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Overview |
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Definition |
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Pertussis is a disease reported since the 1500s. Pertussis, meaning intense
or violent cough, is a highly communicable, bacterial infection of the
respiratory system. The gasping inspiratory sounds, heard mostly in young
children, give it its common name, whooping cough. Patients are contagious for
three weeks, with an incubation period of one to two weeks. Before a vaccine for
pertussis was developed in 1948, it was the leading cause of death from
communicable disease for children under age 14 in the United States. Worldwide
reduction in the use of the vaccine in recent years has caused an increase in
incidence of pertussis. |
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Etiology |
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Bordetella pertussis and B. parapertussis, small gram-negative
coccobacilli, are the infectious organisms that produce pertussis in humans.
Aerosol droplets are usually spread from the cough of infected patients. The
bordetella organism adheres to the cilia of the epithelial cells lining the
mucosa of the respiratory tract, producing the pertussis toxin, causing local
tissue reaction, and eventually systemic illness. |
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Risk Factors |
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- Lack of immunization to pertussis
- Exposure to infected
person(s)
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Signs and Symptoms |
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After an incubation period of 5 to 20 days, there are three phases
(catarrhal, paroxysmal, and convalescent) each with its own signs and
symptoms.
Catarrhal phase (one to two weeks):
- Upper respiratory tract infection; often indistinguishable from the
common cold but increasingly severe
- Low-grade fever
- Rhinitis
- Anorexia
Paroxysmal phase (one to four weeks):
- Cough increases (2 to 50 episodes a day) and fever
subsides
- Sudden, forceful inspirations (whooping sound)
- Paroxysms of cough include bulging eyes, tongue protrusion,
lacrimation, cyanosis.
- Vomiting (thick secretions), choking, and/or apnea follow
paroxysms.
- Patient may not appear ill between paroxysms; infants often exhausted
and may lose consciousness
Convalescent phase (two weeks to several months):
- Residual cough
- Older children and adults with previous vaccine or illness have
nonspecific bronchitis-like symptoms, usually without the characteristic
whooping sound.
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Differential
Diagnosis |
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- Acute upper respiratory infections
- Pneumonias
- Bronchiolitis
- Cystic fibrosis
- Tuberculosis
- Foreign bodies in respiratory tract
- Chronic obstructive pulmonary disease
- Leukemia
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Diagnosis |
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Physical Examination |
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The patient initially presents with cold-like symptoms. Paroxysms may occur
following a slight startle. Often a child who appears well begins to flail and
gasp as the face reddens, eyes water, and the inspiratory whoop may be heard.
Adults describe feelings of strangulation and bursting headache before air again
enters the lungs. |
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Laboratory Tests |
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- Pertussis organisms are cultured from respiratory tract secretions
(highly specific, but not sensitive) or nasopharyngeal secretions (more
sensitive); negative cultures occur with patients taking antibiotics or with
previous vaccination.
- Direct fluorescein-conjugated antibody (DFA) staining of
nasopharyngeal secretions effectively identifies B. pertussis; may give
false negatives and positives; only reliable in experienced
laboratories.
- Serologic tests (now commercially available) show that IgM and IgA
are elevated with infection.
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Pathology/Pathophysiology |
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- Lymphocytosis is stimulated by pertussis toxin.
- White blood count is elevated (15,000 to 60,000).
- Pertussis toxin causes leukocyte dysfunction, insulin secretion, and
histamine sensitivity.
- Local epithelial damage results from tracheal cytotoxin,
dermonecrotic factor, and adenylate
cyclase.
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Imaging |
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Chest X ray may be clear or show mild infiltrates. |
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Other Diagnostic
Procedures |
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Available laboratory tests are generally used for research and patients with
severe complications. Pertussis should be suspected for severe cough (longer
than two weeks) with post-tussive vomiting, leukolymphocytosis, inspiratory
whoop, and known exposure. A lack of immunization is not a good indicator of
possible pertussis, as a large percentage of immunized people contract
pertussis. |
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Treatment Options |
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Treatment Strategy |
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Treatment is largely to control symptoms and prevent spread. Quarantine for
four weeks. Parenteral fluid and nutrition, oxygen supplementation, and
mechanical ventilation may be required. |
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Drug Therapies |
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- Antibiotics—usually erythromycin (40 to 50
mg/kg/day, with a maximum dose of 2 kg, in four divided doses for 14 days)
reduces transmission and is effective even for infants. Unless given in the
catarrhal phase, antibiotics do not reduce the severity or length of illness.
- Corticosteroids (e.g., betamethasone, 0.075 mg/kg/day) may reduce
severity and length of paroxysms, especially for infants.
- Albuterol (0.3 to 0.5 mg/kg/day) reduces the severity of cough
paroxysms.
- Immediate resuscitation from loss of consciousness is essential to
avoid anoxic brain damage and death.
- Suctioning of secretions, oxygen administration, parenteral fluids
and electrolytes are used for infants and protracted illness.
- Mist by tent may benefit infants.
- Do not use cough
suppressants.
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Complementary and Alternative
Therapies |
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Pertussis is more serious in children under the age of 2 and in the elderly.
For those people with healthy immune systems, pertussis can be treated with
nutrition, herbs, and homeopathy with excellent results. Alternative therapies
require intensive nursing on the part of the caretaker. |
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Nutrition |
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Note: Doses given are for children. Adults should double the
amounts.
- Eliminate mucus-forming foods such as dairy, bananas, wheat, and meat
products.
- Encourage small, frequent meals of vegetable broths, steamed
vegetables, and fresh fruit (especially pineapple and grapes) and vegetable
juices. Add therapeutic foods to broths, including onions, garlic, ginger,
leeks, turnips, carrots, and leafy greens.
- Vitamin C (200 to 500 mg tid), zinc (10 to 15 mg/day), and
beta-carotene (10,000 to 25,000 IU/day) support the immune
system.
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Herbs |
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Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
Respiratory and immune-stimulating herbs are used in a variety of modalities.
For best results use both internal and external treatment.
Catarrhal stage: Use immune-stimulants, expectorants, and antiseptics to
facilitate expectoration, enhance immunity, and reduce severity of infection.
Choose two herbs from each of the first three categories. Combine in equal parts
in a tea (1/2 cup every three to four hours), a tincture or glycerite (30 drops
every three to four hours).
Paroxysmal stage: In addition to the above formula, add antispasmodic herbs
to ease cough. Combine 2 parts of catnip with two to four of the other
antispasmodic herbs in a tincture or glycerite (20 drops every one to two
hours).
Immune-stimulating herbs:
- Coneflower (Echinacea purpurea)
- Usnea lichen (Usnea spp.)
- Garlic (Allium sativum)
- Astragalus (Astragalus membranaceus)
Expectorants:
- Licorice root (Glycyrrhiza glabra)
- Elecampane (Inula helenium)
- Mullein (Verbascum densiflorum)
Antiseptics:
- Thyme (Thymus vulgaris)
- Hyssop (Hyssopus officinalis)
- Anise seed (Pimpinella anisum)
Antispasmodics:
- Indian tobacco (Lobelia
inflata)—should not be more than 1/4 of a
combination.
- Catnip (Nepeta cateria)
- Chamomile (Matricaria recutita)
- Cramp bark (Viburnum opulus)
- Valerian (Valeriana officinalis)
Garlic (Allium sativum) and ginger root (Zingiber officinale)
can be made into a syrup and given throughout the course of illness. Combine 10
to 12 cloves of sliced garlic with 10 to 12 slices of fresh ginger root. Using 2
cups of raw sugar, layer ginger, garlic, and sugar in a glass jar. Let sit in
cool place for two days. Strain and store in amber jar. Give. 1/2 to 1 tsp. tid.
Garlic and ginger can also be combined in a tea. Using 2 to 3 cloves of garlic
and 2 to 3 slices of ginger, simmer in 1 cup of water for 10 to 15 minutes.
Drink 1/2 cup tid to qid. May add honey and lemon for flavor.
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Homeopathy |
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An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency. For acute
prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours
until acute symptoms resolve.
- Aconite for sudden onset of cough and great thirst for cold
drinks
- Belladonna for sudden onset, high fever with flushed face and
irritability
- Drosera for cough that is aggravated by tickle in the throat or
on lying down. Paroxysms of coughing may be so severe that the patient cannot
catch his or her breath
- Bryonia alba for cough that is dry and painful and is
aggravated by eating and any motion
- Arnica montana for painful cough with nosebleed. Child may cry
in anticipation of cough.
- Antimonium tartaricum for rattling cough and weakness that
prevents expectoration
- Ipecacuanha for persistent nausea with paroxysmal cough leading
to or ending in gagging or vomiting
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Physical Medicine |
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- Chest rubs. Use 3 to 6 drops of essential oil (camphor, thyme,
eucalyptus, rosemary) with 1 tbsp. food grade oil (almond, flaxseed, or olive).
Rub on chest to increase circulation and ease spasm.
- Castor oil pack. Used externally, castor oil is a powerful
anti-inflammatory and may help prevent consolidation in pertussis. Apply oil
directly to chest, cover with a clean soft cloth (e.g., flannel) and plastic
wrap. Place a heat source (hot water bottle or heating pad) over the pack and
let sit for 30 to 60 minutes. For best results use three consecutive days in one
week. Use daily during acute infection. Can add three to six drops of essential
oil (see chest rub) to enhance the benefit.
- Herbal steams. Place 3 to 6 drops of essential oil (see chest rub) in
a humidifier or a warm bath. This will help thin mucus and open respiratory
passages.
- Contrast hydrotherapy. Alternating hot and cold applications to the
chest and/or back increases circulation to the chest, brings nutrients to the
lungs, and diffuses metabolic waste from inflammation. The overall effect is
decreased inflammation, pain relief, and enhanced healing. Alternate three
minutes hot with one minute cold. Repeat three times. This is one set. Do two to
three sets/day.
- Warming sock treatment. Before bed, place cold, damp socks on warmed
feet and cover with dry wool socks. Let child sleep with the wet socks on
overnight. This will stimulate immune function, decrease congestion, and may
allow more restful sleep.
- Tapotement and postural drainage may also help prevent consolidation
and decrease duration of illness.
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Acupuncture |
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Both acupuncture and acupressure are used for children. May enhance immunity
and decrease duration and severity of infection. |
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Massage |
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See chest rubs under physical medicine. Foot massage has an overall relaxing
effect and can help induce relaxation and sleep in an anxious child.
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Patient Monitoring |
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Patients who have serious complications, severe paroxysms, or are under one
year of age should be hospitalized. |
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Other
Considerations |
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Prevention |
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Vaccination (0.5 mL, intramuscularly)
- 80% to 90% effective but lasts only up to 12 years (disease is less
severe and often undiagnosed in older child and adult); studies show observer
bias in efficacy of vaccine
- Typically given with diphtheria and tetanus
The following whole-cell (DTP) side effects have led to reduction in
use.
- Inoculation site soreness
- Fever
- Persistent (more than three hours) crying
- Seizures
- Encephalopathy
Acellular (DTaP)—rare, infrequent side effects
similar to DTP
- Patient should be isolated for seven days.
- Antibiotic (erythromycin) prescribed to nonimmunized, exposed person
may prevent pertussis.
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Complications/Sequelae |
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- Death in infants (more common in infants under 6 months of
age)
- Pneumonia—low-grade fever after the
catarrhal phase is indicative of secondary infection (10% of infants)
- Otitis media
- Seizures
- Coma
- Encephalopathy (1%)
Interathoracic and intraabdominal pressure during paroxysms can cause the
following.
- Umbilical and inguinal hernias
- Subconjuctival, scleral, and cerebral hemorrhages
- Hemoptysis
- Rectal prolapse
- Periorbital edema
- Subcutaneous emphysema
- Pneumothorax or
pneumomediastinum
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Prognosis |
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Without complications, complete recovery can be
expected. |
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Pregnancy |
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Pertussis is generally uncomplicated in healthy adults. Nutritional support
and homeopathics are safe in pregnancy. Herbal treatment should be under the
supervision of a qualified practitioner. |
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References |
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Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace
Publishers; 1995:452-453.
Behrman RE, Kliegman R, eds. Nelson Textbook of Pediatrics. 15th ed.
Philadelphia, Pa: WB Saunders Co; 1996.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:432.
Bove M. An Encyclopedia of Natural Healing for Children and Infants.
New Canaan, Conn: Keats Publishing; 1996:205-208.
Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB
Saunders Co; 1998.
Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical
Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1996.
Scott J. Natural Medicine for Children. London: Gaia Books Ltd;
1990:133-134. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |