detected. Due to the phenomenon of the booster effect, the increase in the titer of specific antibodies is characterized as more intense and is detected already at the beginning of the 2nd week of the period of convulsive cough.

Complications may be the following.

Specific:

• Emphysema.
• Emphysema of the mediastinum, subcutaneous tissue.
• Segmental atelectasis.
• Pertussis pneumonia, characterized by the presence of a productive process in the interstitial tissue of the lungs and hemodynamic disorder.
• Violation of the breathing rhythm (breath holding - apnea up to 30 s and stopping - apnea more than 30 s). Recently, it has been customary to distinguish two types of apnea: 1) spasmodic - occurring during an attack of convulsive cough (duration 30 s - 1 min); 2) syncope (paralytic) - not associated with a coughing attack, occurring against the background of lethargy, general hypotension, pallor of the skin, followed by cyanosis, with lack of breathing for 1-2 minutes. Risk factors for the development of apnea include prematurity, perinatal damage to the central nervous system, and the presence of intrauterine infection.
• Cerebrovascular accident.
• Encephalopathy.
• Bleeding (from the nasal cavity, posterior pharyngeal space, bronchi, external auditory canal).
• Hemorrhages (under the skin, in the mucous membranes, sclera, retina, brain, subarachnoid and intraventricular, epidural hematomas of the spinal cord).
• Hernias (umbilical, inguinal).
• Prolapse of the rectal mucosa.
• A tear or ulcer of the frenulum of the tongue.
• Ruptures of the eardrum.

Non-specific:

• Pneumonia.
• Bronchitis.
• Sore throats.
• Lymphadenitis.
• Otitis, etc.

Nonspecific complications are caused by the layering of secondary bacterial flora. The leading cause of complications in whooping cough is concomitant infectious diseases, mainly acute respiratory viral infections. The layering of ARVI leads to increased ventilation disturbances and the appearance of respiratory rhythm disorders, increased frequency of coughing attacks, the development of bronchopulmonary complications - common bronchitis and pneumonia, and the appearance of encephalic disorders. In addition to ARVI, great importance in the development of complications has mycoplasma, and in young children - cytomegalo viral infection.

Diagnosis of whooping cough

Diagnosis of whooping cough is based on clinical and epidemiological data (discussed above) and the results laboratory research.

Laboratory diagnostics

Bacteriological method - isolation B. pertussis from the mucus of the back wall of the pharynx, which is taken on an empty stomach or 2-3 hours after eating. Two methods are used: the “cough plate” method and the “posopharyngeal swab” method. Inoculation is carried out on casein-charcoal agar. A preliminary answer can be received on the 3-5th day, a final answer only on the 5-7th day. For diagnostic purposes, persons with suspected whooping cough and who have been coughing for more than 7 days, but not more than 30 days, are examined. The percentage of cases where whooping cough receives bacteriological confirmation, for example, in St. Petersburg does not exceed 15-25%; in many territorial districts it is even lower.

Serological methods (RPGA, RA, RNGA) can be used to diagnose whooping cough in the later stages of the disease or for epidemiological analysis (when examining foci of infection). The diagnostic titer for a single examination is 1:80 in unvaccinated and unsick children.

In vaccinated people and adults, positive RA results are taken into account only when studying paired sera with an increase in titers of at least 4 times.

Enzyme-linked immunosorbent assay (ELISA) allows you to determine the content of antibodies of the Ig M class (in the early stages) and Ig G (in the late stages of the disease).

Currently, thanks to intensive research, express methods for diagnosing whooping cough (immunofluorescence, latex microagglutination) have been developed. Immunofluorescence (RNIF) method allows you to detect the presence of corpuscular antigens B. pertussis in the laryngopharyngeal wash from the back wall of the pharynx. The doctor is able to confirm the diagnosis of whooping cough within 2-6 hours and carry out a differential diagnosis with other diseases with similar symptoms. The latex microagglutination (LMA) method makes it possible to detect antigens of the causative agent of whooping cough in the mucus of the posterior pharyngeal wall within 30-40 minutes. A comparative assessment of the generally accepted nomenclature and express diagnostic methods revealed the undoubted advantages of the latter, since they allow several times to increase the percentage of laboratory-confirmed cases of whooping cough.

The molecular method (PCR) is highly specific and has found widespread use in the laboratory diagnosis of whooping cough in most foreign countries. Currently, PCR is being implemented in a number of laboratory complexes in Russia.

Hematological method: leukocytosis with lymphocytosis (or isolated lymphocytosis) with normal ESR is detected in the blood. These changes are especially clearly detected in unvaccinated children.

Thus, based on the above, we can conclude that modern clinicians have every opportunity for early laboratory diagnosis of pertussis infection, no matter what form it occurs.

Differential diagnosis

Differential diagnosis is carried out depending on the period of the disease. In the catarrhal period it presents the greatest difficulties. It is necessary to differentiate whooping cough from the ARVI group, measles, parawhooping cough, etc. ARVI is most often mistakenly diagnosed. Meanwhile, whooping cough is characterized by persistent cough syndrome, lack of expression of other catarrhal phenomena, paucity of physical data, and absence of a pronounced temperature reaction; often typical hematological changes. The decisive role may belong to laboratory express diagnostic methods (RNIF, latex agglutination reactions) or isolation of the pathogen during bacteriological examination. During the period of spasmodic cough, whooping cough must be differentiated from the following diseases:

ARVI with obstructive syndrome; respiratory syncytial infection; respiratory mycoplasmosis; tuberculous bronchoadenitis; aspiration foreign body; mediastinal tumor; bronchopulmonary form of cystic fibrosis.

With parawhooping cough, differential diagnosis becomes more complicated when whooping cough occurs in mild, erased or abortive forms. In these cases, it is necessary to remember that parawhooping cough is generally much milder; a whooping cough-like cough lasts from several days to 2 weeks. The hemogram is most often unchanged. The results of bacteriological examination, RNIF and PCR data are of decisive importance. Data from serological research methods are less significant.

Thus, the diagnosis and differential diagnosis of whooping cough with diseases with similar symptoms require careful clinical and epidemiological monitoring using both traditional and new laboratory technologies.

Treatment

Currently, the vast majority of children are treated in outpatient setting. These are, as a rule, older children who have been vaccinated and have a mild form of whooping cough.

The following are subject to mandatory hospitalization: young children (first 4 months); patients with severe forms of whooping cough; patients with life-threatening complications (impaired cerebral circulation and respiratory rhythm); patients with moderate forms with an unsmooth course, unfavorable premorbid status, exacerbation of chronic diseases.

Since in whooping cough departments more than half of the children suffer from whooping cough in the form of mixed infections (ARVI, mycoplasma, chlamydial, cytomegalovirus), it is necessary to strictly observe anti-epidemic measures in order to prevent the development of nosocomial infections.

The regimen for patients with mild forms of whooping cough is gentle (with a decrease in negative psycho-emotional and physical stress). Individual walks are required. It is considered favorable for the patient to stay in an atmosphere of fresh, clean, cool and humid air. The optimal temperature for walking is from +10 to -5°C. Duration - from 20-30 minutes to 1.5-2 hours. Walking at temperatures below -10...-12°C is undesirable.

The diet should include foods rich in vitamins and be age appropriate. In severe forms of whooping cough, food is given in small quantities and at shorter intervals, preferably after a coughing attack. If vomiting occurs after eating, the child should be fed in small portions 10-15 minutes after vomiting. It is recommended that infants be given barbiturate preparations 15 minutes before feeding. IN acute period diseases, with symptoms of severe hypoxia, use expressed breast milk, which is given to the child using a pipette.

For whooping cough, the main therapeutic interventions should be aimed at combating respiratory failure and eliminating the consequences caused by hypoxia. Whooping cough is a disease whose pathophysiological symptom complex is primarily due to the diverse effects of pertussis toxin on the body. Because of this, indications for etiotropic therapy, contrary to the prevailing opinion among doctors, must be clearly justified and very limited.

Etiotropic therapy

The therapeutic effectiveness of antibiotic therapy for whooping cough is limited to the early stages of the disease: for macrolides this is the first 10 days, for ampicillin, etc. - 7 days from the onset of the disease. From antibacterial drugs, preventing the colonization of B. pertussis on the cylindrical epithelium of the upper respiratory tract, preference is given to macrolide preparations. For mild and moderate forms, erythromycin, midecamycin (macropen), azithromycin (sumamed, azitral, azitrox, hemomycin), roxithromycin (rulid, roxide, roxilor), clarithromycin (clacid, clubax, clerimed) are prescribed. In addition, penicillin antibiotics (amoxiclav, augmentin, etc.) are used.

In severe forms and in the absence of the possibility of taking drugs by mouth (infants, repeated vomiting, etc.), preference should be given primarily to carbenicillin and aminoglycosides. You can also prescribe ampicillin, chloramphenicol sodium succinate.

Carrying out antibacterial therapy during the spasmodic period of coughing in order to prevent complications, it is inappropriate, since this contributes to a more frequent complicated course of whooping cough due to the negative effect of antibiotics on the microecological systems of the body and increased colonization of the respiratory tract by secondary microflora. Indications for the prescription of antibiotics during the spasmodic period of whooping cough are bronchopulmonary complications caused by secondary microflora and the presence of concomitant chronic lung diseases. For common bronchitis, antibiotic therapy is prescribed if they are accompanied by purulent sputum and other signs indicating the involvement of secondary microflora in their origin. Pneumonia complicating whooping cough is treated with antibiotics in any case. The listed groups of children are prescribed broad-spectrum antibiotics, taking into account the effect on gram-negative flora.

The lack of effectiveness of antibiotic therapy for whooping cough prompted clinicians to use immunoglobulin preparations in the acute phase of the disease. However, practical experience in using these funds both in our country and abroad has shown that they do not have any significant therapeutic effect, even with early use.

In the structure of methods of pathogenetic therapy to improve bronchial patency, as well as to lower venous pressure in the pulmonary circulation in the treatment of whooping cough, aminophylline is used orally or parenterally in a daily dose of 4-5 mg/kg. This drug is administered orally as a mixture in combination with potassium iodide, which has a pronounced mucolytic effect. Parenteral administration of aminophylline is justified in case of obstructive syndrome, pulmonary edema, if signs of cerebrovascular accident appear. Eufillin is an important pathogenetic agent for whooping cough, as it prevents the accumulation of c-AMP in cells, which is observed when exposed to pertussis toxin. If you have an individual intolerance to the medicine, you can use ambroxol preparations (ambrohexal, lazolvan, ambrobene), etc.

At the same time, drugs such as adrenaline, ephedrine, atropine, solutan are inappropriate to use: although they eliminate bronchospasm, they simultaneously cause hypertension in the pulmonary circulation and increase the excitability of the central nervous system, which can lead to increased paroxysmal coughing. Phenothiazine derivatives (aminazine) used in previous years have now been replaced by benzyldiazepine drugs (seduxen, relanium, sibazon, etc.). They are used as an addition to basic therapy for moderate forms and are included in the range of main pathogenetic drugs for severe forms of whooping cough. The dose of Relanium is 0.5% 0.5-1.0 mg/kg per day. Course duration is 6-7 days.

The importance of antitussives is relatively small due to their low effectiveness. Synecode, paxeladine, coldrex broncho, tussin, sinetos, etc. are used as antitussives. In addition to aerooxygen therapy, the use of phenobarbital and dibazole helps to increase the resistance of brain cells to hypoxia. Presented above basic therapy, however, turns out to be untenable in severe forms of whooping cough developing in children of the first year of life. In this case, the main task of the clinician becomes the fight against respiratory failure by conducting aerooxygen therapy, restoring airway patency, stimulating aerobic tissue respiration, and using agents that increase the resistance of the central nervous system to hypoxia. There is a need for oxygen therapy in oxygen tents. Moreover, the content pure oxygen in the inhaled mixture should not exceed 40%. Some clinicians recommend transferring sick children to prolonged automatic ventilation. In severe forms of whooping cough, accompanied by frequent and prolonged apnea, it is advisable to prescribe piracetam or its analogues. Piracetam as a psychotropic drug improves metabolic processes in the brain and prevents karyolysis of nerve cells under hypoxic conditions. The use of glucocorticoids (GC), in particular hydrocortisone, causes cessation of apnea, reduces the frequency and duration of cough, improves hemodynamic parameters, and prevents the development of encephalic disorders. Hydrocortisone is used in a daily dose of 5-7 mg/kg, prednisolone - 2 mg/kg. This dose is used until a therapeutic effect is obtained, usually for 2-3 days. The reduction in GC doses should be gradual, since if the drug is quickly discontinued, severe coughing attacks may resume for a short time. Indications for the use of GC hormones in cases of severe whooping cough are:

• the presence of coughing attacks with apnea;
• the presence of diffuse facial cyanosis during coughing attacks in children in the first months of life;
• the presence of encephalic disorders.

Along with respiratory disorders, in patients with whooping cough, the need for emergency treatment may arise with the development of encephalopathy. For initial and mildly expressed signs of brain disorders, GC hormones and diuretics are prescribed - Lasix (at the rate of 1 mg/kg/day), Diacarb 10 ml/kg/day, anticonvulsants, mainly seduxen (at a dose of 0.3-0.4 mg/kg), nootropic drugs - piracetam 30-50 mg/kg body weight daily in 2 doses, Cavinton orally 5-10 mg 3 times a day, Pantogam 0, 75-3 g/day.

In case of repeated and continuous seizures, patients should be transferred to the intensive care unit, where complex treatment can be carried out to the fullest extent.

In case of severe manifestations of encephalopathy, it is necessary to intensify both anticonvulsant and dehydration therapy. In order to relieve convulsive status, along with seduxen administered intravenously, a good result is obtained by administering sodium hydroxybutyrate in the form of a 20% solution at the rate of 50 mg/kg (in a 10% glucose solution). If necessary, the drug can be re-administered. Dehydration therapy is intensified by prescribing dexazone, which has a more pronounced anti-edematous effect compared to other GCs. Dexazone is used parenterally at a dose of 0.25 mg/kg every 6 hours for 4 days, followed by a transition to prednisolone and gradual withdrawal of hormonal drugs. A more pronounced dehydrating effect is achieved by increasing the dosage and frequency of administration of Lasix (up to 2 mg/kg per day every 6 hours). Osmotic diuretics should be used with caution during hypoxic cerebral edema, as they increase circulating blood volume (CBV) and cardiac output; at the same time, the blood vessels of the brain dilate, which leads to a transient but dangerous increase in intracranial pressure. In order to improve oxygen utilization and stimulate oxidative processes in tissues, cocarboxylase is used, which is administered intravenously and added to drip-fed liquids in doses of 25-50 mg 1-2 times a day. Entered inside ascorbic acid and B vitamins. Infusion therapy is prescribed only for complicated whooping cough caused by the addition of massive pneumonia or acute intestinal infections. Indications for its use are: the presence of toxicosis, hemodynamic disorder, decreased blood volume, the likelihood of developing disseminated intravascular coagulation syndrome.

Symptomatic therapy includes the prescription of vitamins, antihistamines, biological products, etc. During periods of early and late convalescence, the use of immunorehabilitation methods is indicated.

The following are subject to dispensary observation:

• convalescents of severe forms of whooping cough regardless of age;
• children of the first year of life with an unfavorable premorbid status (damage to the central nervous system, etc.);
• convalescents of complicated forms of whooping cough (bronchopulmonary system, central nervous system, etc.).

The following scheme of examinations of children by medical specialists is regulated:

• pediatric infectious disease specialist - 2, 6 and 12 months after discharge;
• pulmonologist - after 2 and 6 months;
• neurologist - after 2, 6 and 12 months (paraclinical examination is carried out according to indications - EEG, EchoEG).

Literature

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2. Gerasimova A.G., Petrova M.S., Tikhonova N.T. et al. Clinical and epidemiological characteristics of modern whooping cough//Vaccination. 2004. No. 5 (35). pp. 4-5.
3. Lytkina I.N., Chistyakova G.G., Filatov N.N. Incidence of whooping cough in Moscow and organization of measures to reduce it // Vaccination. 2004. No. 5 (35). pp. 8-9.
4. Ozeretskovsky N. A., Chuprinina R. P. Vaccinal prevention of whooping cough - results and prospects // Vaccination. 2004. No. 5 (35). pp. 6-7.
5. Popova O. P., Petrova M. S., Chistyakova G. G. et al. Clinic of whooping cough and serological variants of the pertussis microbe in modern conditions // Epidemiology and infectious diseases. 2005. No. 1. P. 44-46.
6. Selezneva T. S. Evolution of infectious diseases in Russia in the 20th century / Ed. V. I. Pokrovsky, G. G. Onishchenko, B. L. Cherkassky. M., 2003.

A. N. Sizemov, Candidate of Medical Sciences
E. V. Komeleva
Research Institute of Children's Infections, St. Petersburg

What could be worse than a constant, suffocating cough when communicating with people? A long-term, paroxysmal symptom that cannot be treated within several days with many potent drugs - this condition is difficult to endure. At the same time, endless trips to the doctor and examinations do not bring the desired result. Diagnoses change one after another, and treatment is ineffective. In this case, the cough may be a symptom of whooping cough.

Despite universal vaccination, this disease has not disappeared. What kind of disease is this, why is it dangerous and how does it manifest itself today?

What is whooping cough

The first information about the disease appeared in the middle of the 16th century, when an outbreak of whooping cough was recorded in Paris. Since then, the disease has increasingly appeared in European countries. The causative agent of whooping cough was described in 1900 and 1906 by J. Bordet and O. Zhangou. After which the bacillus bordetella pertussis began to bear the name Bordet-Gangu. It is a small bacterium that does not form spores and is extremely sensitive to changing environmental conditions. It dies under the influence of any disinfectants, ultraviolet radiation and when heated. That is why it does not linger in the external environment for a long time and after it gets on objects it is considered non-infectious.

What kind of disease is whooping cough? The disease belongs to the group of acute infectious diseases, which is transmitted by contact, and its main symptom is a prolonged paroxysmal cough. In nature, there are three main types of whooping cough: 1, 2, 3. The second type causes the most severe changes in the body.

Features of the disease:

• Whooping cough is characterized by periodicity: every 3–4 years there is an increase;
• exacerbation in most cases is observed in the hot season - in July and August;
• the peak of incidence occurs at the end of autumn and beginning of winter;
• whooping cough is an acute bacterial infection, outbreaks of which occur throughout the year, but the atypical course of the disease often interferes with diagnosis;
• high susceptibility to the bacteria of unvaccinated people, the microorganism affects about 75% of those who came into contact with the patient;
• a greater number of complications are observed when a child under one year of age is infected with whooping cough.

Ways of contracting whooping cough

How is whooping cough transmitted? - by airborne droplets, from a sick person to a healthy person in close contact. The microorganism spreads in the environment no more than 2.5 meters. And since it is sensitive to environmental factors, transmission occurs through close contact. Bacteria carriers and people with an atypical or mild clinical picture play an important role in the spread of infection.

How contagious is whooping cough? The most dangerous period for the spread of whooping cough is considered to be the first four weeks from the moment the suffocating cough begins. At this time, the bacterium is released into the environment.

The likelihood of infecting others gradually decreases.

1. The first week of spasmodic cough contributes to the infection of almost 100% of others.
2. In the second week, this probability drops to 60%.
3. The third week is less dangerous - whooping cough affects only 30–35% of people.
4. Then no more than 10% become infected.

Isolating patients and vaccinating others significantly reduces the possibility of spreading whooping cough.

The problem is the difficulty of diagnosis. It is almost impossible to make a correct diagnosis before the typical classical signs appear. This contributes to the spread of the microorganism and its constant circulation in the environment.

Whooping cough symptoms

The leading symptom of the disease is a prolonged paroxysmal cough, which cannot be relieved by almost all available medications. It does not matter whether it is a herbal preparation or another potent substance. A cough does not appear due to the accumulation of mucus in the bronchi and not due to a narrowing of their lumen, as in other diseases.

What is the reason for such a pronounced cough with whooping cough? The toxin that the bacillus bordetella pertussis secretes when it enters the human body is to blame. This substance begins to act on the vagus nerve, constantly irritating it. And this nerve, as is known, ensures the functioning of many organs:

The toxin irritates the vagus nerve, after which a signal about the disruption is sent to the brain. Coughing is a protective reaction of the body to the action of an irritant, an attempt to get rid of the cause.

What symptoms accompany the disease?

The incubation period of whooping cough depends on the type of pathogen and the body's reaction to it and lasts from 3 to 15 days. Most often it occurs within 5–8 days.

Diagnostics

It is difficult to suspect the presence of the disease in its initial stage. It often looks like a common viral infection, complicated by inflammation of the tracheal mucosa. Only during the appearance of a cough with reprises can one assume the presence of this bacterial disease.

What you need when making a diagnosis:

Treatment of whooping cough

How is whooping cough treated? Depends on the situation. Moderate and severe forms of the disease are subject to hospitalization. This rule primarily applies to newborns and babies up to one year old.

If treatment of the disease can be carried out at home, doctors in their recommendations are guided by the following important rules:

Complications of the disease

Complications are the most unpleasant moment in the development of any disease. IN childhood they are much more dangerous and there have been cases when the disease ended in the death of a child. With the advent of the whooping cough vaccine, such conditions are observed much less frequently and the disease itself is easier.

Complications of whooping cough include:

• in mild cases the outcome is favorable without consequences;
• lung diseases: bronchiectasis, emphysema, bronchopneumonia;
• bleeding in the brain;
• epileptic seizures were noted after an infection;
• rupture of the eardrum;
• death;
• The consequences of whooping cough include bacterial complications - inflammation of the middle ear, mediastinitis ( inflammatory process mediastinal organs), pleurisy.

Parawhooping cough

In its course, parawhooping cough resembles a mild form of whooping cough. What is parawhooping cough? This is also an acute bacterial infection, but it is much milder and without dangerous complications.

The parawhooping cough bacillus was discovered a little later - in 1937. The disease is caused by the bacterium Bordetella pertussis. The route of transmission is airborne droplets from sick to healthy. The microorganism affects the same structures as whooping cough.

Symptoms and treatment of parawhooping cough

Symptoms of parawhooping cough only in 15% of cases resemble the usual course of whooping cough - with coughing attacks and relapses ending in vomiting.

Parapertussis is characterized by following symptoms:

• normal body temperature;
• prolonged cough, not amenable to treatment;
• slight increase in blood leukocytes;
• complete absence of intoxication or, in rare cases, slight weakness.

In the treatment of parawhooping cough, home regimen and the prescription of symptomatic medications are mainly recommended. In severe cases, treatment is no different from the treatment of whooping cough infection. Antibiotics, antipsychotics, and anticonvulsants are used.

Pertussis infection in children

In many situations, the course of the disease depends on external factors and from the child’s nervous system. Any irritant - be it bright light, screaming or cold - causes coughing episodes. Children are more susceptible to this influence.

Signs of whooping cough in a child:

The diagnosis is made based on symptoms and tests. How to recognize whooping cough in children? - A thorough history taking helps to identify the disease. Mothers note a change in the child’s behavior, a frequent cough that gets worse at night and cannot be treated; in older children, it recurs. This disease is difficult to identify in a child. Timely diagnosis is helped by tests - an increase in the number of leukocytes in the blood with a normal ESR level, determination of the pathogen in smears taken from the nasopharynx and sputum. Serological research methods are carried out - they take tests for whooping cough.

Treatment of whooping cough in children

In the vast majority of cases, treatment takes place in a hospital setting under the constant supervision of specialists.

How to treat whooping cough in children?

1. All possible annoying a child factors.
2. Adequate nutrition is prescribed, breastfeeding is maintained, and the frequency of meals is increased.
3. Antibiotics and neuroleptics are prescribed.
4. Antitussive and sedative medications are used.

Babies at birth are not given their mother’s immunity against whooping cough, and the immune system is still imperfect, so complications are more common in childhood:

• bronchiectasis;
• the appearance of a hernia due to frequent severe coughing;
• rectal prolapse;
• Whooping cough in children under one year of age is often fatal.

Whooping cough in adults

Do adults get whooping cough? The infection constantly circulates in nature and adults are also susceptible to it. Those who do not carry out preventive measures in a timely manner get sick especially often. Severe forms of the disease occur classically with coughing attacks and relapses. In other cases, signs of whooping cough in adults are:

What to do if a pregnant woman gets whooping cough? It's pretty a rare event, because mostly adults are vaccinated against this disease. But in exceptional cases this is also possible. Whooping cough during pregnancy is dangerous in moderate to severe cases, when coughing episodes reach 30 times a day. In this case, spontaneous miscarriage is possible. In addition, the infection can affect the development of the fetus - sometimes deviations in its development develop.

Treatment of whooping cough in adults

How to treat whooping cough in adults? The treatment is long-term! Antibiotics are prescribed for a course of no more than two weeks, and expectorants are prescribed. After confirmation of the diagnosis, long-term sedatives and antipsychotics are used.

It is important to strengthen the immune system so that another infection does not occur. New diseases delay the recovery process and can lead to the resumption of coughing attacks.

Disease prevention

Prevention of whooping cough begins in childhood. It consists of isolating sick people from healthy people, timely treatment of infection, and carrying out universal immunization.

The first vaccine is administered at three months, then at 4.5 and at 6. The vaccine is used. It contains 20 billion microbial pertussis cells. DTP is a three-component drug, but the greatest number of complications is caused by its pertussis component. Some countries use single vaccines.

The whooping cough vaccine in a dose of 0.5 ml is administered intramuscularly into the thigh. Revaccination is carried out once at 18 months. If a child has had whooping cough, vaccination is not carried out.

Complications from the vaccine include:

• increased body temperature;
• pain and allergic reaction at the injection site;
• reactions from the nervous system: weakness, lethargy, irritability, vomiting and loss of appetite;
• in severe cases, the development of convulsive syndrome, angioedema and anaphylactic shock is possible.

Despite frequent complications after immunization, the whooping cough vaccine remains the most reliable prevention of the development of the disease. Refusal to vaccinate contributes to the spread of infection and infection of others.

Whooping cough is an acute infectious disease transmitted by airborne droplets and characterized by a long course with the presence of specific stages.

The name of the pathology comes from the French word coqueluche, which means a severe paroxysmal cough. Indeed, the main symptom of the disease is painful coughing attacks (so-called relapses), which occur against the background of a relatively satisfactory general condition of the patient.

Some statistics

Whooping cough is widespread, but in cities this diagnosis is made more often than in rural areas. This is due to a number of reasons: greater population density in large cities, environmentally unfavorable urban air and more scrupulous diagnosis (in towns and villages, erased forms are often not diagnosed due to less epidemiological alertness).

Like other respiratory infections, whooping cough is characterized by seasonal incidence with an increase in the frequency of recorded cases of infection during transition periods (autumn-winter and spring-summer).

Epidemiological data indicate the presence of unique mini-epidemics of whooping cough that occur every three to four years.

In general, the incidence of whooping cough in the world is quite high: up to 10 million people fall ill every year, while for 600 thousand patients the infection ends tragically. In the pre-vaccination period, about 600,000 people fell ill annually in the USSR, and about 5,000 died (the mortality rate was on average more than 8%). The highest mortality rate from whooping cough was among children in their first year of life (every second child died).

Today, thanks to widespread long-term vaccination, the incidence of whooping cough in civilized countries has sharply declined. However, it should be noted that the whooping cough vaccine does not provide immunity to parapertussis infection, which is transmitted in a similar way and clinically occurs as a mild form of whooping cough.

In recent years, the incidence of whooping cough among adolescents has increased; doctors attribute these figures to a general decrease in immunity, violations of the rules of vaccination of children, as well as an increase in the number of cases of parents refusing vaccinations.

The causative agent of whooping cough and routes of transmission

Whooping cough is an infection transmitted by airborne droplets from a sick person to a healthy person. The causative agent of whooping cough is the Bordet-Gengou whooping cough bacillus (bordetella), named after the scientists who discovered it.
The Bordet-Gengou pertussis bacillus has a “relative” - Bordetella parapertussis, which causes the so-called parawhooping cough - a disease whose clinical picture is similar to whooping cough, which occurs in a mild form.

Bordetella are unstable in the external environment and quickly die under the influence of high and low temperatures, ultraviolet radiation, and drying. So, for example, open sunlight destroys bacteria in one hour, and cooling - in a matter of seconds.

Therefore, handkerchiefs, household items, children's toys, etc. do not pose an epidemic danger as transmission factors. Special sanitary treatment of the premises in which the patient stayed is also not carried out.

Transmission of infection, as a rule, occurs through direct contact with the patient (staying at a distance closer than 1.5 - 2 m from the patient). Most often, inhalation of mucus particles released into the air occurs when coughing, but the pathogen can also be released into the environment when sneezing, talking, etc.

The maximum danger in epidemiological terms is posed by the patient in the first week of spasmodic cough (during this period, the causative agent of whooping cough is isolated from 90 to 100% of patients). Subsequently, the danger decreases (in the second week, about 60% of patients secrete bordetella, in the third - 30%, in the fourth - 10%). In general, infection is possible through contact with a patient with whooping cough, ranging from last days incubation period up to the 5-6th week of the disease.

With whooping cough, bacterial carriage also occurs, that is, a condition in which a person releases dangerous bacteria into the environment, but does not feel any signs of the disease. But bacterial carriage in whooping cough is short-lived and has no particular significance for the spread of the disease. The greatest danger is posed by mild and erased forms of whooping cough, when a periodically coughing child or adult remains in a group.

Whooping cough is a disease that is usually classified as a so-called childhood infection. The proportion of children among those diagnosed with whooping cough is about 95-97%. The greatest susceptibility to infection is observed between the ages of 1 and 7 years.

However, adults are also not immune to developing whooping cough. According to some data, the probability of infection among adults in a family with a sick child can reach 30%.

In adults, the disease often occurs in an erased form. Often such patients are mistakenly diagnosed with “chronic bronchitis” and unsuccessfully treated for a non-existent disease. Therefore, doctors advise that if you have a prolonged cough, especially in cases where it occurs with painful attacks, you should pay attention to the epidemiological situation - whether there has been contact with a child who has been coughing for a long time.

Patients who have recovered from whooping cough develop lifelong immunity. However, as with vaccination, immunity to whooping cough does not exclude the disease from parapertussis, which is clinically indistinguishable from a mild form of whooping cough.

The portal of infection in whooping cough is the upper respiratory tract. The pertussis bacillus colonizes the mucous membrane of the larynx, trachea and bronchi, this is prevented by class A immunoglobulins secreted by the epithelium - they make it difficult for bacteria to attach and contribute to their rapid removal from the body.

The functional immaturity of the mucous membranes of the upper respiratory tract in young children leads to the fact that whooping cough predominantly affects this age group of the population. The infection is especially severe in children in the first two years of life.

Having attached to the epithelium, bacteria begin to secrete special substances - toxins that cause inflammatory reaction. The small bronchi and bronchioles are most affected. The pathogen does not penetrate inside the cells, so pathological changes are minimally expressed - plethora and swelling of the surface layers of the epithelium are observed, sometimes desquamation and death of individual cells. When a secondary infection occurs, erosions may develop.

After the death and destruction of bacteria, pertussis toxin reaches the surface of the mucous membrane, which leads to the development of spasmodic cough.

The mechanism of occurrence of a specific cough during whooping cough is quite complex. First, cough shocks are associated with direct irritation of epithelial receptors by toxins of the pertussis bacillus, then an allergic component is added, associated with the release of specific substances - inflammatory mediators. A spasm of the bronchi and bronchioles occurs, so that the cough begins to resemble the clinical picture of asthmatic bronchitis.
Subsequently, due to constant irritation of the vagus nerve, a focus of congestive excitation develops in the central nervous system in the area of ​​the respiratory center, and the cough takes on a specific paroxysmal character.

It is the presence of a central mechanism that leads to the fact that coughing attacks occur when exposed to a wide variety of irritants of the nervous system (bright light, loud sound, strong emotional stress, etc.).

Nervous excitation from a stagnant focus can spread to neighboring centers in the medulla oblongata - emetic (in such cases, attacks of convulsive coughing result in painful vomiting), vasomotor (a coughing attack leads to fluctuations in blood pressure, increased heart rate, etc.), as well as to other subcortical structures with the development of seizures resembling epilepsy.

In very young children, excitement can spread to the respiratory center with the development of various breathing rhythm disturbances, up to apnea (stopping breathing).

Severe, prolonged, frequently repeated coughing attacks lead to increased pressure in the vessels of the head and neck. As a result, swelling and cyanosis of the face and hemorrhages in the conjunctiva of the eyes develop. In severe cases, hemorrhages in the brain tissue may occur.

Clinical periods of whooping cough

Clinically, the following periods are distinguished during whooping cough:

• incubation;
• catarrhal cough;
• spasmodic cough;
• permissions;
• convalescence (restorative).

Incubation period for whooping cough, it ranges from 3 to 20 days (on average about a week). This is the time required for the pertussis bacterium to colonize the upper respiratory tract.

Catarrhal period begins gradually, so that the first day of the disease, as a rule, cannot be established. A dry cough or coughing appears, a runny nose with a thin viscous mucous discharge is possible. In young children, catarrhal symptoms are more pronounced, so the onset of the disease may resemble ARVI with profuse nasal discharge.

Gradually, the cough intensifies, patients become irritable and restless, but the general condition remains quite satisfactory.

Period of spasmodic cough begins in the second week from the appearance of the first symptoms of infection and lasts, as a rule, 3–4 weeks. This period is characterized by paroxysmal cough. Older children may report warning signs of an attack, such as a scratchy throat, tightness in the chest, or feelings of fear or anxiety.

Characteristic cough
Attacks can occur at any time of the day, but most often occur at night. Each such attack consists of short but strong coughing shocks, interspersed with convulsive breaths - reprises. Inhalation is accompanied by a whistling sound as air forcefully passes through the spastically narrowed glottis.

The attack ends with coughing up characteristic viscous transparent sputum. The appearance of vomiting, impaired breathing and heartbeat, and the development of seizures indicate the severity of the disease.

During an attack, the child's face swells, in severe cases acquiring a bluish tint, the veins of the neck swell, the eyes become bloodshot, and lacrimation and drooling appear. A characteristic sign: the tongue protrudes outward to the limit, so that its tip bends upward, and, as a rule, the frenulum of the tongue is injured by the incisors of the lower jaw. In a severe attack, involuntary urination and loss of feces may occur.

Complications of persistent cough
In the absence of complications, the child’s condition between attacks is satisfactory - children play actively, do not complain of appetite, body temperature remains normal. However, over time, puffiness of the face develops, and on the frenulum of the tongue damaged by teeth, an ulcer covered with a whitish coating appears - a specific sign of whooping cough.

In addition, hemorrhages under the conjunctiva are possible, and there is often a tendency to nosebleeds.

Resolution stage
Gradually the disease passes in the resolution stage. Coughing attacks occur less frequently and gradually lose their specificity. However, weakness, coughing, and irritability persist for quite a long time (the resolution period ranges from two weeks to two months).

Convalescence period can last up to six months. This period is characterized by increased fatigue and emotional disturbances (moody, excitability, nervousness). A significant decrease in immunity leads to increased susceptibility to acute respiratory infections, against the background of which an unexpected resumption of a painful dry cough is possible.

Criteria for the severity of whooping cough

There are mild, moderate and severe forms of typical whooping cough.

In mild forms, coughing attacks occur no more than 10-15 times a day, while the number of cough impulses is small (3-5). Vomiting after coughing, as a rule, does not occur, the general condition of the child is quite satisfactory.

With moderate whooping cough, the number of attacks can reach 20-25 per day. The attacks have an average duration (up to 10 coughing impulses). Each attack ends with vomiting. In such cases, asthenic syndrome (general weakness, irritability, decreased appetite) develops quite quickly.

In severe cases, the number of coughing attacks reaches 40-50 or more per day. The attacks last a long time and occur with general cyanosis ( skin acquire a bluish tint) and severe breathing problems, and convulsions often develop.

In severe cases of whooping cough, complications often develop.

Complications of whooping cough

All complications of whooping cough can be divided into three groups:

• associated with the underlying disease;
• development of an autoimmune process;
• addition of a secondary infection.

During severe, prolonged coughing attacks, the supply of oxygen to the brain is significantly disrupted - this is associated both with bronchospasm and breathing rhythm disturbances, as well as with impaired blood flow in the vessels of the head and neck. The result of hypoxia can be brain damage such as encephalopathy, manifested by convulsions and signs of irritation meninges. In severe cases, hemorrhages occur in the brain.

Besides, coughing against the background of spasm of the bronchi and bronchioles, it can lead to disruption of the filling of the lungs with air, so that emphysema (bloating) occurs in some areas, and atelectasis (collapse of lung tissue) in others. In severe cases, pneumothorax develops (accumulation of gas in the pleural cavity due to rupture of lung tissue) and subcutaneous emphysema (penetration of air from the pleural cavity into the subcutaneous tissue of the neck and upper half of the body).

Coughing attacks are accompanied by an increase in intra-abdominal pressure, so in severe cases of whooping cough, umbilical or inguinal hernia and rectal prolapse may occur.

Among secondary infections, the most common are pneumonia and purulent otitis media (inflammation of the middle ear).
Sometimes autoimmune processes develop, which arise as a result of long-term inflammation with a pronounced allergic component. Cases of whooping cough progressing to asthmatic bronchitis and bronchial asthma have been reported.

Atypical forms of whooping cough

Atypical forms of whooping cough - abortive and erased, are usually observed in adults and/or vaccinated patients.
In the erased form, characteristic coughing attacks do not develop, so the sign of the disease is a persistent dry cough that cannot be eliminated by conventional antitussives. Such a cough can last for weeks or even months, without, however, being accompanied by a deterioration in the general condition of the patient.

The abortive form is characterized by an unexpected resolution of the disease 1-2 days after the appearance of the first coughing attacks specific to whooping cough.

Whooping cough in patients from different age groups

The characteristic clinical picture of whooping cough usually develops in children over one year of age and adolescents. Adults suffer from whooping cough in an erased form.

In children of the first year of life, whooping cough is especially severe and is often complicated by the development of secondary pneumonia.

In this case, the periods of the clinical picture have a different duration: incubation period reduced to 5 days, and catarrhal - to one week. At the same time, the period of spasmodic cough lengthens significantly – up to two to three months.

In addition, during attacks of spasmodic cough in infants there are no reprises; a coughing attack often ends in temporary cessation of breathing and a convulsive seizure.

Diagnosis of whooping cough

If you have a persistent paroxysmal cough that lasts more than a few days, you need to visit a general practitioner (general practitioner); if we are talking about a child, then you need to see a pediatrician.

Doctor consultations

At an appointment with a general practitioner or pediatrician.
At the appointment, the doctor will find out your complaints; he may be interested in whether you have had contact with coughing patients (especially those with whooping cough), and whether you have been vaccinated against whooping cough. It may be necessary to listen to the lungs and conduct a general blood test. To make the diagnosis more certain, the doctor will send you for a consultation with an ENT doctor or an infectious disease specialist.

At an appointment with an ENT doctor
The doctor will be interested in the condition of the mucous membrane of the larynx and pharynx. To do this, the doctor will examine the laryngeal mucosa using a special reflective mirror or flashlight.
Signs of whooping cough upon examination include swelling of the mucous membrane, the presence of hemorrhages, and light mucopurulent exudate.

At an appointment with an infectious disease doctor
The doctor will listen to your complaints. May inquire about possible contacts with coughing and whooping cough patients. Typically, the final diagnosis is made based on the results of laboratory tests, which an infectious disease specialist will send you for.

Laboratory diagnosis of whooping cough

General blood analysis
Reveals general signs inflammation in the body.

1. Increased level of leukocytes
2. Increased level of Lymphocytes
3. ESR is normal

Bacteriological research
The material is collected in several ways: when coughing, the scanty sputum released is collected and placed on a nutrient medium.
Another way is a swab from the pharyngeal mucosa. It is done in the morning on an empty stomach or 2-3 hours after eating.

The collected material is placed in a special nutrient medium. However, you will have to wait a long time for the result, 5-7 days.

Serological tests

Direct hemagglutination reaction (DRHA), indirect hemagglutination reaction (IRHA) This blood test technique allows you to identify antibodies to the causative agent of whooping cough. The result can be positive (confirmation of the diagnosis of Whooping Cough) or negative (exclusion).

ELISA (Enzyme-linked immunosorbent assay) Now there are express tests that can be used to detect whooping cough using ELISA. The result can be positive (confirmation of the diagnosis of Whooping Cough) or negative (exclusion)

PCR (Polymerase chain reaction) Allows you to identify the pathogen within a few days. The result can be positive (confirmation of the diagnosis of Whooping Cough) or negative (exclusion).

Treatment of whooping cough

Does a patient with whooping cough need bed rest?

In mild cases of the disease, bed rest is not indicated for a patient with whooping cough. On the contrary, the patient needs frequent walks in the fresh air, during which it is advisable to avoid noisy, irritant-rich places. Since moist air helps reduce the frequency of attacks, if possible, it is better to walk with your baby near bodies of water.

A cough is more easily tolerated in the cold, so it is necessary to frequently ventilate the room and prevent the air from drying out and overheating (ideally, the temperature in the patient’s room should not be higher than 18-20 degrees Celsius). It is advisable to use humidifiers. To prevent your child from freezing, it is better to dress him warmly.

Toys, puzzles and others are used as a distraction Board games not of an aggressive nature.
In addition, sufficient attention should be paid to the patient’s nutrition. Infants who are on breastfeeding, it is advisable to increase the number of feedings by reducing the amount of food taken at one time. Older children are recommended to drink plenty of alkaline drinks (juices, fruit drinks, tea, milk, alkaline mineral water).

When is inpatient treatment necessary?

Hospital treatment is necessary for moderate to severe disease, as well as in the presence of concomitant pathology, which increases the risk of complications. Children under two years of age are usually hospitalized if whooping cough is suspected, regardless of the severity of the signs of the disease.

What medications and physiotherapeutic procedures are used for whooping cough?

As studies show, during the spasmodic period, medicinal destruction of pertussis infection is impractical, since bordetella is already independently washed out of the body by this time, and coughing attacks are associated with a stagnant focus of excitation in the brain.

Therefore, antibiotics are prescribed only during the catarrhal period. Ampicillin and macrolides (erythromycin, azithromycin) are quite effective; tetracyclines can be prescribed to children over 12 years of age. Data antibacterial agents taken in medium doses in short courses.

Standard antitussive drugs are ineffective for whooping cough attacks. To reduce the activity of the focus of excitation in the brain, psychotropic drugs are prescribed - antipsychotics (aminazine or droperidol in age-appropriate dosages). Since these medications have a sedative effect, they are best taken before bedtime or nighttime sleep. For the same purpose, you can use a tranquilizer (Relanium - intramuscularly or orally in an age-specific dosage).

In mild forms of whooping cough, antihistamines are prescribed to relieve coughing attacks - pipolfen and suprastin, which have an antiallergic and sedative effect. Diphenhydramine is not used because this medicine causes dry mucous membranes and may increase coughing.
In severe forms of whooping cough with a pronounced allergic component, some clinicians note significant improvement with the use of glucocorticoids (prednisolone).

All of the above remedies are taken until the attacks of spasmodic cough disappear (usually 7-10 days).

In addition, to liquefy viscous sputum, inhalations of proteolytic enzymes - chymopsin and chymotrypsin - are used, and in case of severe coughing attacks, drugs that improve blood circulation in the brain (pentoxifylline, vinprocetin) are used to prevent hypoxia of the central nervous system.

To improve mucus discharge, massage and breathing exercises. During periods of resolution and convalescence, restorative physiotherapeutic procedures and courses of vitamin therapy are prescribed.

Traditional methods of treating whooping cough

In folk medicine, plantain leaves are traditionally used to treat whooping cough. The well-known plant has a pronounced expectorant and anti-inflammatory effect. To prevent coughing attacks and thin sputum, prepare a drink from young plantain leaves poured with boiling water and honey.
Traditional herbalists also advise getting rid of seizures painful cough using regular onions. To do this, boil the peels of 10 onions in a liter of water until half the liquid has boiled away, then pour and strain. Drink half a glass three times a day after meals.

To liquefy sputum during whooping cough, an infusion of tricolor violet is also used: 100 g of the herb is poured into 200 g of boiling water and infused for half an hour. Then filter and take 100 g twice a day.

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View full version: Antibodies to whooping cough and parapertussis

Hello! A girl (1 year and 4 months), vaccinated with DTP 3 times in accordance with the calendar, had her blood tested for antibodies to whooping cough and parapertussis at the Research Institute of Epidemiology on Novogireevskaya. Reason: prolonged cough during 3 months mostly in the morning.

anti-Bordetella pertussis 1:160

anti-Bordetella parapertussis 1:80

Please tell me whether, based on a single test with such titers, it is possible to talk about whooping cough in a vaccinated child (in an erased form).

No, definitely not.

The titer of antibodies to parapertussis bacillus is very low and requires repeated determination (if the titer increases 4 times after 2 weeks, then yes). The antibody titer to pertussis is almost diagnostic, but it was detected in a vaccinated child. So here, too, you need to take a repeat analysis and proceed from the increase (called the “paired serum method”).

Thank you, Timofey Alexandrovich!

I’m trying to understand: the cough lasts for three months, it seems that the disease should be subsiding, but the titers are increasing?

Is it advisable to retake the analysis after 2 weeks in the same laboratory?

Is the Center for Molecular Diagnostics at the Research Institute of Epidemiology of Rospotrebnadzor distinguished by the quality of its work, in your opinion?

It seems like the disease should be on the decline, but [B]titles are increasing?

Is it advisable to retake the analysis after 2 weeks in the same laboratory? yes

The Center for Molecular Diagnostics at the Research Institute of Epidemiology of Rospotrebnadzor is distinguished by the quality of its work, in your opinion? Quite trustworthy (even though I’m not Tim Vetrov)

Thanks for your answer, Tusia! For me, your opinion as an infectious disease specialist is no less authoritative.

Could you, dear experts, resolve one more of my bewilderments? Is it possible for a vaccinated child who has not had whooping cough to have such high titers in the blood of 1:160?

P.S. I just want to dwell on this whooping cough in search of the cause of the lingering cough, and donating blood from a vein again is a pity for the girl.

Sorry for wasting time with my meticulous questions. Zhanna.

In fact, 1:160 is not such a high titer at all; healthy vaccinated people (especially recently) may well have it.

When taking an analysis, first of all, you need to ask what the result will practically give. Even if it is whooping cough, it is too late to treat it with antibiotics. So, you can calm down and not do any more tests. Well, whooping cough was registered, well, God bless him - if, of course, the cough goes away, there is a positive trend.

If the cough persists (there is no dynamics characteristic of an infectious disease), then perhaps you should think about an allergy? Has your pediatrician thought in this direction? In general, a morning cough is not very typical for whooping cough (although, of course, anything can happen).

It was the pulmonologist-allergist who sent us to donate blood, having found no pathology on his part.

Timofey Alexandrovich, if you had answered in the affirmative about this unfortunate whooping cough, I would have been happy and calmed down. And so. I'm still unsure again. If we do re-donate blood, how many units should the titres rise to make a 100% diagnosis?

P.S. Of course, at the beginning of the illness the girl coughed not only in the morning, coughed, but without vomiting (there was vomiting 1-2 times), now there is a residual cough.

In any case, thanks for the advice!

The main thing is the dynamics of clinical symptoms; tests, as a rule, are secondary.

With whooping cough, as with any acute infection, there must be dynamics (the so-called “cyclical course” - that is, from health through all periods of the disease (incubation, prodromal, height and recovery - in whooping cough the names of the periods are specific, but the essence is the same same) back to health). If this dynamic is observed, you don’t have to bother additional analyzes and stop at whooping cough. If the cough continues to be the same (or increases and decreases in uniform waves without a tendency to recovery), we need to look for a non-infectious disease.

Don’t do any more tests, walk with your child near water, in

Timofey Alexandrovich, forgive me, but questions have arisen again: rolleyes:.

If you don't mind, please answer!

1. I had a consultation at the Research Institute of Epidemiology regarding an antibody test. I was asked to take a blood test from my finger. And not in commercial laboratory, which now exists on the basis of the research institute, and, so to speak, in the state part of it. How informative will this analysis be? This is all somehow strange.

2. If a finger blood test for antibodies is not informative, we will retake it from a vein 🙁 . In this regard, the question is: maybe at the same time, in order not to inject the child 158 times, test for infections that cause a prolonged cough? Which ones exactly? The list of laboratory services includes:

anti-Chl. trachomatis IgG,

anti-Chl. trachomatis IgA,

anti-Chl. pneumonia IgG,

anti-Chl. pneumonia JgA,

anti-Myc. hominis JgG,

anti-M. hominis JgA,

anti-M. hominis JgM,

anti-M. pneumonia JgG (JgA, JgM),

anti-Ureaplasma urealyticum JgG (JgA, JgM).

All this costs money. 😮

3. In August, according to the vaccination calendar, there should be another DPT revaccination. Our last one was on October 5th. So what should we do? Include a pertussis component?

4. At the Research Institute of Epidemiology, a doctor during a consultation said that they consider a parapertussis titer of 1:80 as diagnostic, because We do not have vaccinations against the causative agent of parapertussis.

Timofey Aleksandrovich, can the latter be an argument for parawhooping cough or do you still think that for diagnosis there must be a titer of 1:320? :confused:

Once again I apologize for taking up your time with my post, which already looks like an epic! I hope for your indulgence :)!

You know, if the child is getting better (or has already gotten better), I would not recommend examining him further.

And I would rather lean towards the diagnosis of parawhooping cough (especially since a titer of 1:80 was regarded as diagnostic).

I want to emphasize once again that the examination is always to help the patient. If the examination cannot help the patient, because He’s already recovered, no examination is needed.

Both mycoplasmas and chlamydia can cause respiratory infections (acute respiratory infections, pneumonia), but they do not last very long and are not chronic. Therefore, if the child has already recovered, there is no need to look for anything else from him.

There is somewhere to spend the saved money, right?

Thank you! Sorry for allowing myself to write to the PS.

The thing is that my child continues to cough (it’s already the 4th month). Not as much as before, but still. This explains my anxiety and desire to settle on some precise diagnosis. I hope you understand me.

Zhanna, a healthy person has the right to 5-6 coughs per day. especially after sleep.

Respiratory chlamydia or mycoplasmosis does not last that long.

These may be residual effects of whooping cough or parawhooping cough, but they no longer require specific therapy (the regimen boils down to quiet walks near bodies of water, in shady places).

There is no point in additional examinations if the situation is improving, albeit slowly.

2 weeks after the first analysis, blood was re-donated (only from a finger) in the laboratory of the Epidemiology Research Institute. Result:

antibody titer to whooping cough 1:320

antibody titer to parapertussis 1:160

That is, the credits only doubled.

The doctor's diagnosis from the laboratory: whooping cough + parawhooping cough. Vaccination against whooping cough is not needed now, because there is good protection.

Timofey Alexandrovich, you wrote that revaccination is necessary if there was no severe reaction to the vaccine.

The girl did not have a severe reaction. Because of two opposing opinions, I am at a loss. Wouldn't it be an extra burden to include the pertussis component in our case?

And further. Do a healthy (who has not had whooping cough/para-whooping cough) vaccinated child also have titers that increase during repeated testing?

There is such a thing as a booster effect. This means that as the infectious process develops, not only the titers of antibodies to the pathogen increase, but also the titers of other antibodies that already exist. I would not regard the increase in titer of antibodies to whooping cough as diagnostic.

But antibodies to parawhooping cough are now at such a good diagnostic titer (they shouldn’t exist at all - they don’t vaccinate against parawhooping cough).

Tests indicate a history of parawhooping cough.

The presence of antibodies in the blood to pertussis bacillus is not a contraindication for pertussis vaccination according to the calendar.

Thank you, Timofey Alexandrovich!

Everything was sorted into shelves. Doubts, go away.

We are still waiting for vaccination against rubella, measles, and mumps (we missed one year). Between revaccination with DTP and this graft should be indented? What's the best thing to do first (if it makes any difference at all)?

Best regards, Zhanna.

It's better to do them together.

Oh, Good morning, Maria Alexandrovna!

Good morning, Zhanna. :)) How is Masha feeling?

The first day the temperature is normal. But a rash appeared. Last night on the face. Today on the torso: the entire back, chest, stomach, lower abdomen. The hands are clean, the legs seem to have something pecked, but not as obvious as, for example, the torso.

Masha has been sick for five days. Since the beginning of the illness, I noticed that the stool was a little thin and bright: orange-carrot color.

The local doctor ran in; says that this is an enterovirus infection, nothing needs to be done, if desired, you can give an antihistamine + adsorbent.

Perhaps this is redundant? And for some reason, the local doctor, unsure of the truth, said that the vaccinations should be divided.

Still, what worries me most today is her cough every morning, dry, and not five or six, but about 12 cough shocks. After this, the voice is a little hoarse, but it goes away instantly.

I've read a lot here about cystic fibrosis, allergic alveolitis, bronchus. I have asthma and am upset.

Masha is one and a half years old. Today we are going to get vaccinated against measles, rubella, mumps, which we missed in a year. In addition, according to the schedule we have 4 DTPs. The clinic refuses to perform both vaccinations.

In this regard, I have a question: what is the possible minimum interval for vaccinations?

P.S. Masha continues to cough in the morning.

The minimum interval is 1 month. But vaccinations can be combined. On what basis do they refuse to merge?

Hello! Help me please! The child has been sick for 1.5 months. It all started with a cough, it was wet, then RE seemed to be getting better, when suddenly the cough appeared again, paroxysmal to the point of vomiting! As soon as I start feeding, I vomit! At first they put ARI:ai: although it is clear that this is not ARI! The fever did not go away within 2 weeks! up to 38.5 degrees. We took tests. A clinical blood test was good (they said that it was as if PE was not sick, although at the time of the test it was the same temperature). X-rays of the lungs were done 2 times, 1 time from an infectious disease specialist, 2nd time from a pulmonologist. The pulmanologist didn’t find anything from her side either! We visited the ENT specialist, she also didn’t say anything intelligible, everything is fine on her part! Feces and urine are also normal! I still assumed WHOOPING COUGH. When I told our pediatrician, she immediately picked up this diangosis and said, go and donate blood for antibodies. So we went. Results: titer a.t. whooping cough 1/256, titre a.t. p/whooping cough 1/256. What does this result mean? Did we get whooping cough or not?! The cough continues at night and happens during the day. When will it end? When can you get RE-vaccination?! I cannot send my child to kindergarten without vaccination. The child is 1.7 years old.

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Whooping cough is an acute anthroponotic infectious disease with an airborne transmission mechanism, caused by the whooping cough microbe and characterized by a long-lasting, peculiar spasmodic cough affecting the respiratory, cardiovascular and nervous systems. The causative agent of whooping cough is Bordetella pertussis– gram-negative coccobacilli, belongs to the genus Bordetella. Besides B. pertussis respiratory infections in humans can cause B. parapertussis And B. bronchiseptica.

B. parapertussis causes parawhooping cough, a disease similar to whooping cough, but with a milder course. There is no cross-immunity between pertussis and parapertussis. B. bronchiseptica causes bronchisepticosis (bordetellosis), which occurs as an acute respiratory viral infection that occurs upon contact with an infected animal, in people with weakened immune system may cause pneumonia. There are typical (the cough has a paroxysmal character) and atypical (there is no spastic cough) forms of whooping cough. During typical forms of whooping cough, there are 4 periods: incubation (on average 14 days), catarrhal (1–2 weeks), period of spasmodic cough (4–6 weeks) and resolution period. The severity of clinical manifestations depends on the severity of the disease, assessed by: the duration of the catarrhal period, the frequency of coughing attacks, the presence of facial cyanosis during coughing, hypoxia outside of coughing attacks, the degree of disruption of the cardiovascular system, the presence and severity of encephalic disorders. The diagnosis of pertussis is confirmed if there is a clinical standard case definition for pertussis, laboratory confirmation, and/or an epidemiological link to a laboratory-confirmed case. Co-infection with other pathogens of acute respiratory infections is possible, which aggravates the course of the disease.

Indications for examination. Diagnosis: patients with suspected pertussis and parapertussis (according to the standard case definition*), as well as long-term (5-7 days or more) cough, regardless of indications of contact with patients.

By epidemic indications: children and adults in children's institutions, maternity wards and children's hospitals in which patients with whooping cough were identified.

• Acute bronchitis caused by Mycoplasma pneumoniae, Chlamydophila pneumoniae, viral pathogens of respiratory infections;
• foreign body aspiration;
• cystic fibrosis;
• lymphogranulomatosis.

Material for research

• Postopharyngeal smear - culture;
• nasopharyngeal swab - cultural examination;
• smears from the mucous membrane of the nasopharynx and oropharynx - detection of DNA of microorganisms;
• laryngeal-pharyngeal washes – detection of hypertension;
• blood serum – detection of AT.

Etiological laboratory diagnostics include isolating a pure culture of Bordetella and determining their species; DNA detection B.pertussis, B. parapertussis, B. Bronchiseptica PCR method, detection of hypertension B. pertussis in laryngopharyngeal washes using RNIF; detection of specific antibodies.

Comparative characteristics of laboratory diagnostic methods. When Bordetella is identified, a pure culture of microorganisms is isolated and their species is determined by microscopy, RA with species-specific sera, biochemical tests and assessment of microbial mobility. The cultural method is characterized by a long duration of the study, its diagnostic sensitivity does not exceed 10–20%; analytical performance largely depends on the quality of the media used (the addition of animal blood is a prerequisite) and reagents for immunological and biochemical identification tests.

DNA detection by PCR is the most effective and in demand for early diagnosis; the greatest diagnostic capabilities have techniques that allow the detection and differentiation of species that are significant for humans Bordetella with a sensitivity of 5 x 10 2 – 1 x 10 3 GE/ml of test material with a specificity of 100%.

Detection of AT allows diagnosing whooping cough in the later stages. Detection of specific antibodies is carried out using: RA for the diagnosis of whooping cough and parapertussis, ELISA for the detection of antibodies (Ig M, A, G) to various antigens B.pertussis And B. parapertussis. Detection of specific IgA by the RNIF method is practically not used due to the lack of standardization; The sensitivity of the analysis, according to the authors of the method, varies over a wide range from 10 3 to 10 5 microbial cells in 1 ml, while positive results of the study can be taken into account only in the presence of typical symptoms of whooping cough.

Indications for the use of various laboratory tests. Cultural examination for diagnostic purposes should be carried out in the early stages of the disease (1–2 weeks of illness); at later dates, the sowing rate of the pathogen sharply decreases. The optimal time for detecting DNA using PCR is up to 3 weeks from the onset of the disease. Determination of AT is advisable from the 3rd to 6th weeks from the onset of the disease, then AT titers begin to decrease. In children under 6 years of age vaccinated against whooping cough, only blood samples taken over time (paired sera) can be used, and the first time blood is taken no earlier than 3 weeks from the onset of the disease, and again after 2 weeks.

Features of interpretation of laboratory research results. The diagnosis of whooping cough is considered laboratory confirmed if a culture is isolated B.pertussis; detection of a specific genome fragment B.pertussis PCR method; pronounced seroconversion (increase by 4 or more times in the level specific IgG and/or IgA in paired sera, or detection of specific IgM in an unvaccinated patient). The diagnostic titer of the agglutination reaction in unvaccinated and unsick children is considered to be a dilution of 1:80. It must be taken into account that in children under 3 months of age maternal antibodies may be present, but, as a rule, in low titers. Diagnosis of whooping cough caused by B. parapertussis, placed in case of culture isolation B. parapertussis or detection of a specific genome fragment B. parapertussis by PCR method, or if AT is detected by the RA method in a titer of at least 1:80. Disease caused B. bronchiseptica, is diagnosed by isolating a culture or detecting a specific genome fragment using PCR.

* The standard definition of a case of whooping cough is an acute disease characterized by: a dry cough with its gradual intensification and the acquisition of a paroxysmal spasmodic character at 2-3 weeks of the disease, especially at night or after physical and emotional stress; phenomena of apnea, facial hyperemia, cyanosis, lacrimation, vomiting, leuko- and lymphocytosis in the peripheral blood, development of “whooping cough lung”, hard breathing, viscous sputum; slight increase in temperature.

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Decipher the analysis please.whooping cough:: Whooping cough igg to bordetella pertussis

Topic: “Please decipher the analysis. Whooping cough

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decipher the analysis please. whooping cough (66)

anti-Bordetella pertussis IgG - positive;

anti-Bordetella pertussis IgM - negative;

anti-Bordetella pertussis IgA - positive;

A blood test was done from a vein using a serological method. I've been coughing for 6 weeks now. During the day the cough is normal, but at night you can't even call it a cough - it's an attack... I'm afraid to be left alone at night.. hrushka **K** 11/25/11 5:20 pm Have you had any vaccinations against whooping cough? Orcid V.I.P. 25.11.11 17:24 there was, but revaccination from the main one was very delayed. Secondly, the presence of vaccination does not guarantee 100%.. hrushka **K** 25.11.11 17:51 “the presence of vaccination does not guarantee 100%..”

You didn’t come here to discuss the effectiveness of vaccination against whooping cough, but the specific results of the analysis.

So, based on these results, it will be accepted. IgG is most likely vaccine (but in order to say this for sure, it would be better to know the titer more precisely), and negative. IgM indicates that the child does not currently have whooping cough. Marina Shadrina C.S. 25.11.11 18:37 Now there is no whooping cough. Marina Shadrina C.S. 11.25.11 17:28 yeah.. all pediatricians say so.. and all because children are vaccinated.. and the effect of the vaccine begins to weaken after 3 years, and after 12 years there is no immunity to whooping cough at all.. hrushka **K** 25.11.11 17:53 I meant that according to these results, the child has this moment no whooping cough. Marina Shadrina C.S. 25.11.11 18:31 oh sorry. Thank you! hrushka **K** 11.25.11 18:44 In the acute form, IgM must be present. And not enough time has passed since the onset of the disease for them to completely turn into IgG.

By the way, there is also parawhooping cough in nature with a clinical picture similar to whooping cough. Marina Shadrina C.S. 11/25/11 18:49 Parawhooping cough A-le-no-chka * 11/26/11 00:42 Is the child vaccinated? this is very important. If yes (they did DTP), then it’s very difficult to say from these tests. More likely no than yes. We need dynamics, and not just then positive/negative and squiggles in the form of numbers)

6 weeks. hmm, it’s impossible to tell by looking at the nasopharynx. Anonym127 25.11.11 17:45 did you do it in vitro?? most likely yes. I recently encountered this myself. if you suspect whooping cough, you need to do an analysis with titers (done at the Pediatrics Research Institute). I don’t know exactly the number of credits, but I’ll give you an example. if (FOR EXAMPLE) - up to 20 - there is no whooping cough. if 20-40 - you have had whooping cough, now the residual effects do not need to be treated, more than 40 - whooping cough. but, from my practice, I will say - the child coughed for 2 months, and they just didn’t test him, they tested him in vitro for whooping cough, ureaplasma, and mycoplasma. all OK. and the child coughs. until I had an appointment with a pediatrician, who now teaches at a medical institute. what she said - not a single laboratory in Moscow looks at antigens, but only antibodies. And if a child coughs for a long time, then the reason is ureaplasma and mycopsam. She told me where to get tested for antigens. They did the analysis for me there for 500 rubles (as opposed to Invitrov’s 4000) - in the end - a huge amount of ureaplasma. Treated, no cough. With whooping cough, there is a peculiar cough, paroxysmal, suffocating, it cannot be confused with anything. Test for other infections. ksu83 ** 11/25/11 5:53 pm Thank you. Where can I test for antigens? Please send me a personal message if it’s easy.. and in more detail if I can ask (antigens for whooping cough or URPLZM, mycoplasma). And is this a blood test or a smear? hrushka **K** 11.25.11 17:55 no, no. Does your child have a very severe cough? Or does he usually clear his throat in the morning and a little during the day? ksu83 ** 11.25.11 17:59 We’ve already passed the hard one (the first 2 weeks) now it’s 6 weeks, but it’s not getting better. periodically during the day, often from the cold air after ventilation... at night it turns into an attack like whooping cough (this doesn’t happen during the day), but several times a night, not often anymore... I’m just tired of experimenting with syrups and treating for no reason... I want a reason know. hrushka **K** 11.25.11 18:02 Yes, a vaccinated child can also become infected with whooping cough, but not in such a strong form. But usually with whooping cough, doctors hear hard wheezing. you take everything to the Research Institute of Pediatrics, the same thing that you took - Ig A, Ig M, Ig G for whooping cough, they’ll just write to you there - not just positive or negative, but with numbers, and you’ll understand for yourself whether it’s real whooping cough. Their common phone number is 9671420. If everything goes well with this analysis, write to me and I’ll tell you where to get tested for another infection. ksu83 ** 11.25.11 18:07 paroxysmal cough? Is there a characteristic whistle? vomit? Anonymous 11/25/11 18:11 here is the whistling at night... I had vomiting in the first 2 weeks.. hrushka **K** 11/25/11 18:20 get tested quickly at the research institute. and if, God forbid, it is confirmed, just go argue with the doctors. Now there is one reassurance for you - at this stage whooping cough is no longer treated. You just accept it as a fact that the child will cough for about six months. ksu83 ** 25.11.11 18:26 thank you! By the way, at the research institute I’m just saying that I want to get tested or make an appointment with a pediatrician first? And does this test cost 500 rubles? And at which metro station? There are a lot of addresses that the Internet gives out hrushka **K* * 11/25/11 18:48 It’s not necessary to see a pediatrician. You should call there first and find out what days they take the test. Union metro station. you say that it is necessary to take immunoglobulins A, M and Zhe for whooping cough, everything is the same as what you took. I already said that the research institute will write credits for you, and not just approve or deny. This analysis is far from 500 rubles. 500 rubles is an analysis for antigens to ureaplasma and mycoplasma. cheap - because the laboratory is a research laboratory, has existed for several decades and is sent there only on recommendation. They look there ONLY for ureaplasma and mycoplasma. ksu83 ** 25.11.11 22:32 You can also get tested for whooping cough at Gabrichevsky, I got myself into trouble with this invitro and specifically found out at Gabrichevsky how they have it - they have it/don’t have it or the quantity, they said they write the quantity. But the analysis is not ready yet (by the way, you can receive it from them by e-mail). Shaolin * 02.12.11 05:31 Tell me, please, where did you take the test for ureaplasma and mycoplasma, in the same place at the research institute, you need a referral for tests. Can you tell me which pediatrician is best to contact there? Korolkova **K** 11/27/11 4:13 pm You don’t need a referral))) Well, first go to the pediatrician, in case you don’t need to take anything, and the tests don’t cost 3 kopecks. Nikulina is an excellent pediatrician there. A very competent person, he does not heal. You can trust her a million percent! ksu83 ** 11/28/11 11:42 it looks like whooping cough. Anonymous 11/25/11 20:11 please tell me which research institute of pediatrics you took the exam at? On Taldomskaya? Oksana39 *** 25.11.11 22:05 on Lomonosov ksu83 ** 25.11.11 22:28 Thank you very much, tell me what is the correct name for the analysis? I didn’t find it on the website (antibodies to mycoplasma and uroplasma?) and they didn’t test for chlamydia pneumonia? Oksana39 *** 25.11.11 23:01 What symptoms do you have, what do you want to test? ksu83 ** 25.11.11 23:04 the cough has been dry for a month, it has not become productive from treatment (a child with a mild form of asthma - basic pulmicort), tested in vitro for chlamydia and mycopl. pneum. - negative, tested for whooping cough - we are waiting Oksana39 ** * 25.11.11 23:11 Will they deny your IgA IgM IgG? Have you taken all 3 types?? and ureapalzma? In mine it was precisely this that caused the cough. ksu83 ** 25.11.11 23:19 G and M negative. , ureapl. didn’t take Oksana39 *** 11/25/11 23:21 Yes, you are right. There is no Mycoplasma now and the child has never encountered it. With whooping cough, Ig G will be increased, because were vaccinated. but in invitro they only write whether it will be positive or negative. That's what's bad. They don't write IgG numbers. You would have handed over everything at once, otherwise it would be a pity to constantly inject a child. ksu83 ** 11/25/11 23:39 received r-you - whooping cough 1,200 positive, para whooping cough 0.14 positive - the child is vaccinated, the form is lubricated. The cough began as a sore throat, now it’s just dry attacks, none of the doctors could understand, took tests on my own initiative Oksana39 *** 02.12.11 22:50 this is not whooping cough - look for the cause in another Cerera * 25.11.11 23:09 My children were sick with whooping cough in the summer, he is walking around Moscow with might and main. Based on what you described, I am sure that the child has whooping cough. But there is no IgM now, because the child was vaccinated, and those who are vaccinated usually have blurred forms of whooping cough.

IgM begins to be released on the 3rd day of the disease and by 4-5 days it reaches a maximum and by 6-7 there is ALREADY a significant decrease. Don't forget that the half-life of this pentamer monster is ONLY 5 days. By week 4 there should be no trace of it. But, in fairness, it must be said that the excretion schedule is logarithmic, and it is difficult to say what specific logarithm is at the base, it can only be done using paired sera. However, in general terms - at week 6 - it should ALREADY no longer exist in the OVERWHELMING majority of cases.

But I wouldn’t judge based on gender/sex. Anonym127 11/26/11 10:46 Absolutely right, IgM is detected within 3-5 days after the onset of the disease and reaches a peak in the interval from 1 to 4-5 weeks, then decreases to diagnostically insignificant levels within several months. Moreover, children have higher levels of IgM compared to adults. Therefore, at the 6th week of illness they should not yet be negative.

Of course, it would be possible to talk in more detail if the credits were known, and not just put. or negative.. And even better, analysis with titers in dynamics (an increase in titers has diagnostic value

antibodies 4 or more times after 2 weeks).

So I would agree with the statement that in the absence of IgM, whooping cough is present, only under the condition of the above increase in IgG.

At the same time, it was necessary to take tests for parawhooping cough. Marina Shadrina C.S. 26.11.11 11:16 You are wrong. Stating categorically that IgM at the 6th week of illness should be present in a VACCINATED child. N-ik S.B. 26.11.11 13:29 IgM has nothing to do with vaccination and their presence indicates an acute process (because even vaccinated people can get whooping cough). IgG can indicate whether a child is vaccinated. To speak for sure, you need to know the titer and its dynamics. Marina Shadrina C.S. 26.11.11 13:35 By the 6th week there is no longer any acute process left, at least read about the course of the disease. And among those vaccinated, it is precisely that the disease often occurs in a blurred form. Therefore, I completely disagree with your categoricalness, having before my eyes a picture of whooping cough progressing completely differently in my four children. Do you have a lot of visual experience to confirm? N-ik S.B. 26.11.11 13:41 By acute process I mean recent, i.e. a recent disease, and not some time in the past. If a person is sick, he will produce IgM. And they will be produced during any course of the disease (both with a severe course and with a blurred clinical picture). Over time, IgM will decrease, but IgG will increase. Marina Shadrina C.S. 26.11.11 13:50 From the anonymous quote above to you: “IgM begins to be released on the 3rd day of the disease and by 4-5 days it reaches a maximum and by 6-7 there is ALREADY a significant decrease. Don't forget that the half-life of this pentamer monster is ONLY 5 days. By week 4 there should be no trace of it.” All his further reservations are just that: reservations. By week 6, the “decrease”, in your words, IgM has already reached an undetectable level.

My fully vaccinated child was sick with whooping cough and when we 2 months later. They did serology (on their own initiative), then IgM was still detected and was not negative.

Sorry, I don’t want to argue on this topic anymore, neither with you nor with anyone else.

The author has already been given advice: complete serology is needed, with titers and in dynamics, then it will be possible to say more definitely, and not guess. If this is not possible, then you need at least general Ig with a titer, taken at least 2 times with an interval of 2 weeks, to see if there is an increase in titer. If there is growth, then the conversation will be different. Marina Shadrina C.S. 26.11.11 14:08 And what follows from this? Based on your child, will you now throw everyone under the rug? I just wrote you our example, that the antibodies were not detected even in the 2nd week. And by the 6th week they should not be determined even according to the classical description.

With that, let’s part ways with the world :) Marina Shadrina C.S. 26.11.11 14:21 The total titer was given once to the unvaccinated person who was the most ill. I wrote about him. I didn’t want to write about the rest, but since we’re talking about it, my vaccinated daughter was given IgM and IgG tests on the 8th day, and the test was negative.

N-ik S.B. 26.11.11 14:44 girls! let's live together, without increased speed - this is where constructivism will appear.

Generally speaking, IgM should practically disappear at 2-3 weeks of the disease; I calculated empirically that by the 4th week approximately 1.5% of the 5th day of the disease will remain.

But! it all depends on the notorious logarithm of the decrease in concentration; there are some diseases in which trace amounts of M remain for up to 2-3 months. (depends on the disease, body, immunity)

And there is - when after 15 days they are no longer there.

YOU ARE BOTH RIGHT. (but each in its own way)

Usually, I repeat, by week 6 M is significantly less than 1% (about 0.2-0.3%, which is approximately 1 in 5, the device will show “-“, but it WILL SHOW THE NUMBER in IU)

Regarding the author’s question - without paired analysis (with numbers, or dilutions, for whooping cough it is, if memory serves, 1 in 80) - I cannot say EXACTLY. And no one will tell. Marina is at her best here. Anonym127 11/26/11 2:46 pm 1 in 80 they refused to diagnose us with whooping cough, they said we needed at least 1 in 160. But I didn’t inject the child further just for “dynamics”, and so everything is clear, even the titer is 80 in an unvaccinated person along with The most characteristic clinical picture is the diagnosis. N-ik S.B. 26.11.11 14:48 I think that you are right about your diagnosis. In most cases of a positive result, the dilution ranges from 1:50 to 1:100, 1:80 in an unvaccinated person with the appropriate clinic is it. By the way, how did it go, what was the treatment, how quickly did the cough go away, if it ALREADY went away? Anonym127 11/26/11 18:08 I wrote above that with any cold/virus (which children get sick in different forms almost every month when attending children's groups), the characteristic paroxysmal cough returns, but goes away along with the virus.

http://eva.ru/topic/136/2693048.htm Well, look at the title we had. The retitration in Gabrichevsky did not even leave a chance for whooping cough.

Did you take it to the Central Medical Center? IMHO they messed up quite a bit in the summer. And maybe not only in summer. Anonymous 02.12.11 03:35 I don’t understand what not to say? N-ik S.B. 02.12.11 10:03 “even a titer of 80 in an unvaccinated person, along with the most characteristic clinical picture, is a diagnosis.”

This is true only in theory. More precisely, with 100% confidence in the data obtained. I got a titer of not just 1:80, but 1:320. It would seem so. And a second retake showed that whooping cough was not even close. That is, in practice, a one-time test does not guarantee anything. But when the titer increases, yes. It’s no longer possible to screw up so masterfully :-) Anonymous 12/02/11 10:56 UPD I answered you in another topic, I’m not going to continue the discussion anymore, since your conclusions are speculative, you are trying to stretch your situation onto everyone else, not paying attention to the written facts .

Week 6: whooping cough 1:320

Week 8: whooping cough 1:640

normal value< 1:20

It’s interesting that whooping cough and parawhooping cough happened here?

A 3.5 year old child is fully vaccinated on time. The disease had a classical course, rather in a mild form. Now we are exactly 3 months from the start, we are still coughing (about 5 times a day), not violently and not convulsively. I am waiting full recovery. Li_Tea ** 11/26/11 21:46 I no longer trust these tests 100%, perhaps it’s just the sensitivity of the markers in this particular laboratory, which shows a reaction to both whooping cough and parawhooping cough at the same time. I’m saying this after the test showed no antibodies at all in my daughter, who was already actively suffering from whooping cough and was vaccinated, to boot. N-ik S.B. 28.11.11 15:30 What tests need to be taken to determine the causes of frequent obstructions? Tested for mycoplasma and pneumochlamydia - negative, the child has been coughing for a year with short breaks of 2 weeks. Any ARVI = obstruction, once a month, every two months. (Sorry, I’m interjecting with my own painful question). Leko4ka + 26.11.11 22:19 for ureaplasma!! ksu83 ** 11/27/11 11:23 And what ureaplasma? there are several types of them. Leko4ka + 27.11.11 12:42 For respiratory allergens, obstruction may be of an allergic nature. Shaolin * 02.12.11 05:34 We had 100 percent of the mildest whooping cough 2 years ago, although the tests didn’t show it!

I don’t recommend leaving the child alone for now! Anonymous 02.12.11 01:12

Whooping Cough - Symptoms, Diagnosis and Treatment of Whooping Cough

Disease code (ICD-10) A37.0

Whooping cough (pertussis) is an acute anthroponotic airborne bacterial infection, the most characteristic symptom of which is a paroxysmal spasmodic cough.

Historical information

The whooping cough epidemic was first described by G. de Bayu in Paris in 1578, in the 17th century. a description of the epidemic in England was presented by T. Sydenham in the 18th century. Hoffmann reported on whooping cough in Holland. In the 18th century The first monograph on whooping cough appeared, created by A. Brendel and Bassiville. A detailed description of whooping cough was made by N.F. Filatov. In 1900 and 1906 The pathogen was isolated from coughed up mucus and studied in detail by J. Bordet and O. Zhang. In 1957, a killed pertussis vaccine was created in our country; since 1965, vaccinations have been carried out with an associated vaccine (DTP). A great contribution to the doctrine of whooping cough was made by domestic scientists M.G. Danilevich, A.I. Dobrokhotova, V.I. Ioffe, S.D. Nosov and their collaborators.

Pathogen– bordetella pertussis, or Bordet Zhangou bacillus, is a small gram-negative, non-motile microorganism that looks like a short stick with rounded edges.

It can be dyed well with all aniline dyes. Strict aerobic.

Very sensitive to environmental factors– sunlight, increased temperature, all disinfectants.

The causative agent of whooping cough is demanding on nutrient media. It grows well on potato glycerin agar with the addition of 25–30% defibrinated human or animal serum, as well as on casein charcoal agar (KUA medium), which is widely used in the laboratory diagnosis of whooping cough. The temperature optimum for growth is 35–37°C; Bordetella colonies appear on solid media after 48–72 hours, and sometimes later, and outwardly resemble droplets of mercury. From a biochemical point of view, the pertussis bacillus is inert.

Antigenic structure The causative agent of whooping cough is very complex. There are three main serological types: 1, 2, 3; 1.2, 1.3. It is believed that the types containing antigen 2, especially type 1,2, are the most virulent. Circulation in pertussis foci of two or all three serotypes of the pathogen has been proven. In addition to agglutinogens (on the basis of which serotyping is carried out), the antigenic structure includes hemagglutinins, a toxin, lymphocytosis-stimulating factor, adenyl cyclase, and a protective factor.

Toxin presented by thermolabile (exotoxin) and thermostable (endotoxin) fractions.

Whooping cough is a severe anthroponosis.

Source of infection is a sick person with any form of infectious process: severe, moderate, mild, asymptomatic (bacterial excretion). The greatest danger is posed by patients during the catarrhal period of the disease and in the 1st week of spasmodic cough - 90-100% of them secrete whooping cough. In the 2nd week, the infectivity of patients decreases; the pathogen can be isolated in only 60–70% of patients. At the 3rd week, Bordetella pertussis is detected only in 30–35% of cases, subsequently - in no more than 10% of patients. After 4 weeks from the onset of the disease, patients are practically not infectious and are not dangerous to others. The difficulty is that during the catarrhal period, the diagnosis of whooping cough is made very rarely (especially in the absence of clear indications of contact with a patient with whooping cough), in addition, erased and atypical forms of the disease are common (especially in adults). That is why the source of infection in whooping cough is very active; its isolation is usually delayed and has little effect on the spread of the disease.

Pathogen transmission occurs by airborne droplets, during direct contact with the patient, since the pathogen disperses around the patient no more than 2–2.5 m and is not stable in the external environment.

People's sensitivity does not depend on age, but depends on the presence and strength of immunity, the infectious dose and virulence of the pathogen, premorbid background and genetic constitution. In unvaccinated people normal conditions susceptibility is high, reaching 0.7–0.75 (out of 100 people who come into close contact with the patient, 70–75 get sick). A special contingent of susceptible individuals are newborns who do not receive passive immunity from the mother, even if she has antibodies to Bordetella pertussis. Thus, a person is susceptible to whooping cough from the first days of life, this is extremely important to take into account in work, since newborns and children under 1 year of age suffer from whooping cough severely and not quite typically, among them the mortality rate from this infection is very high.

After the illness, persistent and intense, almost lifelong immunity remains.. Repeated cases of whooping cough are extremely rare. The dynamics of the epidemic process remain cyclical; usually, after 3–4 years, increases in incidence occur.

Whooping cough is characterized by seasonality: the increase in incidence begins in July - August and reaches a peak in the autumn-winter period, but in principle, the circulation of the pathogen among the population does not stop throughout the year. In the pre-vaccination period, whooping cough was characterized by pronounced focality, when most children became infected in child care institutions during an outbreak. Currently, this feature of the epidemic process has been smoothed out. Before the introduction of mandatory vaccination against whooping cough, almost 80% of the incidence was observed in children under 5 years of age. There are no exact data on the incidence among adults, since whooping cough is rarely recognized in them.

Pathogenesis and pathological picture

Entrance gates of infection- upper respiratory tract. Adhesion of microorganisms to the cells of the cylindrical ciliated epithelium of the larynx, trachea, and bronchi occurs. Epithelial damage occurs mainly due to the influence of the pathogen's adenyl cyclase and the lymphocytosis-stimulating factor it produces.

The microorganism does not penetrate the cell.

Major events develop as a result of exposure to pertussis toxin, which causes prolonged irritation of the nerve receptors of the vagus nerve. A continuous flow of impulses coming from the receptors of the mucous membranes of the respiratory tract leads to the formation of a stagnant focus of excitation (dominant) in the region of the respiratory center in the medulla oblongata.

In the dominant focus, irritations are summed up; a specific response is also possible to nonspecific stimuli (painful, tactile, sound, etc.). In addition, excitation can radiate to neighboring centers, hence the possible involvement of the vomiting center (some attacks of whooping cough end with vomiting), the vascular center with a response in the form of generalized vascular spasm, increased blood pressure, acute cerebrovascular accident, the center of skeletal muscles with the occurrence of clonic and tonic convulsions.

Sometimes the dominant transitions into a state of parabiosis, which explains the occurrence of delays and stops in breathing during the convulsive period of whooping cough, especially in newborns and the smallest infants. As a result of toxinemia and attacks of convulsive cough, hemodynamic disorders develop, which are accompanied by an increase in the permeability of the vascular wall, which in the clinical picture is manifested by hypoxia, acidosis, and hemorrhagic symptoms.

Pathogens and their metabolic products cause inhibition of the body's nonspecific defense factors and immunosuppression, which leads to the fairly frequent addition of secondary bacterial flora and viral infections.

Pathological changes with whooping cough are scanty and nonspecific: hyperemia, edema, proliferation epithelial cells respiratory tract, desquamation of individual cells, changes in the lungs and brain. The rest of the pathological picture of whooping cough is determined by its complications, from which death occurs.

Clinical picture (symptoms) of whooping cough

Incubation period ranges from 3 to 14 days, with an average of 5–8 days. Whooping cough occurs in most patients with a typical course of the disease.

Typical course of the disease

In typical cases, 4 more periods can be distinguished:

• Catarrhal (initial),
• Spasmodic (convulsive),
• Permissions (reverse development) and
• Convalescence.

The catarrhal period proceeds in different ways and does not have any specific features.

Body temperature may remain normal, usually low-grade, in very severe and rare cases it may rise to 38–39 ° C; The severity of the disease also determines the severity of intoxication - from mild malaise, anxiety, irritability and loss of appetite to significant. At the same time, a slight runny nose, cough, and lacrimation occur. The picture of pharyngitis, laryngitis, and tracheobronchitis gradually develops. Occasionally, whooping cough debuts with symptoms of false croup, which, however, quickly resolves.

Cough during this period is the leading symptom of whooping cough: it is dry, does not decrease when taking symptomatic medications, intensifies in the evening or at night, in a third of patients it becomes intrusive, gradually acquiring the character of attacks. In mild cases, the duration of the catarrhal period is longer - up to 11–14 days; in more severe cases, it is reduced to 5–8 days.

Spasmodic (convulsive) period

During the spasmodic (convulsive) period, the cough becomes so peculiar that the diagnosis can be made at a distance; Whooping cough is often recognized by mothers themselves.

Coughing attacks are typical, after which the patient feels quite well, children play calmly, are interested in their surroundings, or fall asleep.

Almost all children feel the approach of an attack in one way or another: the older ones complain of a sore throat, scratching behind the sternum, the younger ones feel fear, worry, start crying, lose interest in toys, often jump up and run to their mother. This is followed by coughing attacks one after another. During an attack, short coughing bursts follow one after another, preventing the patient from breathing. When such an opportunity arises (usually after 10–12 cough shocks), the air whistles through the convulsively compressed glottis, which is accompanied by a loud whistling sound (French authors called such a convulsive inhalation, accompanied by a whistling sound, reprise). Following the inhalation there are several more cough “discharges” with reprises, a total of 3–6 and a duration of 1–4 minutes. The child is scared all this time, the veins in the neck swell, the face turns red, then becomes cyanotic, tears roll down the cheeks, the eyes are wide open, the tongue protrudes from the mouth as much as possible, its tip is raised up. During an attack, some children experience involuntary eruption of feces and urine, and there may be fainting and convulsions. The attack ends with the release of a large amount of viscous, thick mucus, and in many cases vomiting occurs.

Cough paroxysm can be provoked by harsh light, strong sudden noise, fuss around the child, his excitement, fear, an outburst of other emotions (including violent laughter or crying) of the patient himself, as well as examination of the pharynx using a spatula or spoon. The number of such paroxysms varies and depends on the severity of the disease. In a mild form, their number does not exceed 8–10 per day, they are not accompanied by vomiting, and occur with general feeling good and the patient's condition.

For moderately severe whooping cough the number of attacks reaches 15 per day, they usually end with vomiting. Outside of an attack, the state of health improves, but may not completely return to normal: children remain lethargic, refuse to eat, sleep poorly due to coughing attacks, do not get enough sleep, and become capricious. Outside of an attack, the face remains puffy, the eyelids are swollen, and hemorrhages may appear on the conjunctiva.

In severe forms of the disease the number of attacks exceeds 20–25 per day, reaching 30. Especially impressionable, nervous children spend even the “light” periods waiting for the next attack - they become martyrs for the entire spasmodic period. They develop oxygen deficiency, the skin is pale, cyanosis of the nasolabial triangle and acrocyanosis appear and persist. Some patients experience a tear and ulcer on the frenulum of the tongue - a consequence of tension and trauma on the lower incisors.

In particularly severe cases Possible disturbance of cerebral circulation with loss of consciousness, convulsions, disturbances in breathing rhythm, and sometimes paresis, which disappear without a trace during the period of resolution and recovery. Cases of hemorrhage in the brain have been described, the clinical picture of which is determined by its localization and extent, then the consequences can be irreversible.

Body temperature in most cases remains normal throughout the entire convulsive period. During percussion of the chest during this period, a zone of dullness is revealed in the interscapular region; upon auscultation, a small amount of wet large and medium-bubble rales and dry rales are revealed. In the case of a long convulsive period when tapping, a tympanic shade of the percussion sound is possible due to pulmonary emphysema.

In the hemogram leukocytosis is very characteristic (from 10.0–15.0 * 10^9 /l in mild cases, to 30.0–40.0 * 10^9 /l in severe forms of the disease), as well as relative and absolute lymphocytosis - 60 –85% or more in the leukocyte formula. The absence of leukocytosis and lymphocytosis does not, however, indicate the absence of whooping cough, especially in vaccinated and adult patients.

Duration of the spasmodic (convulsive) period 2–8 weeks or more. Towards the end, its attacks are milder, the number of paroxysms gradually decreases, and the disease passes into the next period.

The period of resolution (reverse development) continues for another 2–4 weeks. Attacks become rare, without vomiting, are much easier to tolerate, and the well-being and condition of the patients are normalized.

Convalescence period

The convalescence period covers 2–6 months. With the accumulation of other respiratory infections, primarily acute respiratory infections, the cough may resume. During this period, irritability, weakness, increased excitability of patients, and their susceptibility to other infections persist.

Atypical course of the disease

The atypical course includes erased and abortive forms.

With erased forms disease, there are no attacks of convulsive cough, but the cough itself can last for several weeks and months; it cannot be treated with symptomatic means.

In abortive form after the typical course of the catarrhal period, paroxysms of convulsive cough develop, but after 1–2 days they completely disappear, the cough goes away quite quickly.

Asymptomatic (subclinical) form detected only in foci of whooping cough during bacteriological and serological examination of contact persons.

Features of whooping cough in children

Features of whooping cough in young children. The disease is much more severe than in older children, and the incubation period is shortened. The catarrhal period is usually short, and the convulsive period is longer. The actual convulsive cough is usually absent, but its equivalents are observed: attacks of anxiety, sneezing, screaming, during this period the child can assume a fetal position. Reprises are absent or unclear. Breath holding (from 30 s to 2 minutes) and even stopping (apnea for more than 2 minutes) often develop. They can occur during an attack and, what is especially dangerous, outside an attack and even during sleep. Regurgitation can be a “replacement” for vomiting in very young children. In young children, complications of whooping cough are common, and serious consequences are possible (cerebral circulatory disorders with paralysis, bronchitis followed by bronchiectasis, disturbances in psychomotor development, epileptiform seizures, etc.).

Features of the course of whooping cough in vaccinated people

The disease occurs in a mild form, usually without complications or consequences, and more often in an atypical (erased) form.

Features of whooping cough in adults

Whooping cough most often occurs in the lungs or atypical form and is usually manifested by a long, persistent, obsessive cough that cannot be treated. Repetitions are not pronounced, and vomiting, as a rule, does not occur. Complications are rare. The correct diagnosis is rarely established, usually in cases of simultaneous illness in a child with a typical course of infection or during a bacteriological and serological examination of an adult working in a children's team or who has come into contact with a child with whooping cough.

Complications are numerous, some of them very serious and can lead to death. Pneumonia, emphysema of the lungs, mediastinum and subcutaneous tissue are possible; pulmonary atelectasis rarely develops; sometimes hemorrhage occurs in the brain and retina with corresponding consequences. Ruptured eardrums, prolapse of the rectum, and the formation of hernias have been described, especially in infants.

It is possible that secondary bacterial flora may join with the development purulent otitis, bronchitis, pneumonia, pleurisy, empyema, mediastinitis, etc. Often a consequence of whooping cough (especially in children in the first 3 years of life) is bronchiectasis. It is also believed that some patients suffering from petit and major epileptic seizures acquired them as a result of whooping cough.

In most cases it is favorable, but in newborns and children of the first year of life it is always serious. The prognosis is serious for severe disease and the development of complications. In the pre-vaccination period in the former USSR, about 600 thousand people fell ill with whooping cough every year, more than 5 thousand of them died (i.e. more than 8%), the mortality rate from whooping cough in the first year of life reached 50–60%.

Diagnosis of whooping cough in typical cases is very simple and is based on the assessment of a coughing attack with repeated episodes. Unfortunately, the diagnosis established during this period must be considered late, both therapeutically and epidemiologically.

Diagnosis of whooping cough during the catarrhal period, of course, is possible if there are epidemiological prerequisites (contact with a whooping cough patient). In case of inconclusive epidemiological data, the diagnosis in the initial (catarrhal) period is based on the fact that with whooping cough, cough dominates over all other manifestations of the disease, increases every day, despite symptomatic therapy, occurs in most cases against the background of normal (less often subfebrile) body temperature , intensifies in the evening and night hours, after thermal procedures.

A clinical blood test is very helpful in diagnosis: the hemogram already during this period reveals lymphocytosis and leukocytosis with a normal ESR. Verification of the diagnosis of whooping cough is carried out using the bacteriological method. There are several methods for collecting material (“cough strips”, “retropharyngeal swab”), which is placed in a nutrient medium. The examination is carried out in the first 2 weeks of the disease. A preliminary answer is received in 3–5 days, a final answer in 5–7 days. Also used serological method confirmation of the diagnosis (RA, RSK, RPGA).

Diagnostic titer in the most commonly used RPA 1:80 (in unvaccinated). In all other cases, to confirm the diagnosis, it is necessary to obtain an increase in antibody titer by 4 times or more (in paired sera taken at an interval of 10–14 days). The reaction is performed simultaneously with pertussis and parapertussis antigens.

Differential diagnosis

Whooping cough is differentiated from acute respiratory infections viral diseases, measles, bronchitis, pneumonia (during the catarrhal period), tuberculous and tumor bronchoadenitis, bronchial asthma, cystic fibrosis, foreign body entry into the bronchi.

Children with moderate to severe forms of whooping cough should be treated in a hospital setting. Of exceptional importance in the treatment of patients with whooping cough is the organization of their maintenance and nutrition regimen. It is necessary to eliminate external stimuli, ensure a calm environment, and provide the child with the opportunity to engage in quiet games. The room where the patient is located should be well and often ventilated, with normal temperature You should walk with your child as much as possible (avoiding contact with other children), at any time in the summer, in winter - at an ambient temperature of at least 10–12 °C and there is no wind. Previously, the authors recommended providing a patient with whooping cough not only with fresh, cool, but also moist air. In a room, especially with central heating, you should install an air humidifier, if it is not available, place vessels with water, and hang wet towels. On the street, if possible, you should walk near water (along the banks of a river, lake, canal, pond). Meals should be complete in composition, gentle in preparation, and fractional. It is important to maintain natural feeding for infants, increasing the number of feedings by 1–2 per day, correspondingly reducing the single volume of milk. The same must be done when artificial feeding. After vomiting, the child must be fed additionally. During illness, a child should receive a sufficient amount of fluid (tea, juices, fruit drinks, alkaline mineral water, Borzhom, Essentuki No. 20, etc.). For older children, avoid dry food, which irritates the back wall of the throat, which provokes another coughing attack. Specific therapy for whooping cough has not been developed. Among etiotropic drugs, broad-spectrum antibiotics are used - semi-synthetic penicillin ampicillin (penicillin itself, i.e. potassium and sodium salts of benzylpenicillin and phenoxymethylpenicillin is ineffective for whooping cough), chloramphenicol, aminoglycosides, macrolides in age-related doses. The course of antibiotic therapy is 5–7 days. Antibiotics are effective when the pathogen has not yet left the body, i.e. in the early stages of the disease - during the catarrhal period and in the first days of the spasmodic period. At a later date, antibiotic therapy has no effect. It is resumed when secondary complications develop. From the first days of the disease, pathogenetic therapy is carried out, aimed at weakening the cough reflex, eliminating oxygen deficiency and normalizing hemodynamics. Symptomatic therapy is indicated (for example, in case of seizures); the prescription of conventional antitussive drugs is ineffective. Some patients benefit from acupuncture; sometimes they have to resort to barotherapy. Psychotropic drugs occupy a central place in pathogenetic therapy. Only in a hospital setting is the antipsychotic aminazine prescribed (0.6% solution for intramuscular administration or a corresponding suspension of the drug for oral administration) at a dose of 1–1.5 mg/kg body weight per day, before daytime and night sleep, as well as the antipsychotic droperidol in age doses. Not only in the hospital, but also at home, you can use pipolfen (diprazine) not so much as an antihistamine, but as a drug with a pronounced effect on the central nervous system, sedative activity. The drug is administered intramuscularly or orally in age-specific dosages. Diphenhydramine should not be used, as it dries out the mucous membranes and can provoke a cough attack in a patient with whooping cough. At home, tranquilizers from the diazepam group (Seduxen, Relanium, Sibazon) are usually used intramuscularly 0.5% solution at the rate of 0.5–1.0 mg/kg per day or orally at an age-related dose. The course of treatment is 7–10 days, longer if necessary.

The main and most reliable measure to prevent whooping cough is the creation of active immunity through vaccination. According to the compulsory vaccination calendar in force in the Russian Federation and other countries of the former USSR, vaccination is carried out with adsorbed diphtheria-tetanus pertussis (DPT) vaccine. A patient with whooping cough is isolated for 25 days from the onset of the disease. If a pertussis bacteria is detected in a children's group, it is isolated until 2 negative results of bacteriological examination are obtained (it is carried out 2 days in a row or with an interval of 1-2 days). Discharge of the patient to a children's institution is possible no earlier than the 25th day from the onset of the disease, subject to clinical recovery without a control bacteriological examination. Before the 25th day from the moment of illness, the child can be discharged with significant clinical improvement and two negative results of bacteriological examination. Children who have come into contact with a pertussis patient, especially in the 1st year of life and not vaccinated until 2 years of age, are given donor normal immunoglobulin (2–4 doses). In a children's group, when a patient with whooping cough is registered, children under 7 years of age are quarantined for 14 days from the date of isolation of the patient. Current and final disinfection are not carried out due to the low stability of the pathogen in the external environment.

anonymously

Hello! My child is 2 years old and 8 months old. He has been coughing for about 2 months; at first it was a very terrible paroxysmal cough. Then the attacks passed, but the dry cough remained. We went to a bunch of doctors, took a bunch of tests, and finally the pulmonologist sent me to get tested for whooping cough and parawhooping cough. Finally today I got the result. Antibodies to Bordetella pertussis 1:40. It turns out we had whooping cough? Didn't the pediatrician recognize him? Tell us what we should do now: 1. Should we start drinking Sinekod or Stoptusin, because there isn’t a day when the child doesn’t cough, sometimes a lot, sometimes even slightly, but he coughs. The cough is non-productive all the time. Is any treatment needed? 2. A throat swab was taken and Haemphilus influenzae 10*5 was detected. Should we fight him? take antibiotics (the district police officer insists on this, otherwise they say blood poisoning and other horrors) or is the degree not great? The paid pediatrician said that you don’t need to take antibiotics, get vaccinated with Pneumo23 and Hib Act. Will these vaccinations help? And how to prepare for them? Take antihistamines? 3. ENT discovered grade 1 adenoids. and for the 10th day we have been spraying Nasonex 1 dose, irrigating the pharynx with Miramistin 3 times a day. Should I continue treatment? Is grade 1 not that dangerous? I'm afraid to completely heal the child. Yes, we already breathed Berodual and Pulmicort. A paid pediatrician gave us acute obstructive bronchitis, after the treatment she suggested, the child felt better, and all the district police did was prescribe antibiotics and refer him to an allergist. We didn’t take antibiotics; we went to a paid clinic. 4. His immunoglobulin E is 188 U/ml, we have been on a strict diet for a month now, although before we barely drank chocolate, we drank a lot of milk, we barely drank citrus fruits and even nuts, and everything was fine. We took this test because of a cough. Can we now eat as before? After all, the cough was due to whooping cough? 5. After the child got sick, he sometimes began (when he wakes up or goes to bed, or he doesn’t like to do something) to complain about pain in the lower back, then in the tailbone, then in the knees, then he says that his feet hurt, then Hands. They tested for rheumatoid factor, it was 7IU/ml, i.e. norm. Tell me if this is related to whooping cough or if I still need to go to an orthopedist.

Hello! Your baby has been seen “in real life” by so many specialists that it is probably naive to hope for correspondence advice... But I understand your anxiety and concern for your child. I’ll express my opinion - and you remember that I simply don’t see the baby... 1) In general, the use of antitussives in pediatrics is not encouraged. Only if the cough is very painful for the child, can it be taken in drops... And it is better, in my opinion, to limit oneself to milk with honey, inhalations with plain water, long walks. If a child has been coughing for 2 months, there is no point in using either antibiotics or gamma globulins to cure it. With this infection, the phasing is clearly expressed: first, just a regular cough, then a paroxysmal, persistent cough - and after 2-8 weeks it begins to subside on its own, gradually losing its paroxysmal character... However, with the addition of any acute respiratory infection, it can intensify and again become paroxysmal character, but it does not last long, and the child is not contagious. 2, 4) I would not “knock out” Haemophilus influenzae with antibiotics. Maybe it really makes sense to vaccinate a child (but why Pneumo23 if it wasn’t pneumococcus that was cultured?). No special preparation is required for vaccination; The main thing is that the child is healthy. True, people with allergies are sometimes prescribed antihistamines a few days before vaccination, and they are used for another 2 days after vaccination. Whether you need this is better to decide with an allergist (immunologist). At the same time, discuss the issue of diet with him - after all, it wasn’t only because of you that they put him on a diet? Did you have any allergic reactions? 3) it is better to discuss treatment tactics for adenoiditis with an otolaryngologist. Treatment with Nasonex is now, as far as I know, a priority; The attitude towards Miramistin is not so clear. The adenoids themselves are just growths of lymphoid tissue (your nasopharyngeal tonsil is slightly enlarged). It is necessary to treat when it becomes inflamed; when nasal congestion appears, snoring at night. If there is inflammation, it needs to be treated. If not, from these drugs the size nasopharyngeal tonsil will not decrease. It grows until the age of 4, then for 3 years it remains at its maximum size, and from the age of 7-8 its reverse development begins. Therefore, usually in case of grade 1 adenoids, there is no rush with surgery, but the baby is treated conservatively in case of exacerbations. 5) without examination it is difficult to say what is causing the pain in the limbs. The most common and pleasant option is that these are temporary disturbances associated with the growth of the child. Then they can be easily removed with a warm scarf and some saying or “magic words”. There may be reactive arthralgia associated with acute respiratory infections or with the same adenoiditis; Whooping cough has nothing to do with it, in my opinion. The pain can even be of a neurotic nature (the child, after all, senses your anxiety, your concern about his illnesses; perhaps subconsciously attracts your attention with such complaints. If the pain does not go away after recovery, the child will need to be examined. I would start with blood tests, not orthopedist; however, opinions may differ here. Good health to you!