Pertussis : Causes, Symptoms, Diagnosis, Treatment

Pertussis

Pertussis is also called as whooping cough. Pertussis is an  important communicable disease caused by bacteria,  results in uncontrollable, violent cough. Especially children are affected with pertussis.  As the sound comes during cough and taking air in, is called as whooping cough.  Nearly 5000 to 10000 children in united states are dieing every year because of pertussis.


Causes of pertussis

Bordetella pertussis, the bacteria causes pertussis infection. Pertussis is the disease of upper respiratory tract, if not treated causes permanent disability in children and may lead to death. Pertussis transmitted when an infected person sneezes or coughs, the bacteria spreads to air, and the person who inhales pertussis infected air droplets becomes infected with pertussis. Hence pertussis is an infectious disease easily spreads from person to person. Cough, sneezing, runny nose are the early symptoms of pertussis. After the pertussis bacteria multiplies in body, severe cough starts. Children experience weakness, fatigue and discomfort as the cough becomes severe. The continuous cough leads to impaired breathing and the children make whoop sound after coughing, is called whooping cough. Whooping sound is absent in infants less than 8 months. Some children vomits along with small amount of sputum. Coughing and vomiting simultaneously may lead to chocking in infants. Pertussis infection usually lasts for a period of 6 weeks. Whooping cough affects not only children but elder people can also get infected with pertussis. Now the incidence of pertussis is reduced as children are immunized during infancy, and higher rate pertussis is seen in  adolescents and elders.

Symptoms of pertussis

  • Runny nose, sneezing
  • mild fever up to 102 °F.
  • Severe, continuous cough
  • difficulty in  breathing
  • both night and day cough,
  • vomiting with sputum and cough,
  • dry cough develops after some days,
  • presence of whooping sound after cough while taking breath,
  • generalized weakness and fatigue,
  • Some children will have diarrhoea,
  • Choking may occur in infants.


Diagnosis of pertussis

The initial diagnosis is the physical examination and history collection. The symptoms of pertussis are similar to pneumonia and the careful examination is needed to diagnose pertussis.

  • Sputum test for bacterial culture,
  • Nasal secretions test in laboratory,
  • Chest x ray is also taken to differentiate from pertussis.
  • Blood test is done to check elevated white blood cells.


Treatment of Pertussis

Antibiotics such as erythromycin and amoxicillin are the choice of drugs for pertussis treatment. Analgesics and antipyretics  are given to reduce fever and body ache. Incentive care should be taken to treat the infants infected with pertussis, and careful monitoring of progress of diseases and prognosis of treatment is needed. Hospitalization is needed in severe pertussis infected children. An oxygen tent with high humidity is used for infants have breathing difficulty. Intravenous fluids administration is also done to maintain water and electrolyte balance. Sedatives  may be given by the pediatrician for young children to avoid crying and induce sleep. Expectorants, and cough suppressants are  not helpful in treating pertussis.

Prevention of pertussis

The DPT vaccine ( diphtheria, pertussis,tetanus) or only pertussis vaccine Helps lot in preventing pertussis. Immunization schedule n most of countries  recommended for DPT-vaccine in infancy itself. The booster shot of pertussis is given after some months in infants. In adults also booster dose of pertussis is given to prevent pertussis in adolescents and adults. Pertussis affected children should follow the measures to prevent spread of pertussis infection by wearing face mask, or avoiding school for some days. The vaccination also given to elders aged above 65 years to prevent pertussis.

Rabies vaccine: vaccination grades, dosage and side effects

Rabies can be defined as  ‘ A fatal viral infection, is usually acquired through the bite of an infected animal to the human beings’. Nearly all morbidity in human beings worldwide is due to the bite of a rabid dog, and rabies infection. The rabies occurs from the rabdo virus. Rabies vaccine has reduced the incidence of rabies morbidity.

Rabies vaccination is the active immunizing agent  used to prevent the infection caused by the rabies virus that carried by the animals. It is a killed rabies virus vaccine.

There are two types of rabies vaccinations

  1. Pre-exposure prophylaxis : this type of rabies vaccination is done for the persons who are at high risk of getting infected. Animal handlers, veterinarians, travelers, the persons who are in contact with the wild animals are likely to get infected.
  2. Post-exposure prophylaxis : this type of rabies vaccination prophylaxis is done to the patients who are exposed to the animal bites, indicated by bite, scratch, or lick.

Facts related to rabies vaccine

  • The rabies  spreads through the pet animals as well as wild animals; dogs, bats, raccoons, skunks, cats, horses, swine, foxes and cattle are the usual ones. So it is better to immunize the domestic animals with rabies vaccine.
  • A person who is bitten by the infected animal  should receive the rabies vaccine after the animal bite. If patient is known to be hypersensitive to the rabies vaccine, then the rabies vaccine should be administered under supervision with all the immediate measures for managing anaphylactic shock.
  • Prophylactic use of the rabies vaccination should be avoided in children, adolescents, antenatal mother & adults on treatment for any acute illness.
  • Pre exposure rabies vaccine is to be avoided if person is known to be allergic to rabies vaccine.
  • The further rabies vaccination or  immunization is avoided in persons who had complications on rabies vaccine administration.

The immunization schedule is classified under some grades as

  • Grade I : when the person is in contact with the animal but not in contact with the saliva or blood. For this kind scheduled rabies vaccination is not needed.
  • Grade II : If the animal has licked or if any other kind of expose to the saliva and superficial, non- bleeding scratches made by the animal, immediate rabies vaccine immunization should be given according to the schedule B.
  • Grade III :  includes all bites, bleeding scratches, all wounds on the head, neck, scapular region, extremities. Direct contact of animal saliva with mucous membrane of patient, immediate concomitant prophylaxis with rabies vaccine is needed according to schedule C.

The classification according to severity of expose to animal

Schedule A: In this type one injection of rabies vaccine of Prophylactic immunization prior to exposure is given. One injection is given IM on days 0,7,28 and 365.

Schedule B: Immunization vaccine  should be given after exposure but it is of somewhat long  coarse. One injection of  rabies vaccine IM is given on days 0,3,7,14,30 & if necessary it is given on day 90.

Special precautions for rabies vaccine administration

The person who has received rabies vaccine of doubtful potency and who has discontinued the course of injections has to receive the entire course of rabies vaccine according to exposure.  In case the person is re-exposed after 5 yrs., entire course should be completed according to grade of exposure.

Dosage and administration of rabies vaccine

There is no difference in the dose for children & adults. 1ml of rabies vaccine is given by intramuscular injection in the deltoid muscle (arm) or in the thigh in small children. The prescribed schedule should be followed strictly  even if some time has passed since the exposure.

Rabies vaccine side effects

  • This rabies vaccine doesn’t cause that much vital side effects, but it will cause generally mild and non serious side effects.
  • There will be a mild pain, redness and swelling may occur at injection spot as a side effect.
  • Rarely arthritis, gastrointestinal disorders or lymph node swelling may occur as  rabies vaccine side effects.
  • Sometimes anaphylactic shock may occur.

Contraindications for rabies vaccine

If there are hypersensitivity reactions to the vaccine or acute febrile illness the rabies vaccine is contraindicated for pre-exposure prophylaxis. In case of pregnancy vaccine should be given if the level of risk is high for pre-exposure prophylaxis.