Whooping cough convulsive cough in a child, symptoms, causes, treatment, signs. Symptoms and treatment of whooping cough in children

Pertussis is an acute infectious disease that is transmitted by airborne droplets. Pertussis, the symptoms of which are characterized by the cyclical nature of their own manifestations, as well as a prolonged cough of a paroxysmal nature, is especially dangerous for children (up to two years in particular), although people of any age can get sick with it.

general description

Whooping cough is an infectious disease in which the upper respiratory tract is affected by a specific type of bacteria. It is Bordetella pertussis, which is also referred to as the whooping cough and Bordet-Zhangu sticks. This disease is accompanied by an acute form of catarrh that affects the respiratory tract, as well as bouts of severe spasmolytic cough.

An important point in this case is the consideration of the pertussis causative agent, which is a small stick with rounded edges. The fact is that it is the structural features of this bacillus that are the determining factors in the subsequent manifestation of the symptoms of whooping cough and in the developmental mechanisms inherent in this disease. Let's consider it in more detail.

So, filamentous hemagglutinin - the surface protein of the pathogen, the attachment of which is carried out exclusively to the cells located along the ciliated epithelium and belonging to the respiratory tract. In particular, such a concentration of this protein is concentrated in the bronchi; this process is somewhat less pronounced in the region of the nasopharynx, larynx and trachea.

Further, a kind of capsule in the body, due to which, in turn, an obstacle (protection) is created from the process of absorbing foreign cells and particles by it with subsequent destruction, that is, from phagocytosis, for the causative agent of whooping cough is generally unfavorable.

Due to the effects of whooping cough exotoxin specific symptoms are provided, which in this case arise against the background of neurotoxic action on his part. This manifests itself in the selective defeat of the cough receptors (in particular, the nerve endings concentrated in the bronchial region), in the direct impact on the respiratory / cough center located in the medulla oblongata. It is due to this that a so-called vicious circle is formed, directly related to the appearance of a pathological cough that is relevant to whooping cough. In addition, exotoxin also provides the formation of lymphocytosis-stimulating and histamine-sensitizing effects.

As a "right hand" for pertussis toxin, a tracheal cytotoxin, because it is precisely due to it that additional assistance is provided in the formation of the considered vicious circle, which consists in the appearance of a debilitating cough due to damage in the respiratory tract of the ciliated epithelium. Because of this, in turn, flickering movements stop, and stagnation of bronchial fluid is also provided, while hemorrhage is formed directly in the area in which the pathogen is introduced, followed by necrosis, due to which cough receptors are even more irritated. ...

The next thing we will focus on is dermonecrotoxin, characterized by its own neurotropicity. Neurotropicity by itself means the ability to selectively excite neurons in the medulla oblongata, and not only those that correspond to the cough center, but also neurons corresponding to the vasomotor center. As a result of this ability of dermonecrotoxin, corresponding disorders of the vascular scale develop.

Further - endotoxin, it is released only if the pathogen dies (i.e. after that). A feature of endotoxin in the context of considering processes relevant to whooping cough is its toxic-pyrogenic effect, due to which an appropriate explanation appears for those general clinical symptoms that are characteristic of the catarrhal period of the disease.

Also, the causative agent of whooping cough is produced urease - a specific enzyme, due to which the subsequent decomposition into ammonia of uric acid (ammonia is toxic) is ensured, as well as into carbon dioxide.

Due to the enzymes of pathogenicity, which are also available, it is possible for the pathogen to penetrate into the deep tissues of the respiratory department, these enzymes include hyaluronidase (through action from this side, the separation of intercellular compounds is ensured), lecithinase (exposure leads to the cleavage of the phospholipid membrane layer) and coagulase (impact from this side leads to plasma coagulation).

Due to the ability of the pathogen, which is relevant to the expressed degree of variability of its own harmful (that is, pathogenic) characteristics, it is possible to form on its part resistance to subsequent infection even after vaccination. Meanwhile, after the patients suffered from whooping cough, they develop a fairly stable and almost lifelong immunity to it.

Some patients are interested in how many times you can get whooping cough. Theoretically, re-incidence is not possible, however, in practice, re-cases of the disease are observed. At the same time, we have already noted that after primary whooping cough, the immunity to it is quite persistent, therefore, the disease can develop again only as a result of an immunodeficiency state. Thus, it can be summed up that the previous transfer of whooping cough by patients (along with vaccination) is not an exclusive guarantee of acquiring stable immunity to him, respectively, repeated morbidity is not excluded, and, according to available data, it is noted in 5% of cases for adults patients, which, again, occurs against the background of insufficient immunity.

As for the possible presence of innate immunity against pertussis caused by maternal antibodies, it is not formed. In case of contact with a sick person, the probability of infection is about 90%. It should be noted that whooping cough for children under two years of age is an extremely dangerous disease.

The duration of the infectiousness period is on the order of a week before the onset of a characteristic cough and three weeks after that. Considering the fact that before a patient has such a cough that is characteristic of whooping cough, that is, a cough that is characteristic of him, it is rather difficult to distinguish this disease from diseases of another type. This, in turn, increases the risk of contamination of the environment of infected patients, which occurs within the previously specified week.

A feature of the pathogen is also the fact that it has a significant sensitivity to a number of factors influencing the environment (this is drying and UV radiation, disinfectants). In the external environment, the pathogen is stable for several hours, as well as volatility with the ability to overcome distances of up to 2.5 meters.

With regard to susceptibility to whooping cough, it is ubiquitous, there are no restrictions (age, gender, etc.). At the same time, whooping cough is rightfully considered one of the most common childhood diseases, although, as already noted, a person of any age can get it. There is also no specific seasonality of whooping cough morbidity - it does not exist as such due to the constant circulation of the pathogen in the environment throughout the year. However, similar to outbreaks of existing respiratory infections, outbreaks of pertussis occur predominantly in the fall / winter. The risk of morbidity is reduced in the case of sufficient tension in the body due to the formation of post-vaccination immunity, as well as due to a low dose of infection with the pathogen.

Within the framework of the previous decades, the registration of a tendency towards an increase in the incidence of whooping cough was noted for a number of relevant reasons:

• variability on the part of the pathogen in terms of its pathogenic properties relative to post-vaccination immunity;
• drop in effectiveness from the use of vaccines previously used;
• insufficient level of vaccination;
• weakening of immunity formed after vaccination against the background of defects in immunization.

Summing up, the following picture of the disease can be distinguished. The toxin released by the causative agent of the disease has a direct effect on the nervous system, due to which the nerve receptors located on the side of the mucous membrane of the respiratory tract are subject to irritation. Due to this, the cough reflex, which is relevant for whooping cough, is activated, due to which attacks of a characteristic cough subsequently appear. With the involvement of the nerve centers located nearby, vomiting also appears (it appears after the completion of cough attacks), as well as vascular disorders (vascular spasm, lowering blood pressure) and nervous disorders (which manifests itself in the form of seizures).

Whooping cough: causes

A sick person is noted as the cause, or rather the source of the disease, and the most dangerous are cases of morbidity with an erased or atypical form of its course. Those patients who are within the last days of the incubation period, without exception, and other clinical stages, are also dangerous. The difficulty in preventing the spread of infection is that the incubation period cannot be noticed, the catarrhal period of the disease proceeds in a rather mild form, which excludes special attention to it, and even when a cough appears (in this case, it appears in a gradual manner, with a measured increase). Taking into account such features of the course of the disease and its onset in particular, isolation for the most part, if it happens, then with a delay, that is, without the due effectiveness of it.

We have already spoken about the ways of infection, it is airborne, it is provided through prolonged and close contact with a sick person. It should be noted that in practice, the registration of infection from wild and domestic animals was also noted, although the disease is not exactly whooping cough in this case, but is defined as whooping cough-like disease (or Bordetella bronchiseptica).

Whooping cough: symptoms

The incubation period lasts from 3 to 14 days, although most often the figures fluctuate within 5-7 days. The beginning of this period is accompanied by the introduction of the pathogen with the subsequent manifestation of the first symptoms of the disease. The pathogen enters the body in an aerogenic way, through the upper respiratory tract, after which it attaches to the epithelial layer noted above. In accordance with the achievement of critical indicators of the total amount of the pathogen, the next period of the disease is determined - catarrhal. Already from the final days of this period, the patient becomes contagious to his environment.

The duration of the catarrhal period is about 10-14 days, it does not stand out for its special characteristics (an increase in temperature is possible up to 39 degrees, general malaise and a runny nose are noted). The only difference lies in the nature of the manifestation of the cough: in this case, it is intrusive and dry, it manifests itself mainly in the evening and at night. It is noteworthy that taking drugs aimed at eliminating such symptoms does not bring relief from whooping cough.

Gradually, day by day, there is an increase in coughing, which is due to the relevance of exposure to toxins, tracheal and pertussis. Due to the pertussis toxin, which we noted earlier, the same vicious circle is formed, in which an irritating effect on the cough receptors of the bronchi leads to the transition of the impulse along the nerve fibers to the cough center located in the medulla oblongata, namely to the place in which a pathological focus is formed, which ensures the constancy of excitement (this is also ensured by a direct effect on this center of the toxin).

Then the feedback ensures the transmission of impulses by this focus to the cough receptors (that is, to those receptors from which such impulses were originally received). As a result, pathological foci of such an order are formed, in which their interconnection is ensured, due to which they become already nourishing each other. The cough center located in the medulla oblongata acquires such a strong excitability that a reaction on its part occurs to almost any possible stimulus (emotions, sounds, light, etc.), which manifests itself in a cough characteristic of the disease.

As for the tracheal toxin, its effect is similar to that of pertussis toxin, however, the reaction is achieved only due to a mechanical stimulus. This toxin provides stagnation in the bronchi of mucociliary fluid, which also becomes an irritant for cough receptors (they act both as pressure receptors and as mechanical receptors, which, in fact, in this case, is required for the specified toxin).

The duration of the period of manifestation of spasmodic cough is about 2-8 weeks, although a longer option is also possible. This period literally makes sick patients martyrs, because each attack determines for them the struggle for the possibility of inhaling. This period is accompanied by a rather bright and specific symptomatology, in the manifestations of which in the first place is noted "seizure" cough or paroxysmal cough), following the aura in the form of a sore throat, tickling in it (possibly sneezing). Then, bouts of severe coughing already appear, in which cough tremors appear one by one, without the possibility of inhaling. By the nature of the manifestation, the cough is dry, as already noted, "barking", accompanied by a rather thick sputum (the consistency resembles the silicone used in construction work). Symptoms of whooping cough in children during this period are often supplemented by attacks of apnea (that is, attacks with respiratory arrest), sleep disturbances, and in many cases children have to sleep practically sitting, which somewhat facilitates the manifestations of cough and can contribute to a decrease in its frequency.

The onset of cough is mainly reduced to the evening / night time, relief with standard antitussive drugs does not give a result. If it is possible to inhale, there is a sharp rush of air through the spasmodic glottis, which occurs with a characteristic whistle. The process in this version provides an appropriate explanation for the definition of "whistling breath", which is relevant for whooping cough (another name is a reprise). It is noteworthy that reprises in young children with whooping cough are not expressed.

This period is also accompanied by changes in the functions of the cardiovascular system, which is explained by the above-discussed influence directly on the vasomotor center, against which the following symptoms are manifested: increased blood pressure and venous pressure; vasospasm; violations relevant to vascular permeability (against the background of them, in turn, pallor of the skin, cyanosis of the nasolabial region appears). As a result of actual exposure, the effect on the work of the heart becomes especially significant, which, in turn, can provoke complications.

Prolonged and frequent oxygen starvation during whooping cough becomes the cause of hypoxia (that is, a drop in the oxygen level in the blood), against which, first of all, the central nervous system suffers. This manifests itself in the form of encephalopathy, general anxiety, sleep disturbances, hypodynamia.

In general, the duration of coughing attacks is about 4 minutes, and the number of attacks themselves per day can be on the order of 5 to 50. Whooping cough, symptoms in adults in which they manifest themselves without concomitant attacks of convulsive cough, is compared in manifestation with a long course of bronchitis proceeding with persistent cough ... The temperature in this case corresponds to normal indicators, the state of health is generally satisfactory. Pertussis in erased forms can occur in children who have been vaccinated.

The next period of whooping cough is recovery, its duration can be about three weeks, although a duration within a period of 6 months is not excluded. The cough gradually subsides, accordingly, its manifestations are no longer so painful and severity of attacks. It should be noted that even after the transition to this period has occurred, certain changes remain in the cough center due to a pathologically dominant focus, this provokes, in particular, a decrease in the sensitivity threshold. For this reason, the most common respiratory diseases are associated with a cough with a tinge that makes it similar to whooping cough.

Parapertussis: symptoms

It should be noted that para-pertussis is also isolated in medical practice, the symptoms of which appear in a slightly milder form. This disease does not create immunity against whooping cough after it has been transferred. Parapertussis is an independent nosological form, diagnosed much less often whooping cough. The causative agent of parapertussis determines less specific requirements for the media that are nutritious for them, and also has an antigenic structure. Features of pathogenesis and epidemiology are similar to whooping cough. The incubation period lasts about 1-2 weeks. As noted initially, the clinic is characterized by less severity, which determines the correspondence to the course of mild forms of whooping cough.

The manifestation of parapertussis is compared with tracheobronchitis in terms of symptoms, there is a persistent cough, the treatment of which is quite complicated, the temperature is within normal limits, the state of health is satisfactory. In some cases only (which is relevant for 15% of patients), there is a spasmodic cough in the form of seizures. Complications in this form of the disease are extremely rare, the treatment is similar to the treatment used for whooping cough.

Whooping cough: complications

The most common complication of whooping cough is pneumonia, which is caused by whooping cough or from a bacterial infection (secondary type). As for other topical complications of the disease under consideration, acute laryngitis, bronchiolitis, respiratory arrest, nosebleeds, inguinal and umbilical hernias are noted.

The possibility of the development of encephalopathy, which consists in an altered state of the brain without concomitant inflammation, is not excluded, against which, due to the appearance of seizures, the patient's death or a persistent type of lesion in the form of epileptic seizures and deafness may occur. The listed features of complications are relevant for children, complications of whooping cough in adults are diagnosed extremely rarely.

Whooping cough treatment

First of all, the treatment of whooping cough is focused on the application of measures of etiotropic therapy, they, in turn, are aimed at the destruction of the pathogen that provoked the disease. With whooping cough, a specific type of antibiotics is prescribed, intended for a specific type of pertussis pathogen identified during bacteriological research, to which a wide spectrum of drugs can be prescribed, followed by their replacement with a specific type. The indicated treatment option is relevant for the catarrhal period of the disease, for the entire period of this period (about 2 weeks).

The content of the article

Whooping cough - an acute infectious disease caused by whooping cough. It is transmitted by airborne droplets, it is characterized by a predominant lesion of the nervous system, respiratory tract and peculiar coughing fits.

Whooping cough was first mentioned in the literature of the 15th century, but then under this name febrile catarrhal diseases were described, with which it was apparently mixed. In the 16th century whooping cough was mentioned in connection with an epidemic in Paris, in the 17th century it was described by Sidenham. in the 18th century - N.M. Maksimovich-Ambodik. A detailed description of whooping cough and its isolation as an independent nosological unit date back to the 19th century (Trousseau). In Russia, the clinical picture of this disease is described by S. F. Hotovitsky in the book "Pediatrics" (1847). then NF Filatov. Pertussis has been studied in detail with the disclosure of pathogenesis in the 20th century, mainly in the 30s-40s (AI Dobrokhotova. MG Danilevich. VD Soboleva, etc.).

Etiology of pertussis in children

The etiology of whooping cough was elucidated by Bordet and Gengou in 1906-1908. Its causative agent is the gram-negative hemoglobinophilic bacillus Bordetella pertussis. It is a motionless, small, short rod with rounded ends, 0.5 - 2 microns in length. The classic medium for its growth is potato-glycerin agar with 20-25% human or animal blood (Bordet-Zhangu medium). Casein-charcoal agar is currently used. The stick grows slowly on media (3 - 4 days), they usually add 20-60 U of penicillin to suppress other flora, which easily drowns out the growth of whooping cough; she is insensitive to penicillin. Small shiny colonies resembling droplets of mercury are formed on the media.

Pertussis bacillus in the external environment quickly dies, is very sensitive to the effects of high temperature, sunlight, drying, disinfectants.
Separate fractions with immunogenic properties were isolated from pertussis sticks:

1. agglutinogen, which causes the formation of agglutinins and a positive skin test in recovered and vaccinated children;
2. toxin;
3. hemagglutinin;
4. a protective antigen that confers immunity to infection.

Under experimental conditions, the clinical picture of pertussis cannot be induced in animals, although the pathogenic effect of whooping cough on monkeys, kittens, and white mice is noted. This is of great help in studying it.

Epidemiology of pertussis in children

Patients are the source of infection. Infectiousness is greatest at the very beginning of the disease, in the future it gradually decreases in parallel with a decrease in the frequency of excretion of the pathogen. The sowing rate of whooping cough in the catarrhal period and in the 1st week of a convulsive cough reaches 90-100%, in the 2nd week - 60-70%, in the 3rd week it decreases to 30-35%, in the 4th - up to 10% and from the 5th week it stops. Antibiotic therapy shortens the time for excretion of whooping cough sticks - it ends by the 25th day and even earlier. It is believed that infectiousness ends by the 30th day from the onset of the disease. In all forms of whooping cough, patients are very dangerous as sources of infection. In typical forms, this danger is great, because the diagnosis, with a few exceptions, is made only in the convulsive period and in the preceding catarrhal period with high infectivity, patients remain in children's collectives. Patients with erased whooping cough are often not diagnosed at all, and they spread the infection throughout the course of the disease. The frequency of erased forms is significant - from 10 to 50% of the number of cases. In recent years, cases of infection with pertussis from adults - from mothers, fathers; cases of infection from nurses are known.

Carriage of whooping cough sticks in the spread of infection is not essential. It is observed rarely, for a short time. In the absence of a cough, the release of the microbe into the external environment is limited.

Infection is transmitted by airborne droplets. The patient has an infectious discharge from the upper respiratory tract, sputum, mucus; pertussis contained in them, during coughing, dissipates in the environment, the radius of dispersion is not more than 3 m. Transmission of infection through a third party, through things is unlikely due to the rapid death of the pathogen in the external environment.

Susceptibility to whooping cough almost absolute and, moreover, from birth. It is lost after the transfer of whooping cough due to the acquisition of persistent lifelong immunity (repeated diseases are extremely rare). Immunity is also developed after vaccination, but it is less stable, to maintain it, revaccination is performed. In addition, post-vaccination immunity in some cases does not protect children from the disease, but whooping cough in vaccinated children usually occurs in a mild or worn-out form.

Pertussis incidence in the past it was almost universal and was second only to measles. Infants were ill relatively rarely and accounted for about 10% of all cases, which depended on the characteristics of their regimen (limited communication with a wide range of children and thus less possibility of infection). The greatest number of diseases fell on the age from 1 to 5 years, then it fell after 10 years, and even more so in adults it became rare. There was a frequent defeat of the collectives of nurseries, kindergartens, the emergence of large foci in them.
The situation changed after the introduction of compulsory vaccination in the USSR in 1959, which led to a decrease in the incidence of more than 7 times. At the same time, children under the age of 1 year were in the most disadvantaged position. They are still susceptible to whooping cough, since immunization begins mainly from the second half of life, and the sources of infection are vaccinated older children who develop erased forms of whooping cough. Therefore, the incidence of pertussis in infants is reduced less than in older children, and the proportion of infants among all cases has even increased. More often than in the past, adults began to get sick.

Whooping cough is not seasonal, it can occur at any time of the year. The frequency of incidence is expressed in its increase for several months or for a year and then in the onset of a lull for 3-4 years. After the introduction of active immunization, this frequency has smoothed out.

Mortality with whooping cough in the past was high. Back in 1940 in Leningrad, it was 3.2%, and hospital mortality reached much higher figures, since the most serious patients were hospitalized. Before the introduction of chemotherapy, it was calculated in 8-10%, and in the first half of the 20th century - even in 60% (Yokhman). Among children suffering from rickets II - III degree, malnutrition, mortality increased by 3-4 times.
Currently, whooping cough mortality has been reduced to hundredths of a percent.
In the structure of mortality, whooping cough has practically lost its significance.

Pathogenesis and pathological anatomy of pertussis in children

In the creation of a modern understanding of the pathogenesis of whooping cough, a large role was played by many years of research by a team of employees working under the leadership of A.I.Dobrokhotova, with the participation of I.A.Arshavsky and others.

The active principle of change is whooping cough. It is located on the mucous membrane of the respiratory tract - the larynx, trachea, bronchi, bronchioles and even in the alveoli.
Pertussis endotoxin causes irritation of the mucous membrane, resulting in coughing. Morphologically, this reveals catarrhal changes in the mucous membranes.

A widespread catarrhal process in the respiratory tract, prolonged irritation with toxins lead to increased cough; it takes on a spasmodic character and behind it there is a goal of interrelated changes. With a spasmodic cough, the breathing rhythm is disrupted, inspiratory pauses occur, which leads to stagnation in the brain, to disruption of gas exchange, to incomplete ventilation of the lungs and thereby to hypoxemia and hypoxia, contributes to the development of emphysema. Violation of the rhythm of breathing, delayed inspiration contributes to hemodynamic disorder; there is puffiness of the face, expansion of the right ventricle of the heart; arterial hypertension may develop. A circulatory disorder can also occur in the brain, which, together with hypoxemia, hypoxia, can lead to focal changes, seizures.

Prolonged irritation of the receptor endings of the vagus nerve causes a continuous flow of impulses into the medulla oblongata, which leads to the formation of a persistent focus of excitation in it with dominant features according to A.A.Ukhtomsky. At the same time, nonspecific irritation from other receptive fields seems to be attracted to a stagnant focus, which contributes to the increase and intensification of coughing attacks (this is observed in patients with the layering of any additional diseases, with procedures unpleasant for the child, etc.). Strong stimuli from other receptive fields can suppress the dominant, which is manifested by a weakening or even cessation of coughing when the situation changes, during interesting games, etc. The increased excitability of the focus can contribute to the spread of this excitation to the vasomotor centers located in the medulla oblongata, the centers of tonic muscles, vomiting, which in turn contributes to the emergence or intensification of changes such as hemodynamic disturbances, vomiting, convulsions, etc. The dominant focus of excitation is characterized by persistence, inertia, so the cough can persist for weeks or even months after the pertussis has disappeared from the body. This also explains, as it were, the return of cough, relapses in case of any diseases in the convalescent.

There are indications that pertussis toxin, being absorbed into the blood, can have a direct effect on the nervous, cardiovascular systems, promote bronchospasm, etc. However, there is no convincing evidence in favor of this. A peculiar feature of whooping cough is the absence of intoxication (neurotoxicosis). Specific morphological changes in whooping cough were not identified. In the lungs, emphysema, hemo- and lymphostasis, overflow of blood in the pulmonary capillaries, and peribroichnal edema are usually found. perivascular and interstitial tissue, sometimes spastic state of the bronchial tree, atelectasis: circulatory disorders with degenerative changes are also determined in the myocardium. A sharp expansion of blood vessels, especially capillaries, was found in the brain tissue: degenerative structural changes also occur as a consequence of a special sensitivity to hypoxemia (BN Klosovsky). In an experiment, a similar picture occurs with prolonged increasing asphyxia.

Against the background of changes caused by whooping cough, inflammatory processes, especially pneumonia, caused by pneumococcus, streptococcus, and in recent years mainly staphylococcus, occur extremely often: they are difficult, long-lasting and serve as the main cause of death. Whooping cough is often combined with other infections, especially intestinal infections, with acute respiratory infections, which sharply worsen the severity of the disease. The accession of OVRI, infectious processes, as a rule, leads to an increase in the frequency of coughing attacks. They are also usually the cause of the so-called recurrence of whooping cough.
The basics of whooping cough pathogenesis can be summarized as follows.

Functional and morphological changes in the respiratory system:

1. Changes in the epithelium of the larynx, trachea, bronchi (degeneration, metaplasia without pronounced exudation due to the viscosity of thick sputum).
2. Spastic state of the bronchi.
3. Atelectasis.
4. Inspiratory contraction of the respiratory muscles due to tonic convulsions.
5. Lung tissue emphysema.
6. Interstitial tissue changes:
   and)increased permeability of the vascular walls,
   b) hemostasis, hemorrhage,
   in) lymphostasis,
   d) lymphocytic, histiocytic, eosinophilic peribronchial infiltration.
7. Hilar lymph node hypertrophy.
8. Terminal nerve fiber changes:
   and) a state of increased excitability;
   b) morphological changes in receptors located in the epithelium of the mucous membranes.
9. With complicated whooping cough, the changes are complemented by a correspondingly frequently associated viral microbial infection.

The main causes of hemodynamic disturbances in the central nervous system, leading to increasing oxygen deficiency, acidosis, cerebral edema, in some cases to hemorrhages:

1. Respiratory rhythm disturbance, inspiratory spasm.
2. Increased permeability of the vessel walls.
3. Venous congestion worse during coughing.
4. Changes in the lungs.
5. Increased blood pressure due to vasospasm.

Whooping cough clinic in children

The incubation period ranges from 3 to 15 days (on average 5-8 days). During the course of the disease, three periods are distinguished: catarrhal, spasmodic cough and resolution.

Catarrhal period characterized by the appearance of a dry cough, in some cases there is a runny nose. The patient's state of health, appetite is usually not disturbed, the temperature can be subfebrile, but more often it is normal. A feature of this period is the persistence of the cough; despite treatment, it gradually intensifies and takes on the character of limited attacks, which means a transition to the next period. The duration of the catarrhal period is from 3 to 14 days, the shortest is this period in severe forms and in infants.

The spasmodic (convulsive) period is characterized by the presence of a cough in the form of attacks, often preceded by precursors (aura) in the form of general anxiety, sore throat, etc. which are interrupted from time to time by reprise. A reprise is an inhalation, it is accompanied by a hissing sound due to a spastic narrowing of the glottis. The attack ends with the release of thick mucus, and there may be vomiting. Often, after a short break, a second attack occurs, followed by a third or more.; The concentration of attacks, their occurrence in a short period of time is called paroxysm. During a coughing fit, the appearance of the patient is very characteristic. Due to the sharp predominance of exhalation (with each cough thrust) and difficulty in breathing during the reprise due to spasm and narrowing of the glottis, congestion occurs in the veins. The child's face turns red, then turns blue, the veins on the neck swell, the face becomes puffy, the eyes become bloodshot; with a severe attack, there may be involuntary separation of urine and feces. The patient's tongue is usually stuck out to the limit, it also becomes cyanotic, tears flow from the eyes. As a result of frequent seizures, puffiness of the face, swelling of the eyelids acquire a persistent character, hemorrhages may appear on the skin and conjunctiva of the eyes, which gives the patient with whooping cough a characteristic appearance outside the attack. Friction of the protruding tongue during cough pushes against the teeth leads to the formation of a sore on the frenum of the tongue, covered with a dense white coating.

With short, lighter attacks, there are the same changes, but less pronounced.
Outside the attack, the general condition of patients with mild and moderate forms of whooping cough, proceeding without complications, is almost not disturbed. In severe forms, children become irritable, lethargic, adynamic. They are afraid of seizures.
The temperature returns to normal. In the lungs, dry rales are heard, in severe forms, emphysema is determined. Radiographically, with pronounced forms of whooping cough, more often in older children, the basal triangle is determined (darkening with a base on the diaphragm and apex in the hilus region).
When examining the cardiovascular system, an increase in heart rate is found during an attack; there may be an increase in blood pressure; decrease in capillary resistance. In severe forms, there may be an expansion of the boundaries of the right ventricle of the heart.

In the spasmodic period in the first I - III: weeks, the number of attacks and their severity increase, then they stabilize for about 2 weeks, after which they gradually become more rare, shorter and lighter and, finally, lose their paroxysmal character. The duration of the spasmodic period is from 2 to 8 weeks, but it can be significantly lengthened.
For the resolution period, a cough without seizures is characteristic; it can continue for another 2-4 weeks or more. The total duration of the disease is about 6 weeks, but it can be longer.

In the period of resolution or even after the complete disappearance of the cough, sometimes there are "returns of attacks" (due to the presence of a focus of excitation in the medulla oblongata). They represent a response to any nonspecific stimulus, most often in the form of an ARI, while the patient is not contagious.
In peripheral blood with whooping cough, lymphocytosis and leukocytosis are determined (the number of leukocytes can reach 15-109 / l - 40-109 / l and more). In severe forms, they become especially pronounced. ESR is lowered or normal. Leukocytosis, lymphocytosis appear in the catarrhal period and persist until the infection is eliminated.

Distinguish between typical, erased, atypical and asymptomatic forms. The typical forms include the presence of spasmodic cough. They can be of different severity: light, medium and heavy.

The severity of whooping cough is determined at the height of the convulsive period, mainly by the number of attacks. This is natural, since as the frequency of attacks increases, they become more prolonged, increasing
the number of reprises is increased, paroxysms are formed. The number of paroxysms also increases, changes in the body become more pronounced. This pattern can sometimes be violated.

With a mild form, the frequency of attacks is from 8 to 10 per day, they are short, the general well-being of the patient is not disturbed. With a moderate form, the number of attacks increases to 10-15, they are more prolonged, with a large number of reprisals, which entails venous congestion, sometimes vomiting and other changes: the patients' state of health is disturbed, but very moderately. In severe form, there are up to 20-25 attacks per day, they last for several minutes, are accompanied by many reprisals, there are paroxysms, vomiting; venous congestion is very pronounced even outside the attacks, the state of health is sharply disturbed, the patients become lethargic, irritable, lose weight, eat poorly.

Forms with a weak severity of spasmodic cough belong to erased: coughing attacks are very mild, rare, they can last only a few days. Atypical forms proceed without a convulsive cough at all. Their important diagnostic feature is also a tendency to divide into periods: a gradual increase in cough, its concentration, as it were, in attacks, but real attacks with reprisals do not develop; after stabilization of such changes for 6-10, sometimes for 14 days, a period of resolution begins, the cough gradually subsides. Erased and atypical forms proceed very easily, the well-being of children is not disturbed, in accordance with this, hematological data also change less sharply. Leukocytosis, lymphocytosis can be insignificant, short-term, only one of these parameters can be changed. The asymptomatic form is also described; it is diagnosed only on the basis of immunological changes; there may be mild hematological changes.

Whooping cough is especially difficult in infants. Their incubation and catarrhal periods are shortened, which is characteristic of severe forms. Hypoxemia and hypoxia are very pronounced. Instead of a reprise, the child may have screaming, crying, sneezing, holding or even stopping breathing. Convulsive contractions of certain groups of facial muscles are observed, and general convulsions may occur. Repeated cessations of breathing with cyanosis, loss of consciousness, convulsions indicate severe cerebrovascular accidents and simulate a picture of encephalitis. They join early, complications of an inflammatory nature are difficult. Special examinations reveal the exceptionally frequent presence of saplococcal infection, which develops both in the form of local vosyagelnye foci (pneumonia, otitis media, intestinal forms) and in the form of a generalized infection (ON Alekseeva).

Complications of whooping cough in children

In severe forms of whooping cough, complications arise. character ”is its most pronounced manifestation. As a consequence of severe congestion in combination with a decrease in capillary resistance, nosebleeds and hemorrhages in the conjunctiva may occur. sometimes even into the retina and, as an exceptional rarity, into the brain with corresponding central paralysis. As a result of a decrease in intrathoracic pressure due to respiratory failure in the lungs, emphysema and atelectasis develop. Disorder of gas exchange, impaired cerebral circulation, cerebral edema lead to seizures, loss of consciousness, to a picture resembling encephalitis. With whooping cough, complications can be caused by secondary, mainly coccal, flora (pneumococcus, streptococcus, staphylococcus). Hemostasis, lymphostasis in the lung tissue, atelectasis, impaired gas exchange, catarrhal changes in the respiratory tract create extremely favorable conditions for the development of secondary infection (bronchitis, bronchiolitis, pneumonia, pleurisy). Pneumonia is predominantly small-focal, difficult to treat, often occurs with low-grade fever and poor physical data. Along with this, there is a violent pneumonia with high fever, respiratory failure, with an abundance of physical data. These complications, as a nonspecific irritant, can lead to a sharp increase in the manifestations of the whooping cough process (increased frequency, lengthening of convulsive coughing attacks, increased cyanosis, brain disorders, etc.).

Diagnosis, differential diagnosis of pertussis in children

Timely recognition of whooping cough allows:

1. carry out the necessary preventive measures and thereby prevent infection of others;
2. alleviate the severity of the disease by early exposure to whooping cough.

Early diagnosis of whooping cough in the catarrhal period, as well as with erased, atypical forms is difficult. Of the clinical symptoms, obsession, persistence, a gradual increase in cough with scant physical data and the complete absence of at least a temporary improvement from treatment are important. The cough, despite treatment, intensifies and begins to concentrate into attacks.

In the convulsive period, the presence of coughing attacks with reprisals, viscous sputum, vomiting, etc., the characteristic appearance of the patient is facilitated: pallor of the skin, puffiness of the face outside the seizures, sometimes hemorrhages in the sclera, minor hemorrhages on the skin, a sore on the frenum of the tongue in the presence of teeth etc. When diagnosing a disease in newborns, in Children of the first months of life, the same changes are important, but taking into account the features outlined above.
During the resolution period, coughing attacks remain the basis for diagnosis, which retain their characteristic features for a long time.

With erased forms of whooping cough, the same duration of cough and the lack of effect of treatment should be taken into account; the cyclical nature of the process - a slight increase in coughing in terms corresponding to the transition of the catarrhal period to the convulsive one; increased cough in case of joining another disease.
Epidemiological data help in the diagnosis of contact not only with patients with explicit whooping cough, but also with long-term coughing children and adults.

Differential diagnosis carried out mainly with OVRI, bronchitis, tracheobronchitis, para whooping cough. The main difference between whooping cough is the persistence of the cough, the absence or low severity of catarrhal changes, and poor physical data.
Of the laboratory methods, hematological research is of the greatest value. In the absence of changes, the study is repeated. Along with complex hematological changes (leukocytosis and lymphocytosis), the patient may have only leukocytosis or only lymphocytosis. Changes are also mild.

Bacteriological method. The study is carried out by inoculating sputum on a Petri dish with an appropriate medium. It is better to take phlegm with a cotton swab from the posterior pharyngeal space; sowing on media is done immediately. The method of "cough plates" is proposed: an open Petri dish with a nutrient medium is held at a distance of 5-8 cm in front of the patient's mouth during coughing; the mucus escaping from the mouth settles on the medium. Bacteriological examination has a relatively small diagnostic value, since positive results can be obtained mainly in the early stages of the disease; etiotropic treatment reduces the percentage of chewability. Clinical changes are the basis for diagnosis. In recent years, the possibility of accelerated diagnosis by detecting whooping cough sticks directly in smears from nasopharyngeal mucus in the reaction of immunofluorescence has been studied.

Immunological (serological) method. Agglutination reactions (PA) and complement fixation reactions (CSCs) are used. Reactions are detected starting from the 2nd week of the convulsive period; the most convincing is the increase in the titer of dilutions in immunological reactions in the dynamics of the disease. RSK gives positive results a little earlier and more often. The value of immunological reactions is reduced due to the late appearance. They can also be negative, especially in infants and with early use of some antibiotics.

Intradermal allergic test with pertussis agglutinogen or allergen is proposed. If the reaction is positive after the injection of 0.1 ml of the drug, an infiltrate with a diameter of at least 1 cm is formed at the injection site. The reaction is taken into account after a day; later it weakens. Its lack in the later stages of appearance (in the convulsive period).

Whooping cough prognosis in children

Mortality with whooping cough, at present, with well-organized work, it is practically not observed. Deaths sometimes occur in infants. The cause of death, as a rule, is severe manifestations of whooping cough with cerebrovascular accident, complicated by pneumonia. Layering of OVRI, staphylococcal infection is extremely unfavorable. They intensify pertussis changes, which in turn leads to a more severe course of inflammatory processes - a vicious circle is created.

Severe forms of whooping cough, occurring with impaired cerebral circulation, with severe hypoxemia, respiratory arrest, convulsions, are unfavorable in relation to the long-term prognosis, especially in infants. After them, various disorders of the nervous system are often observed: neuroses, absent-mindedness, mental retardation up to oligophrenia; sometimes the development of epilepsy is associated with whooping cough. Bronchiectasis and chronic pneumonia can be the consequences of whooping cough.

Features of whooping cough in modern conditions

Since 1959, after the introduction of active immunization against whooping cough, there have been changes in the epidemic ological indicators. The clinic has noted an increase in the frequency of mild and erased forms of whooping cough, which cause difficulties in diagnosis due to diseases of vaccinated children.

Clinical manifestations of whooping cough in unvaccinated children (this applies mainly to infants) have fully retained their classic features. Their whooping cough is difficult, with a large number of complications, however, with proper treatment, lethality can be practically eliminated by using a complex of pathogenetic and etiotropic agents that affect both pertussis and secondary microbial infection. The possibility of long-term consequences in these cases remains important. In vaccinated children, whooping cough usually occurs in the form of mild forms, moderate forms are rare, complications of the first group practically do not occur, and complications of the second group are rarely observed and proceed easily.

Whooping cough treatment in children

Treatment of patients with whooping cough is based on an accurate account of its pathogenesis. The primary concern is to eliminate the pertussis bacillus as early as possible, which can prevent the formation of changes in the central nervous system. This problem is solved by etiotropic treatment - the use of antibiotics.
The use of chloramphenicol in the catarrhal period or at the beginning of the spasmodic period has a beneficial effect on the manifestations of whooping cough, the number and severity of attacks decreases, and the duration of the disease is shortened. From the 2nd week of a spasmodic cough and later, when changes in the central nervous system become the basis of the disease, antibiotics do not have a stopping effect.

Levomycetin is given orally at 0.05 mg / kg 4 times a day for 8-10 days. In severe forms, children older than I year are prescribed chloramphenicol sodium succinate. When the process is formed, ampicillin, erythromycin are used from the 2-3rd week of the spasmodic period. Ampicillin is prescribed orally or intramuscularly at the rate of 25-50 mg / kg per day in 4 divided doses for 10 days, the dose of erythromycin is 5-10 mg / kg per reception, 3 to 4 grooves per day. In severe forms, a combination of two and sometimes three antibiotics is indicated.

Specific pertussis γ-globulin complements successful treatment at an early stage of the disease. It is injected intramuscularly in 3 ml 3 days in a row, then several times every other day.
With clinically pronounced symptoms of hypoxemia and hypoxia, gene therapy is indicated - maintenance in an oxygen tent for 30-60 minutes several times a day. In the absence of a tent, the patient is allowed to breathe humidified oxygen. It has a long lasting effect. stay in the fresh air (at a temperature not lower than 10 ° C). It normalizes the heart rate, deepens breathing, enriches the blood with oxygen. Intravenous administration of 15-20 ml of a 25% glucose solution is shown, preferably together with calcium gluconate (3-4 ml of a 10% solution).

Neuroplegic drugs (chlorpromazine, propazine), due to its direct effect on the central nervous system, have a positive effect both in the early and late stages of the disease. They help to calm patients, reduce the frequency and severity of spasmodic cough, prevent or reduce the number of delays, respiratory arrest, and vomiting that occur during coughing. Do injections of 2.5% chlorpromazine solution at the rate of 1-3 mg / kg of the drug per day with the addition of 3-5 ml of 0.25-0.5% novocaine solution; propazine is given orally at 2-4 mg / kg.
The daily dose is administered in 3 doses, the course of treatment is 7-10 days.

Antispastic agents (atropine, belladonna, papaverine) are used to relieve seizures, but they are ineffective. Narcotic drugs (luminal, lidol, chloral hydrate, codeine, etc.) are contraindicated. They depress the respiratory center, decrease the depth of breathing and increase hypoxemia.
When breathing stops, artificial respiration is used. Means that stimulate the respiratory center are harmful, since in these cases it is already in a state of sharp overexcitation.
In severe cases, in recent years, corticosteroids (prednisone, etc.) have been recommended in small doses (up to 1 mg / kg per day) for 8-10 days in a decreasing dosage.
Vitamin therapy is required: vitamins A, C. K, etc.

Physiotherapy is widely used in hospital conditions: ultraviolet irradiation, calcium electrophoresis, novocaine, etc.
Complications of an inflammatory nature, especially pneumonia, require the earliest and sufficient use of antibiotics. Penicillin can also have an effect, but provided there is a sufficient dosage (at least 100,000 U / kg per day). Since complications are often caused by staphylococci, semisynthetic penicillin preparations (oxacillin, ampicillin, methicillin sodium salt, etc.), broad-spectrum antibiotics (oletetrin, sigmamycin, etc.) are prescribed.

In severe cases, a combination of antibiotics is needed. A similar tactic should be followed with an increase in the frequency, intensification of coughing attacks, with relapses, the cause of which, as a rule, is the attachment of an inflammatory process. In these cases, stimulating therapy is also important (blood transfusion, plasma transfusion, y-globulin injections, etc.). physiotherapy procedures.

Whooping cough patient regimen it is necessary to build on the extensive use of fresh air (walks, ventilation of the room), reduction of external stimuli that cause negative emotions. Older children are helped by distraction from illness by reading, calm games. This explains the decrease in coughing when climbing on airplanes, when taking children to other places (inhibition of the dominant by new, stronger stimuli).
In a hospital setting, individual isolation of children with the most severe forms of whooping cough and young children is very important as a measure of prevention of cross infection.

Whooping cough patient food should be complete, high-calorie. A strictly individual approach is required in the organization of child's meals. With frequent bouts of coughing, vomiting, food should be given to the child at shorter intervals, in small quantities, in a concentrated form. You can supplement your baby shortly after vomiting.

Prevention of pertussis in children

Neutralizing the source of infection includes the earliest possible isolation at the first suspicion of whooping cough, and even more so when this diagnosis is established. The child is isolated at home (in a separate room, behind a screen) or in a hospital within 30 days from the onset of the disease. After removing the patient, the room is ventilated.

Children under the age of 7 who have been in contact with a sick person, but have not suffered from whooping cough, are subject to quarantine (separation). The quarantine period is 14 days when the patient is isolated.
All children under the age of 1 year, as well as young children, for any reason not immunized against whooping cough, in case of contact with the patient, 7-globulin is administered (3-6 ml twice after 48 hours), it is better to use a specific anti-pertussis 7- globulin.

Hospitalization is subject to patients with severe, complicated forms of whooping cough, especially those under the age of 2 years, and even more infants, patients living in unfavorable conditions. According to epidemiological indications (for isolation), patients from families with babies, from dormitories, where there are children who have not had whooping cough, are hospitalized.

Active immunization is the main link in the prevention of whooping cough. Currently, the DPT vaccine is used. Pertussis vaccine in it is represented by a suspension of the first phase of pertussis sticks adsorbed with phosphate or aluminum hydroxide. Immunization begins at 3 months, is carried out three times with an interval of 1.5 months, revaccination is carried out 1 1 / 2-2 years after the completed vaccination.
Full coverage of vaccinations and revaccinations of children leads to a significant reduction in morbidity.

Whooping cough is one of the most dangerous childhood infectious diseases that requires urgent treatment. The course of the disease and the condition of the child largely depend on the correct timely actions of the parents.

Whooping cough is a disease that affects the airways and is characterized by a cough with spasms. The causative agent is whooping cough, discovered in 1906 by the Belgian Bordet and the French Zhangu.

Causes of whooping cough

The source of the disease is an infected person. Pertussis bacteria are transmitted by airborne droplets, but at the same time they are not very resistant, so that you can become infected only with prolonged close contact.

IMPORTANT: Parents, whenever possible, should limit contact of their children who are not vaccinated against whooping cough with coughing people.

How does whooping cough manifest in children? Signs

The most important thing is to distinguish whooping cough from the common cold in time.

The incubation period of the disease can last up to three weeks, but more often it is limited to 5 - 7 days.

IMPORTANT: There are no special clinical manifestations of the disease at this time, but the child is already sick and is the source of the spread of the infection.

Then comes the catarrhal period, during which bacteria multiply on the walls of the respiratory tract. The clinic is insignificant: the child coughs, sneezes, a runny nose begins, the temperature rises to 39 ° C.

Symptoms of initial stage pertussis in children are similar to those of SARS

Gradually, the frequency of coughing increases, turning into spasmodic attacks. At the same time, sputum secretion still does not occur.

During an attack, the child begins to literally suffocate, since cough shocks do not allow him to draw air into his lungs.

IMPORTANT: With such spasms, blood pressure increases and, therefore, small hemorrhages in the capillaries of the eyes are possible. Seizures, especially persistent and frequent at night, are often accompanied by vomiting and even involuntary discharge of urine and feces.

With pertussis spasms, bleeding into the capillaries of the eyes is possible

Such a clinic is the peak of the spasmodic period. After that, the frequency of attacks decreases, cough from "whooping cough" turns into an ordinary one, which is the norm for the last, resolving period of the disease.

The child recovers, although the cough may last another 10-15 days. The total duration of the disease is 6-8 weeks.

Whooping cough: symptoms in children under one year old

In infants, the first two periods of whooping cough are practically absent, which is characteristic of severe forms of the disease.

Although coughing fits are shorter, "oxygen starvation" is observed in all tissues and organs of the baby. Therefore, a cough is often accompanied by loss of consciousness, convulsions, and respiratory arrest.

IMPORTANT: If the latter happened, it is necessary to artificially induce vomiting in the child by pressing on the root of the tongue. This will help restore the respiratory process.

How is whooping cough spread in children?

Pertussis bacteria are very whimsical microbes. They die quickly, so the likelihood of infection of the child through household items (toys, dishes, linen) is minimal. The same cannot be said about the direct contact of children with each other.

Kids communicate, hug, kiss - this is a great opportunity to pick up the pathogen transmitted by airborne droplets from an infected child.

Whooping cough in children is spread by direct contact

IMPORTANT: If a child is sick with whooping cough, it is better to take walks with him away from playgrounds and attractions. So you will protect other children from infection, and your child from the addition of a new infection.

Whooping cough: diagnosis in children

To diagnose the disease at an early stage - in the catarrhal period - is very difficult, especially in children under the age of six months, since their whooping cough is atypical.

• If the child has an unusually severe cough and general malaise, a bacteriological analysis
• The material for inoculation is taken with a curved swab from the back of the pharynx and placed in Bordet-Zhangu medium (glycerin-potato blood agar)
• Pertussis sticks grow in 72 - 96 hours in the form of small colonies of oily consistency with a metallic sheen (like drops of mercury)
• You can also diagnose the disease immunofluorescence reaction or by polymerase chain reactionallowing the detection of a microbe in swabs of nasopharyngeal mucus

IMPORTANT: Bacteriological confirmation of the diagnosis of whooping cough allows you to timely isolate a sick child from the children's team and thereby prevent further spread of the disease.

When are children tested for whooping cough?

If the child is sick, and, according to the history, has been in contact with coughing children, it's time to get tested for whooping cough:

• First you need to pass general (clinical) blood test. It is needed in order to determine the presence of any infection in the body. Since whooping cough has a bacterial nature, the level of leukocytes in the blood will be increased, and lymphocytes will prevail in the leukocyte formula, while the rest of the indicators will not change significantly
• If the disease becomes severe, then you need to pass general urine analysisand blood chemistryto identify possible complications
• It is also necessary to pass general analysis of respiratory secretions - sputum. The method consists in the fact that at the time of an attack, an open cup with a nutrient medium is brought to the child's mouth, on which, when coughing, droplets of mucus containing an infectious agent are deposited. The crops are placed in a thermostat at 37 ° C for 2 - 3 days
• Equally important immunological tests of blood and nasal secretions... This test determines the content of immunoglobulin M in the blood, and immunoglobulin A in the nasal mucus - antibodies to the bacillus that provokes whooping cough.
• In addition, before starting treatment, bacterial culturedetecting whooping cough 3 to 4 days after the test

A general blood test will reveal the presence of whooping cough in the child's body

How to cure whooping cough in a child?

Since whooping cough is bacterial in nature, you can get rid of it only with the help of antibiotics designed to treat various infectious diseases of the respiratory tract:

• erythromycin
• rovamycin
• tetracycline
• azithromycin
• ampicillin

IMPORTANT: Treatment with antibacterial drugs should last at least 10 days.

In parallel with the main treatment, you need to use other cough suppressants. But it must be remembered that none of the syrups will cure a cough, but will only help not to catch a secondary infection that can develop against the background of whooping cough: bronchitis, pneumonia or pleurisy.

Complication of whooping cough in children

A severe course of the disease in a child can lead to negative consequences for the body:

• Decreased capillary stability often provokes nosebleeds, retinal hemorrhages and, extremely rarely, in brain with subsequent paralysis of the central nervous system
• Due to a violation of the respiratory process, it is possible the development of pathology in the lungs of the child
• The presence of coccal flora in the body can lead to development of streptococcus, staphylococcus, pneumococcus
• Cases of development are not uncommon bronchitis, pleurisy, pneumonia

Nosebleeds are one of the complications of whooping cough in children

What to do if a child suspects whooping cough?

The most important thing is not to panic, but to consult a doctor in a timely manner and take a blood test with a leukocyte formula. After receiving the result, the doctor will see the presence of the disease.

You also need to submit the material for bacteriological culture, the results of which will show with maximum accuracy the presence or absence of whooping cough in the child's body.

Treatment of whooping cough in children with drugs and folk remedies

In most cases, treatment for pertussis in children takes place at home. However, if infants are ill for up to six months, or a severe complication of the course of the disease occurs in an older child, then it is safer to undergo treatment in a hospital.

IMPORTANT: One of the important conditions of treatment is the regimen and diet. Such components of therapy can be easily organized at home.

The food consumed by the child must be complete and fortified. You need to eat often, but dosed, since the specificity of the course of the disease can cause vomiting.

One of the conditions for successful treatment of pertussis in children is diet

Daily long walks are required, but away from crowded places, and even more so children. A long stay of the patient near water bodies has a positive effect.

IMPORTANT: Symptomatic treatment includes taking antipyretics (if the child's temperature is above 38 ° C), antibiotics prescribed by the attending physician, antitussives, sedatives, syrups to improve sputum discharge and inhalations with aminophylline.

Many moms do not disregard and traditional medicine, reflected in the advice of grandmothers, mother-in-law, neighbors and girlfriends.

There are a lot of options and recipes. But there are still the basic ingredients for making whooping cough killer cocktails - onion, garlic, honey, and milk in combinations - and the disease will be easier and the likelihood of secondary infection will be minimized.

Honey and onions are the main components of folk recipes for treating whooping cough

Recipe number 1. Place chopped garlic (50g) and thyme (30g) in an enamel container, add water (0.5l) and put on low heat. Let the broth boil well, then remove it from heat, cool and strain. Add honey (250g) to the liquid part and mix well. Give the syrup to the child 3 to 4 times a day, 1 tsp. after every meal.

Recipe number 2. Boil a large onion, chop finely and mix with honey in a 1: 1 ratio. Every hour, offer the child this medicine in minimal portions (1/4 - 1/6 tsp).

Recipe number 3. Mix honey (150g) with homemade butter (100g). The remedy is given to the child three times a day, 1 tsp. after meal.

Recipe number 4. Grate horseradish root (100 g) and mix with honey (100 g). Take twice a day for 1 tsp.

Recipe number 5. Add 5 cloves of garlic to boiling milk (1 tbsp.) And boil for 5-7 minutes. Offer the child this broth several times a day. Let him drink as much as he can.

Recipe number 6.Mix equal proportions of butter and lard. Add the grated garlic (3 cloves per 100g of product) and mix thoroughly. Rub the child's chest and back in the absence of fever.

Recipe number 7. Chop licorice root (300g), boil in milk (1l) for 7-10 minutes. Cool, strain, add honey (2 tablespoons). Take warm, 3 times a day, 1 tsp.

Recipe number 8.Chop the onion (2 pcs.), Mix with sugar (2 tablespoons). Leave to infuse overnight in a sealed container. In the morning, heat the mixture and strain. Onion-sugar syrup take 1 tablespoon. during bouts of coughing.

Video: Treatment of whooping cough with folk remedies

Prevention of whooping cough

Whooping cough mostly affects children. The infection is transmitted from patients by airborne droplets.

IMPORTANT: Due to the low resistance of whooping cough bacteria, the role of various objects surrounding the patient is very insignificant, therefore, it makes no sense to carry out disinfecting measures.

• It is necessary to isolate the infected child as early as possible, and quarantine the children in contact with him for 14 days from the moment of the last communication with the sick person
• Since the late 1950s, developed countries have been vaccinating against whooping cough with killed pertussis sticks associated with diphtheria and tetanus toxoid (DTP)
• Babies are vaccinated three times from three months of age every 45 days. Then revaccination is performed at 18 months

Vaccination is a reliable method to prevent whooping cough

Since the killed bacteria are very strong allergens, artificial vaccines are now used, consisting of individual components of the killed microorganisms, which are enough for a child to develop an active immunity to whooping cough.

Video: Whooping cough - Doctor Komorowski's School

Whooping cough is an infectious disease that is transmitted by airborne droplets. You can only get infected through a sick person - if saliva during coughing gets on the mucous membrane of the mouth or nose of a healthy person. In an open space, the whooping cough stick does not survive, so it is impossible to get infected through common household items.

Whooping cough is a very serious illness that causes severe coughing fits. Whooping cough is dangerous because during a spasm, the lumen of the larynx can close and lead to respiratory arrest. Pertussis often affects children under 6 years of age, but there are cases of infection with whooping cough in adults. A few decades ago, whooping cough was a fatal disease that killed a huge number of young children. With the advent of mass vaccination of pertussis patients, it has become less, and the disease has become much easier to tolerate. The whooping cough vaccine is administered as part of the general DPT vaccination, and it is this vaccine that causes such a reaction as an increase in temperature, a general deterioration in well-being.

Pertussis bacillus, getting into the body, begins to multiply actively. The waste products of this stick poison the body with toxins, which cause a severe cough. I would like to note that the cause of coughing is nerve impulses that are sent to the brain. The cough is not caused by inflammatory processes in the bronchi, therefore, often when listening to the chest of a patient with whooping cough, the doctor makes the conclusion "The lungs are clean."

How long does the disease last

From the moment a person becomes infected until the first symptoms appear, it takes from several days to several weeks. On average, the incubation period is one week. Symptoms gradually increase over 5-15 days. This is followed by a period of convulsive spasmolytic cough, which can last a month or more. The attacks then become infrequent and less intense. People say that whooping cough is a disease of a hundred days. This suggests that the disease lasts on average for three months, although often distant symptoms in the form of a rare cough can last up to six months. Re-infection does not occur - a child who has been ill develops lifelong immunity.

Whooping cough symptoms

Very often whooping cough (especially at an early stage of development) is confused with acute respiratory viral infections, acute respiratory infections, bronchitis and other respiratory diseases. Here are some of the symptoms of whooping cough.

1. Cough. This is the main and main symptom. Often, coughing becomes a decisive factor in the diagnosis. The doctor can say with precision one cough that it is whooping cough. The cough with this disease is debilitating, long, paroxysmal. A baby can have up to 50 coughing fits per day. During an attack, the child coughs incessantly, he has no way to breathe. When the child breathes in the air again, a characteristic whistle is heard, which indicates swelling of the larynx.
2. During a severe cough, the child may vomit. This is due to excessive irritation of the back wall of the tongue.
3. In addition, general intoxication of the body occurs. The child becomes lethargic, apathetic, capricious, he loses his appetite.
4. In the initial stages of pertussis development, a slight temperature may appear, but it rarely rises above 38 degrees.
5. At the end of a coughing attack, sputum can be observed - viscous, transparent, glassy.
6. During a coughing fit, the child's face turns red and sometimes even blue. Veins protrude on the neck, during the coughing process, the bridle may be damaged, the tongue is exposed during an attack, the whites of the eyes may turn red from stress.
7. Coughing fits during whooping cough are quite long lasting, and can last for about five minutes.

If a bacterial infection joins whooping cough, complications such as bronchitis, pneumonia, and laryngitis develop. An umbilical or inguinal hernia can occur from a severe cough. But the worst complication is suffocation. Therefore, it is very important to properly treat whooping cough and be able to get rid of a coughing attack.

Whooping cough can be treated both on an outpatient basis and in a hospital - it all depends on the patient's age and the severity of the disease. If the patient is not even a year old, it is better to remain under the supervision of doctors in order to remove the condition of the false croup at the right time and save the child from suffocation.

As a drug treatment for whooping cough, antibiotic therapy is used. Antibiotics are selected, the most sensitive to an infectious bacillus. As a rule, these are ampicillin, chloramphenicol, aminoglycosides, macrolides. The course of treatment is 5-7 days. It is also very important to introduce into the body a special gammaglobulin against whooping cough at the beginning of treatment.

In addition, symptomatic treatment is prescribed. First of all, these are antihistamines. They help relieve laryngeal edema, which reduces the number and intensity of coughing fits. In severe cases, a small patient is prescribed antispasmodics to relieve the intensity of the cough at night. Sedatives may also be prescribed to reduce the amount of nerve impulses that trigger coughing fits. When a runny nose and nasal congestion appear, vasoconstrictor drops are used, and antipyretics are used to bring down the temperature.

Antitussives and expectorants do not need to be taken, or under the supervision of a physician and with great care. The fact is that such drugs are aimed at removing phlegm, that is, they stimulate the cough, which we are trying to get rid of.

The prognosis for patients with whooping cough is favorable. Today, modern methods of treatment are so effective that death is extremely rare and only in old age. You can survive whooping cough, the main thing is to do it right.

How to relieve a child's whooping cough

Here are some tips to help you shorten your child's illness and reduce the duration and intensity of coughing fits.

1. It is a proven fact that seizures hardly occur in the open air. Therefore, with a child who has whooping cough, you need to often and for a long time (if he feels good).
2. Be sure to ventilate the room as often as possible to ensure your child has access to fresh air.
3. Wet cleaning of the room should be done daily to eliminate the provoking factor - house dust.
4. At the time of illness, it is imperative to put a humidifier in the room. It will significantly reduce the frequency and intensity of attacks.
5. In the first days of the child, when there are still signs of intoxication of the body, it is necessary to provide the patient with bed rest. Instead of active games, read a fairy tale to your child, look at books.
6. Meals should be balanced and light. The child should eat often, but little by little. Avoid provoking factors - chocolate, spicy, smoked and fried foods.
7. If whooping cough is severe, an oxygen mask may be needed. But this is usually practiced only in stationary conditions.
8. It is very good to use a nebulizer to treat whooping cough at home. This is an apparatus that supplies steam in a concentrated form. When the vapor is inhaled, the swelling of the mucous membrane subsides, the attack stops.
9. It is very important to maintain a calm atmosphere in the house, since any nervous experience, crying, fright or emotional shock can trigger the onset of an attack.
10. If a baby is sick with whooping cough, it should be left in a dark and cool room, away from provoking sounds and noise. This will reduce the number of coughing fits.
11. In winter, the batteries work at full capacity, drying out the air in the apartment. This is highly undesirable for a whooping cough patient. If possible, you need to reduce the intensity of their work or more often ventilate the room and hang wet towels on the radiator.

These simple rules will help you ease your illness and make whooping cough less debilitating.

If you have a coughing fit during the night, try helping your child. You can give him a drink of warm water to calm the mucous membrane. Do not stop taking antihistamines to keep the swelling from getting worse. In addition, with a strong attack of coughing, you can let the baby breathe the inhaler - it will become much easier for him. If the inhaler is not at hand, take the child into the bath, turn on the hot water and close the door. Tilt the baby towards the water to inhale the hot, wet steam. This will help with the coughing fit.

A salt lamp may be helpful against a coughing fit during whooping cough. It is an ordinary lamp covered with a mineral salt shade. As the salt heats up, it releases special ions that purify the air.

If the child is small, do not risk it - it is better to call an ambulance. A coughing fit with whooping cough can cause false croup and suffocate the child.

Folk remedies for whooping cough

Unfortunately, folk recipes are ineffective against such an insidious and annoying disease. They can only be used in combination with conservative treatment. There are some herbs and herbs that can help relieve cramping, making the attacks easier.

The Arnica plant is an herb that helps to stop barking and dry coughs, relieves agitation and spasm. Pour a spoonful of dry plant with a glass of boiling water and let it brew for a couple of hours. Arnica broth should be brewed before night (since it is at night that more attacks occur). Keep the Arnica decoction warm to give your child a drink if an attack occurs. Usually half a glass is enough for the baby to calm down and fall asleep for at least 2-3 hours.

Here is a recipe for another effective collection against a choking cough. Mix marshmallow flowers, oregano herb, thyme, pine buds, plantain leaves, nettle and coltsfoot leaves in equal proportions. Pour three spoons of the collection with a liter of boiling water and leave for at least 6 hours. Drink a tablespoon every 3 hours, especially before bed. The active substances of medicinal herbs soothe the laryngeal mucosa, relieve swelling, and reduce the activity of nerve endings that cause spasm.

Whooping cough is a serious medical condition. It exhausts the child not only physically, but also mentally. Indeed, due to constant bouts of coughing, the baby cannot sleep normally, gets scared, cries. In this state, the mother should remain calm, follow the doctor's instructions and be an unshakable support and protection for the child. After all, if the mother is calm and the baby is comfortable, then everything is going as it should. And the calm state of the baby reduces the number of spasms and seizures. Remember, prevention is the best protection, vaccinate children on time!

Video: how to treat whooping cough cough

Whooping cough - an acute infectious disease with an airborne transmission mechanism, characterized by a cyclic course and a long-lasting paroxysmal cough and is an extremely contagious, potentially serious bacterial respiratory tract infection. Symptoms develop in three stages, each of which lasts several weeks. Anyone can get whooping cough, but it is most dangerous for children when a severe cough interferes with breathing. Pneumonia, seizures, and encephalopathy can be serious complications in young children. Whooping cough in older children and adults leads to mild symptoms such as stuffy nose and cough. The vaccine does not provide complete immunity, but it does protect children when they are most at risk of infection. How to treat this ailment with folk remedies.

Etiology of whooping cough and parapertussis. The causative agents of whooping cough and parapertussis are Bordetella pertussis and Bordetella parapertussis, belonging to the genus Bordetella, small coccobacillary, asporogenic gram-negative chemoorganotrophic immobile aerobic bacteria. They breed in blood-rich environments. The species differ in the following ways: B. pertussis has a delicate capsule. B. parapertussis has no capsule, unlike B. pertussis, it utilizes citrates, grows on MPA, MPB, forms a soluble pigment, produces urease, and does not reduce nitrates.

Bordetellae are characterized by a pronounced variability of properties, antigenically also heterogeneous. Bacteria contain a genus-specific thermostable antigen, a capsular agglutinogen, a set of 14 genus- and species-specific agglutinogens, called factorial and designated 3, 4, 5, 6, for parapertussis - 8, 9, 10.

B. pertussis has histamine-sensitizing, leukocytosis-stimulating, dermatonecrotic, hemagglutinating and hemolytic activity. The pathogenesis of whooping cough is associated with the release of toxic substances:

- filamentous hemagglutinin (PHA); - pertussis toxin (CT); - lipopolysaccharide (LPS); - thermolabile toxin (TLT); - tracheal cytotoxin (TC); - adenylate cyclases (AC), etc.

Enzymes of pathogenicity - coagulase, hyaluronidase, lecithinase, etc., contribute to the manifestation of pathogenic potential.

The causative agents of whooping cough and parapertussis are unstable in the external environment, die when dried, ultraviolet radiation, under the action of disinfectants.

Are sensitive to antibiotics macrolides, tetracyclines, chloramphenicol, aminoglycosides.

The reasons

... Infection with the bacterium Bordetella pertussis is the cause of whooping cough. ... Whooping cough is spread through the air when an infected person sneezes or coughs. The infection can spread in families, schools and childcare centers; Living in overcrowded or unsanitary conditions creates an increased risk of illness. Children under six months of age and premature babies are also at increased risk.

Epidemiology of whooping cough. The source of infection is a sick person. Isolation of the pathogen begins in the last days of the incubation period. In the catarrhal period, whooping cough is isolated by almost all patients. With the development of spasmodic cough, the infectiousness of the patient decreases, however, at the 4th week, 5-15% of patients continue to be sources of pertussis infection. Under the influence of antibacterial drugs, the release of the organism from the microbe is accelerated.

Patients with erased forms of the disease play an important role as a source of infection.

Carriage of whooping cough in healthy children is extremely rare and short-lived.

The pathogen is transmitted by an airborne mechanism. During a cough, droplets of the patient's nasopharyngeal mucus containing microbes enter the air. Due to the low resistance of the bacillus outside the human body and its low volatility, contact with the patient should be sufficiently close and prolonged.

They suffer from whooping cough, starting from the first month of life, since there is no congenital pertussis immunity.

The highest incidence rates are observed at the age of 3 to 6 years.

In the last decade, there has been an increase in the incidence of whooping cough. The reasons for the periodic increase in the incidence of whooping cough since 1990 are:

Antigenic drift of whooping cough as a result of adaptation of the pathogen to the population of children with pronounced post-vaccination immunity; ... low efficiency of "old vaccines"; ... low vaccination rate (70% or less); ... an increase in the incidence of whooping cough among adolescents and adults due to a decrease in protective immunity; ... an increase in morbidity in young children; ... defects in immunization, lack of a booster at 6 years of age; ... improved diagnostics and registration.

Whooping cough pathogenesis. The pertussis bacillus enters the upper respiratory tract by airborne droplets, where it attaches to the ciliated epithelium, colonizes it. At the site of adhesion and colonization, ciliastasis occurs, hemorrhages and necrosis develop. The most pronounced pathological process in the bronchi, bronchioles, less - in the trachea, larynx, nasopharynx. Muco-purulent exudate closes the lumen of small bronchi, which leads to the formation of atelectasis, emphysema.

Pertussis bacillus secretes several toxic and virulent substances: filamentous hemagglutinin, pertussis toxin, lipopolysaccharide, thermolabile toxin, tracheal cytotoxin, adenylate cyclase. Pertussis toxin is of the greatest importance. It causes profound changes in the receptive zones of the cough reflex, leading to prolonged afferent impulses in the area of \u200b\u200bthe cough and respiratory centers. In addition, pertussis toxin itself acts directly on the respiratory center. All of the above contributes to the formation of a focus of pathological excitement, the appearance of a characteristic paroxysmal cough, a change in the breathing rhythm, a decrease in the sensitivity of medullary chemoreceptors to the level of CO 2. Violation of the rhythm of respiration, bronchial patency, changes in oxygen utilization in the cellular metabolic cycle (inhibition of cytochrome oxidase) lead to the formation of hypoxemic, cytotoxic hypoxia. Changes in intracellular metabolism, cytoxic hypoxia, circulatory disorders contribute to the development of encephalic disorders and the most formidable complication - encephalopathy.

Of great importance in the formation of clinical manifestations of whooping cough is damage to the cardiovascular system, which is based on the pathological effect of pertussis thermolabile toxin, irradiation from the dominant focus of excitation to the vasomotor center. The above leads to vasospasm, increased blood pressure, vascular permeability.

Morphological changes in whooping cough... Fatal outcomes from pertussis are currently rare and are caused by the development of severe forms of mixed infections or complications.

In the larynx, trachea, bronchi of a patient with whooping cough, a mild serous inflammation is found.

In the lungs, manifestations of functional disorders are emphysema, atelectasis, spastic state of the bronchi. Productive inflammation is present in the peribronchial, perivascular, and interstitial tissues. Inflammatory changes in the lungs are found against the background of severe acute disorders of blood and lymph circulation, infiltration of the interstitial tissue of the lung with lymphocytes, neutrophils and eosinophils is possible.

From the side of the central nervous system, hyperemia, edema, stasis and hemorrhages are detected. In the myocardium, signs of myocardial dystrophy are determined.

Immunity after suffering whooping cough. An important role in the protection of the human body belongs to the humoral link of immunity. The first line of defense is due to secretory immunoglobulins "A", which prevent the attachment and colonization of the epithelium of the upper respiratory tract by pertussis microbes.

Long-term resistance to whooping cough is due to specific immunoglobulins A and G.

In the cellular link of immunity, the leading role belongs to T-lymphocytes and macrophages. An increase in the number of all T cell populations is found.

Symptoms

... The first (catarrhal) stage (similar to the common cold and lasting from 10 days to two weeks); runny nose; sneezing; moderate cough; a general feeling of not being well. ... The second (paroxysmal) stage (lasting four to six weeks): attacks of severe coughing, sometimes accompanied by characteristic "barking" sounds when the air is suddenly inhaled at the end of a coughing fit; bulging eyes and swollen neck veins; bluish skin tone during a coughing attack due to lack of oxygen; vomiting caused by efforts to remove thick phlegm; convulsions (rare). ... Stage three (convalescence): Coughing fits are moderate and less frequent.

Clinical manifestations of the catarrhal period of whooping cough.The clinic of the catarrhal period of whooping cough is characterized by the gradual development and presence of catarrhal and general infectious syndromes. However, the general infectious syndrome is noted in no more than half of the patients and consists of a short-term subfebrile body temperature (no more than 3-4 days) and minor malaise. The main symptom of the catarrhal period is cough, which is characterized by a gradual increase in intensity and frequency from day to day. The ongoing symptomatic therapy has no effect. At the same time, the data of percussion and auscultatory examination of the lungs do not reveal any changes.

Other catarrhal phenomena (serous nasal discharge, hyperemia of the posterior pharyngeal wall) are poorly expressed in 1/3 of patients and are stopped within 3-5 days.

The catarrhal period lasts an average of 10-14 days. In patients immunized with the DPT vaccine, it can be lengthened, and in young children, it can be shortened.

Clinic of the convulsive period of whooping cough. The convulsive period of whooping cough has vivid clinical manifestations. During this period, the cough becomes paroxysmal. The appearance of a coughing attack, as schoolchildren note, may be preceded by a kind of aura in the form of tickling and tickling in the throat, sneezing, general malaise, indefinite compressive pain in the chest area. A coughing attack is characterized by the presence of a series of expiratory coughing impulses, rapidly replacing each other, from time to time interrupted by a wheezing breath - a reprise. The coughing attack lasts up to 5 minutes and ends with the release of viscous sputum or vomiting, or regurgitation in children of the first year of life. The incidence of a characteristic cough varies from 5 to 40-50 attacks per day. Coughing fits more often occur during sleep, can be triggered by feeding, physical activity.

The appearance of the patient during an attack is characteristic: the face is hyperemic, puffy, tears stand out from the eyes, the skin veins of the face, head, neck swell. At first, perioral appears, and then diffuse cyanosis of the face, mucous membranes, tongue is possible. The tongue protrudes as much as possible during an attack, an ulcer forms on the bridle. At the time of a coughing attack, hemorrhages in the sclera, nosebleeds, petechiae on the face and upper body may appear.

Equivalents of a paroxysmal cough can be attacks of spasmodic sneezing, in young children - attacks of syncope. In older children, during a coughing fit, spasmodic apnea occurs as a result of spasm of the glottis and the smooth muscles of the airways.

The body temperature during the period of convulsive cough does not rise.

When examining the respiratory organs, a tympanic shade of percussion sound is found (in almost 90% of patients). Auscultation of the lungs reveals, against the background of hard breathing, dry and moist large bubbling rales, which can completely disappear after a coughing attack and resume after a while.

The cardiovascular system is almost always involved in the pathological process, as evidenced by long-term tachycardia, arterial and venous hypertension, an increase in the size of the heart to the right, muffledness and deafness of heart sounds.

Damage to the cardiovascular system, metabolic disorders as a result of hypoxia lead to the development of pallor of the skin, cyanosis of the lips and acrocyanosis, cold extremities.

Changes in the nervous system are diverse and are determined, in particular, by the degree of oxygen deficiency and the depth of circulatory disorders.

The first signs of incipient pertussis encephalopathy are general anxiety, alternating with hypodynamia, sleep disturbance at night and increased sleepiness during the day, increased tendon reflexes, convulsive readiness. Convulsions, impaired consciousness, hemiparesis indicate a more severe damage to the nervous system.

Encephalopathy develops mainly in patients with an unfavorable premorbid background (intrauterine damage to the central nervous system, birth trauma, etc.), with a combination of pertussis with viral infections (influenza, adenovirus infection, CMVI, etc.). The duration of the convulsive cough period varies from 1-1.5 weeks in immunized children, to 4-6 and even 8 weeks in unvaccinated children.

Pertussis convalescence period. The duration of the recovery period is 2-3 weeks.

The cough gradually loses its paroxysmal character. Coughing fits during this period can be triggered by physical or emotional stress.

After recovery, children retain a tendency to relapse of spasmodic cough with the development of acute respiratory diseases.

Supporting diagnostic signs of the typical form of whooping cough. The following basic diagnostic signs of a typical form of whooping cough can be distinguished:

An indication in the medical history of contact with a long-term coughing child. ... Dry growing cough at normal or subfebrile body temperature, mild and quickly relieving catarrhal phenomena. ... Lack of effect from the therapy in the catarrhal period. ... The appearance of paroxysmal cough with reprisals, after 1-2 weeks from the onset of the disease. ... Discharge of thick, viscous expectoration or vomiting after a coughing fit. ... The absence of permanent changes in the lungs during the period of spasmodic cough. ... Possible respiratory dysrhythmia and apnea attacks. ... In peripheral blood: leukocytosis, lymphocytosis, ESR below normal or normal. ... Isolation of whooping cough during bacteriological examination by the method of cough plates. ... Increase in the titer of anti-pertussis antibodies in the patient's blood during serological examination by 4 times.

Atypical forms of whooping cough.The erased form of whooping cough is characterized by the absence of a sequential change in the periods of the disease, attacks of convulsive cough. The cough is dry, obsessive, mainly at night. Occasionally, there are single typical coughing fits with intercurrent diseases layering. The condition of the patients remains satisfactory, sometimes there is a pallor of the face and a slight pastiness of the eyelids. Physical examination of the lungs reveals emphysema. Body temperature rarely rises. The duration of the cough ranges from 7 to 50 days. Hematological changes are insignificant.

The subclinical form is characterized by the release of the pathogen, an increase in the titer of anti-pertussis antibodies in the patient's blood and the absence of characteristic clinical symptoms.

Carriage of bacteria is observed in no more than 2% of children, mainly of school age, vaccinated against whooping cough. Within two weeks, the body is cleansed of whooping cough.

Criteria for the severity of whooping cough. There are three forms of whooping cough severity: mild, moderate, severe.

To assess the severity of the infectious process, it is necessary to take into account:

The frequency of attacks of convulsive coughing; ... signs of hypoxia (perioral, acro- and total cyanosis); ... the frequency and duration of apnea attacks; ... the frequency of vomiting when coughing; ... the degree of disruption of the cardiovascular system; ... encephalitic phenomena; ... the presence of complications.

When assessing the severity of whooping cough, the child's age and premorbid status must be taken into account.

Clinical manifestations of mild whooping cough.In patients with mild whooping cough, the general condition is practically not disturbed. The number of coughing fits per day is no more than 10-15. Occasionally, a coughing fit ends with vomiting. Some patients have mild, rapidly passing perioral cyanosis. Hemorrhagic syndrome is extremely rare. A more constant symptom is swelling of the face, eyelids. Examination of the lungs shows signs of emphysema.

The duration of the spasmodic period is 4-5 weeks.

Clinic for moderate whooping cough. For a moderate form of whooping cough, a deterioration in the general condition of patients is characteristic. Children are capricious, irritable, reduced appetite. The number of coughing fits per day is from 16 to 25-30. Paroxysms are long lasting. Often, a coughing attack ends with vomiting. The face is pale. Perioral cyanosis is observed not only at the time of a coughing attack, but also outside the attack. Hemorrhagic elements are possible. Examination of the lungs reveals a boxed shade of percussion sound, single dry and wet wheezing, which disappear after a coughing attack and reappear after a short time.

The duration of the spasmodic period reaches 5-6 weeks.

Clinical signs of severe whooping cough... The prodromal period of severe whooping cough is usually 3-5 days.

The general condition of the child during the period of spasmodic cough is significantly impaired. Children are lethargic, adynamic; sleep, appetite suffer. The weighting curve is flattened or reduced. Coughing fits reach 30 or more times a day, accompanied by frequent vomiting. Respiratory rhythm disorders, periods of apnea are characteristic. Perioral or acrocyanosis persists outside the coughing fit. Signs of damage to the cardiovascular system are expressed: hemorrhagic rash, deafness of heart sounds, expansion of the borders of the heart, increased blood pressure. Possible development of encephalopathy, manifested in the form of seizures, impaired consciousness, paresis.

The duration of the spasmodic cough period can be up to 7 weeks.

Features of the course of whooping cough in young children. The incubation period is shortened and is 4-7 days. The duration of the prodromal period ranges from 4-5 to 8 days, at the same time, the period of spasmodic cough is lengthened to 50-60 days.

In young children, moderate and severe forms of the disease prevail.

Coughing fits can be typical, reprises and protrusion of the tongue are noted much less often and are not clearly expressed. Cough equivalents are possible - sneezing, hiccups, screaming. When coughing, little sputum is released due to its partial swallowing. In the interictal period, the general condition is impaired, the appetite is sharply reduced, the increase in weight decreases, and the loss of previously acquired motor and speech skills is possible. Skin and subconjunctival hemorrhages are less common, and nervous system lesions are more common. In newborns, especially premature babies, the cough is weak, inaudible. A high frequency of specific complications, including life-threatening ones (apnea, cerebrovascular accident), is possible. Nonspecific complications, mainly pneumonia, develop early.

Specific hematological changes are clearly expressed and persist for a long time. Specific antibodies in the blood are determined at a later date (4-6 weeks of the convulsive cough period).

Features of the course of whooping cough at the present stage:

Reducing the incidence of moderate to severe whooping cough. ... Pertussis encephalopathy develops much less frequently. ... Pertussis often proceeds as a mixed infection (in half of the patients), the most common is the addition of herpes viruses, influenza viruses, adenoviruses, mycoplasmas, chlamydia, as well as pneumococci, staphylococci. The development of a mixed infection leads to the formation of pneumonia, bronchitis, which significantly aggravates and prolongs the disease. ... Significant decrease in mortality (up to 0.1-0.9%).

Features of the course of pertussis infection in vaccinated... The incidence of whooping cough among the vaccinated varies from 1.5 to 43.5% and is 4-6 times lower than among the unvaccinated.

The incubation period ranges from 7 to 15 days.

Mild, atypical erased forms develop more often (up to 86%).

Reprisals and vomiting during the period of spasmodic cough are quite rare, and hemorrhagic and edematous syndromes are not typical at all.

The disease is characterized by a smooth course, the formation of complications is not frequent.

Diagnostics

... A medical history and physical examination during the paroxysmal stage are usually sufficient to establish a diagnosis. ... Analysis of the culture of bacteria from the throat. ... Chest x-ray if pneumonia is suspected.

Changes in the peripheral blood of a patient with whooping cough. In the catarrhal period of whooping cough, there is an increase in the number of leukocytes and lymphocytes in the patient's peripheral blood. ESR is either reduced or does not differ from the norm. The revealed changes persist for 2–3 weeks during the period of spasmodic cough. Moreover, the maximum number of leukocytes (up to 40.109 / l - 50.109 / l) and lymphocytes (up to 85-96%) is recorded in patients with severe whooping cough.

Respiratory changes during X-ray examination of patients with whooping cough. X-ray examination of the chest organs of a patient with whooping cough reveals the horizontal position of the ribs, an increase in the transparency of the pulmonary fields, low standing and flattening of the domes of the diaphragm, expansion of the pulmonary roots, strengthening of the pulmonary pattern in the form of reticulation, cellularity and rough linear cords. Lobar or segmental atelectasis are possible.

Methods for laboratory diagnosis of whooping cough and parapertussis. The bacteriological method is a fundamental method of laboratory diagnostics and is aimed at isolating the pathogen. The probability of excretion depends on the timing of the examination, in the 1st week the frequency of excretion of the pathogen can reach 70%, in the 3rd week it does not exceed 20%. Mucus from the upper respiratory tract is examined, which is taken with pharyngeal swabs (dry and moist buffered saline). PCR is a modern method for diagnosing whooping cough.

Serological methods are aimed at detecting antibodies to the pathogen. Most often, the RNGA and RA methods are used with the mandatory study of paired sera. An increase in titer by 4 times or more is of diagnostic value. It is also recommended to carry out ELISA to detect specific antibodies IgM, IgG.

Serological methods are only auxiliary and are important for the retrospective confirmation of the diagnosis in unvaccinated children. Upon contact with whooping cough, vaccinated children increase the level of antibodies, as well as in sick children, which makes it difficult to interpret the results of a serological examination.

Differential whooping cough in the catarrhal period. In the catarrhal period, the leading syndrome is cough syndrome, therefore, the differential diagnosis must first of all be carried out with acute respiratory viral infections, chlamydia, mycoplasmosis, and legionellosis.

The main differences between whooping cough in the catarrhal period from ARVI will be as follows:

Cough that gets worse every day and does not respond to treatment; ... the absence of any changes in the lungs along with an increasing cough; ... weakly expressed other catarrhal phenomena: slight runny nose, slight hyperemia of the mucous membranes of the posterior pharyngeal wall in 2/3 of children, their rapid disappearance; ... mild and quickly passing general infectious syndrome in half of the patients, in the other half - its absence; ... absence of damage to other organs (lymph nodes, liver, intestines, eyes, brain, meninges, etc.); ... characteristic changes in peripheral blood that develop in some patients already in the catarrhal period: leukocytosis, lymphocytosis; ESR does not differ from normal values; ... isolation of whooping cough with the method of cough plates.

Differential diagnosis of whooping cough in the period of spasmodic cough.

The leading whooping cough syndrome in the period of spasmodic cough is paroxysmal, spasmodic cough.

Pertussis-like paroxysmal cough can be observed in a number of diseases: bronchitis and tracheobronchitis, bronchopulmonary cystic fibrosis, tuberculous bronchoadenitis, spasmophilia with symptoms of laryngospasm, foreign body in the respiratory tract, mediastinal tumors, bronchial asthma, paracoccus pulmonary disease, pneumonia.

Tuberculous bronchoadenitis from whooping cough in the period of spasmodic cough is distinguished by:

An indication in the epidemiological anamnesis of contact with a tub-infected child or adult; ... in the history of the child's life - a sharply positive Mantoux reaction; ... characteristic appearance of a long-term ill child: decreased nutritional status, pallor of the skin, pronounced asthenovegetative syndrome; ... generalized micropolyadenitis; ... positive symptoms of Caranya — De la Camp and Filosofov; ... characteristic bitonal cough; ... positive tuberculin tests; ... characteristic changes on the roentgenogram of the respiratory system.

Mediastinal tumors are distinguished from whooping cough:

In the epidemiological anamnesis there is no indication of contact with a long-term coughing patient; ... the cough is spastic, but there are no reprises; ... possible breathing disorders with expiratory dyspnea; ... possible changes in the rhythm of the pulse due to compression of the vagus nerve; ... dysphagia and a hoarse voice are possible when the recurrent laryngeal nerve is compressed; ... ptosis, miosis and enophthalmos are possible; ... swelling of the face and neck with compression of the superior vena cava; ... characteristic changes on the chest x-ray.

Acute tracheobronchitis is distinguished from whooping cough:

More pronounced catarrhal phenomena (rhinitis, pharyngitis, conjunctivitis) at the onset of the disease; ... a longer increase in temperature to febrile numbers; ... persistent dry and wet large-bubble wheezing on auscultation of the lungs; ... high probability in the peripheral blood of moderate leukocytosis, neutrophilia.

The bronchopulmonary form of cystic fibrosis is distinguished from whooping cough:

A family history of a similar illness in other children in the family; ... lag in physical development; ... identification during examination of the bronchopulmonary system of signs of long-term bronchial obstruction; when a secondary infection is attached - manifestations of pneumonia; ... possible signs of cor pulmonale; ... symptoms of pancreatic insufficiency, including steatorrhea; ... persistent constipation in case of violation of the diet and inadequate enzyme therapy; ... the possibility of biliary cirrhosis with signs of portal hypertension; ... laboratory examination of sweat reveals an increased content of sodium and chlorine ions; ... radiographically - signs of bronchiectasis, pulmonary fibrosis; movement of the mediastinal organs during inhalation.

A foreign body in the respiratory tract is distinguished from whooping cough:

History of the first sudden attack of cough; ... lack of general infectious syndrome at the onset of the disease; ... periodic resumption of paroxysmal cough, often in connection with a change in body position, the absence of leukocytosis with lymphocytosis in the peripheral blood; ... characteristic changes on the X-ray of the respiratory organs are possible.

Pneumonia is distinguished from whooping cough:

Long-term fever and intoxication; ... the possibility of detecting shortening of the percussion sound during percussion of the chest; ... identification during auscultation of the lungs persistently moist, finely bubbling, crepitant rales; ... in peripheral blood: leukocytosis, neutrophilia with a shift to the left, increased ESR, toxic granularity of neutrophils; ... detection of infiltrative changes in the lungs on the chest x-ray; ... positive clinical dynamics against the background of adequate antibiotic therapy.

Whooping cough classification

Pertussis classification (Nisevich N.I., Uchaikin V.F., 1990):

I. In form:

1. Typical. 2. Atypical: a) erased; b) subclinical.

II. By the severity of the process:

1. Lightweight. 2. Moderate. 3. Severe.

III. In the course of the disease:

1. Acute. 2. Lingering.

IV. By the nature of the complications:

1. Specific: atelectasis, emphysema, pneumonia; 2. Non-specific: urinary tract infection, otitis media, dysbiosis, etc.

V. Mixed infection.

Treatment

Treatment with antibiotics in the first stage can limit or prevent more serious symptoms. Antibiotics given during the second stage will not prevent the disease from progressing, but may reduce its spread to others. A fourteen day course of antibiotic treatment is recommended. ... Patient care aims to create the possible comfort. Drinking plenty of fluids and eating frequent small meals is recommended. ... It may be necessary to isolate young children, especially those under six months of age. Oxygen and IV fluids and nutrients may be needed. ... See your doctor if your child's cold persists or worsens. ... Attention! Call an ambulance if your child turns blue or stops breathing.

Pertussis treatment should be comprehensive, taking into account the patient's age, the state of the premorbid background, the severity of the disease.

Children with severe and complicated forms, children of the first two years of life who have not been vaccinated against whooping cough, as well as patients from closed children's groups are subject to hospitalization.

Etiotropic therapy is prescribed in the catarrhal period and within 2 weeks of the spasmodic cough period. At a later date, antibacterial agents are prescribed to patients with bacterial complications. Preference should be given to macrolides (sumamed, rovamycin, rulid, erythromycin), cephalosporins of the 1-2-3rd generation (cefazolin, ceclor), aminopenicillins (ampicillin, amoxicillin). In case of mixed infection (pertussis-herpesvirus), it is necessary to prescribe antiherpetic drugs (Zovirax, etc.). For patients with severe disease, it is desirable to administer parenteral antibacterial agents.

The course of antibiotic therapy is 5-7 days.

Pathogenetic treatment:

In order to improve bronchial conductivity, relieve bronchospasm: aminophylline orally in mild and moderate forms, in severe forms - parenterally; inhalation with berodual through a nebulizer; ... antitussives that suppress the cough reflex: for young children - neocodion, codipront, mixture with belladonna, for children over three years old - paxeladin, stoptussin, sinekod, libek-sin, tusuprex; ... mucolytic agents: mixture with potassium iodide, ambroxol, bromhexine, bronchicum, medicine with plantain root, inhalation therapy (with enzymes, ambroxol); ... small tranquilizers for patients with mild and moderate forms (inside seduxen, relanium, tazepam), as well as tinctures or decoctions of valerian root, motherwort, for patients with severe forms - phenobarbital, seduxen or relanium are prescribed parenterally; ... vascular drugs (cinnarizine, cavinton) and nootropics (nootropil, piracetam) in order to restore hemodynamics and metabolic processes in the central nervous system; ... immune preparations for patients with severe and complicated forms of whooping cough: intravenous immunoglobulin, intramuscular leukinferon, interferon preparations (Viferon suppositories, leukocyte interferon in inhalation and intramuscularly; interferonogenesis inducers - cycloferon, neovir amiksin, anaferon); for patients with concomitant viral infection - antiviral drugs (arbidol, inosine pranobex); ... oxygen therapy depending on the form of severity: walking and sleeping in the fresh air for patients with mild and moderate forms of the disease, an oxygen tent and humidified oxygen through a nasal catheter - for patients with severe and complicated forms. Transfer to mechanical ventilation only in extreme cases (frequent and prolonged respiratory arrest); ... glucocorticoids (prednisolone - 1-3 mg / kg body weight per day) in severe whooping cough; ... patients with severe whooping cough - 1000 units / kg of body weight per day to restore cell membranes; ... infusion therapy is indicated only for patients with severe whooping cough (including encephalopathy), the volume of infusion is up to 50-60 ml / kg of body weight per day, the ratio of glucose-salt solutions is 3: 1. Infusion therapy should be performed by forced diuresis using lasix; ... metabolic rehabilitation drugs: riboxin, cytochrome, B vitamins, ascorbic acid, cocarboxylase, etc .; ... physiotherapy: inhalation with mucolytics, electropharesis on the collar zone with chlorpromazine; ... breathing exercises, vibration massage of the chest.

Patients are prescribed medical nutrition, children of the first year of life with moderate and severe forms during the height of the disease can be transferred to dosed feeding.

Terms of isolation of patients with whooping cough. Hospitalization of patients for clinical and epidemiological indications. Children under 7 years of age are admitted to the collective after 25 days from the onset of the disease, and schoolchildren - immediately after the end of the period of acute manifestations of the disease.

Patients undergo a double bacteriological examination and a study of peripheral blood.

Obtaining two negative results of bacteriological examination is not a basis for canceling the diagnosis in the presence of a clinic and specific changes in the peripheral blood.

Reconvalescent is exempted from prophylactic vaccinations for 1 month with an uncomplicated course of the disease, for 2 months - with the formation of complications. He is recommended breathing exercises, chest massage, vitamins, herbal adaptogens. Examined by the KIZ doctor 1 month after discharge from the department or outpatient treatment.

Complications of whooping cough

1. Specific complications:

Emphysema of I, II, III degree - in 80-90% of patients, the tympanic character of percussion sound, increased transparency of the pulmonary fields on the roentgenogram; ... emphysema of the mediastinum; ... atelectasis - slight shortness of breath, changes on the X-ray of the respiratory organs in the region of the 4th, 5th segments of the lungs; ... hemorrhages under the skin, mucous membranes, retina, brain; ... indomitable vomiting; ... tearing of the frenum of the tongue; ... complications from the nervous system: encephalopathy, cerebral edema; ... myocardial dystrophy; ... bleeding from the nasal cavity, posterior pharyngeal space, bronchi, external auditory canal; ... prolapse of the rectal mucosa; ... umbilical or inguinal hernias; ... rupture of the tympanic membrane.

2. Complications of an inflammatory nature:

Laryngitis, tracheobronchitis, bronchiolitis, pneumonia, pleurisy, empyema; ... mediastinitis; ... carditis; ... catarrhal, purulent otitis media, antritis.

The second group of complications (bronchitis, pneumonia) develops as a result of the addition of a secondary bacterial or viral infection. A special role in the formation of bronchopulmonary complications is assigned to herpes viruses, mycoplasma, chlamydial infections.

The consequences of whooping cough:

Respiratory tract disorders: chronic bronchitis, chronic emphysema, chronic pneumonia; ... residual changes in the central nervous system: asthenohypertensive syndrome, episyndrome, delayed psychophysical development, vegetative-vascular insufficiency.

Features of the clinical course of mixed pertussis-chlamydial infection:

In 13% of patients with whooping cough, the development of mixed pertussis-chlamydial infection is observed; ... shortening of the catarrhal period - up to 4-6 days; ... subfebrile condition persists for a long time; ... pronounced edematous syndrome; ... during the height of the disease, attacks of spasmodic cough are 1.5 times more frequent; ... vomiting and perioral cyanosis during the height of the disease are observed 1.5 times more often; ... in young children during the height of the disease, the development of bronchial obstruction and respiratory failure is more often observed; ... in older children, during the height of the disease, respiratory rhythm disturbance is more common; ... in peripheral blood - in 15% of patients with eosinophilia, in 10% - increased ESR.

Prevention

... A combination vaccine that protects against diphtheria, tetanus and whooping cough provides years of resistance to whooping cough. ... A 14-day prophylactic course of antibiotics can be given to family members or classmates if one child has pertussis. Children under the age of seven who have not been vaccinated or have not yet received the required number of doses of the vaccine can be actively vaccinated; younger children should be vaccinated as scheduled.

After the isolation of the patient, children under 7 years of age who have not previously suffered from whooping cough are suspended from visiting a children's institution for 14 days.

If it is impossible to isolate the patient, the observation period for contact increases to 25 days.

Children with whooping cough, schoolchildren and adults serving children's institutions are not isolated, they are under medical supervision for 14-25 days. During the observation period, contact persons are subject to double bacteriological examination.

In the children's institution, quarantine is established for 14 days with compulsory medical supervision and a double bacteriological examination of all contacts in the group of the children's institution.

At school, the volume of activities may be reduced. Bacteriological examination is carried out here only for coughing children.

Specific prophylaxis is carried out with a complex preparation of the DPT vaccine (or Tetracoccus 0.5 "Pasteur Merier Connot", France).

Due to the reactogenicity of whole-cell DTP vaccines, the use of Infanrix vaccine has now begun. Infanrix is \u200b\u200ba three-component vaccine: diphtheria-tetanus toxoid and acellular pertussis adsorbed. The pertussis component contains pertussis toxin. PHA - filamentous hemagglutinin and pertactin - outer membrane protein. In terms of effectiveness, Infanrix is \u200b\u200bnot inferior to the whole-cell DTP vaccine. With its use, it became possible to carry out revaccination of older children.

The vaccination course consists of 3 intramuscular injections of the drug (0.5 ml each) with an interval of 1.5 months, starting from 3 months of age. If it is necessary to increase the intervals, the next vaccination should be carried out as soon as possible, determined by the state of health of the children. Revaccination is carried out once at the age of 18 months. Vaccines are stored in a refrigerator at 4-8 ° C for 1 year and 6 months. It is strictly forbidden to freeze them, because they completely lose their immunogenicity.

On the 1st or 2nd day after the administration of the vaccine, an increase in body temperature, soreness, hyperemia and swelling at the injection site, and general malaise are possible. An increase in temperature can provoke short-term febrile seizures.

In rare cases, episodes of a shrill cry, allergic reactions (polymorphic rash, urticaria, angioedema), exacerbation of chronic diseases are noted. Allergic reactions often develop on repeated doses of DPT.

Complications include hyperthermia (more than 40 ° C), dense infiltrates more than 8 cm in diameter, edema, hyperemia at the injection site, anaphylactic shock, a collaptoid state, afebrile convulsions with loss of consciousness, very rarely - encephalitis.

Contraindications to DTP vaccination are:

Excessive reactions and complications to previous vaccinations; ... diseases of the nervous system with a progressive course; ... history of afebrile seizures; ... malignant blood diseases, neoplasms, systemic progressive diseases; ... anaphylactic shock, recurrent Quincke's edema, serum sickness.

Children who have suffered acute illnesses are vaccinated as the clinical manifestations subside. Patients with chronic diseases are vaccinated upon reaching a stable remission (at least 4 weeks). The current scheme of vaccination of pertussis with DTP vaccine (three times vaccination and one revaccination) creates a high level of immunity, but which decreases by school age. This is what prompted many countries to conduct a second or third revaccination. And this became possible only when the Infanrix acellular vaccine was created and applied in practice, which is used according to the same scheme as DTP, but allows additional revaccinations at a later age and with a lower frequency of reactions and complications.

Mumps is an inflammation of the parotid gland, an acute contagious disease. A better known and common name is another name for this disease.