Is it possible to get whooping cough from a child? Whooping cough. Evidence-based guidance for patients. Does a patient with whooping cough need bed rest?

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

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

What is whooping cough

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

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

Features of the disease:

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

Ways of contracting whooping cough

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

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

The likelihood of infecting others gradually decreases.

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

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

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

Whooping cough symptoms

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

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

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

What symptoms accompany the disease?

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

Diagnostics

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

What you need when making a diagnosis:

Treatment of whooping cough

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

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

Complications of the disease

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

Complications of whooping cough include:

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

Parawhooping cough

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

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

Symptoms and treatment of parawhooping cough

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

The following symptoms are characteristic of parawhooping cough:

normal body temperature;
prolonged cough that cannot be treated;
slight increase in blood leukocytes;
complete absence of intoxication or, in rare cases, slight weakness.

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

Pertussis infection in children

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

Signs of whooping cough in a child:

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

Treatment of whooping cough in children

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

How to treat whooping cough in children?

All possible factors that irritate the child must be excluded.
Adequate nutrition is prescribed, breastfeeding is maintained, and the frequency of meals is increased.
Antibiotics and neuroleptics are prescribed.
Antitussive and sedative medications are used.

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

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

Whooping cough in adults

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

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

Treatment of whooping cough in adults

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

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

Disease prevention

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

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

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

Complications from the vaccine include:

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

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

Many fathers and mothers will probably have many questions about possible ways of contracting whooping cough, effective methods of treating this dangerous disease, and effective methods of preventing it. Let's try to find answers to some of them together.

How can you get whooping cough? Do you need to be in close proximity to the patient to do this?

Whooping cough is transmitted exclusively by airborne droplets. Moreover, outside the body, the bacteria that cause it die very quickly under the influence of direct sunlight, so the distance to the patient should be minimal. Another option for infection is prolonged exposure to the same room with other children, some of whom may be carriers of the bacteria. But if you have concerns, it is better to contact your local pediatrician or a specialized clinic. Modern diagnostic methods make it possible to determine the presence of infection in the body in 20-30 minutes.

It largely depends on what drug is used. The DTP (adsorbed pertussis-diphtheria-tetanus) vaccine, which is familiar to many mothers and recommended for use in the Russian Federation, is as follows: your child will receive four vaccinations in infancy: 3; 4.5; 6 and 18 months. Two more - at 7 and 14 years old. And then - re-vaccination of adults every 10 years. For them, ADS or ADS-M preparations are used, which do not contain the pertussis component.

Risk of relapse

What is the probability that a child who has once been ill will “receive” the same diagnosis again and begin to cough violently? Is it safe to be in the same apartment with him?

Pediatricians are aware of cases of re-infection, but they are extremely rare. Children diagnosed with whooping cough in the Russian Federation receive standard and very effective treatment. As a result, their immunity begins to produce specific antibodies, which fight the bacterium Bordetella pertussis. Therefore, if a previously ill child is bothered by a cough, it is almost 100% likely not caused by whooping cough. And if there are other children in the apartment next to him, then they have practically no chance of contracting whooping cough.

Is it possible to diagnose whooping cough without additional research?

In the initial stage of development, this is extremely unlikely: whooping cough can be easily confused with ARVI or bronchitis. Because of this, therapeutic measures do not bring any noticeable results, and the general condition of the child remains quite satisfactory. When whooping cough enters the spasmodic stage, in which external manifestations become more pronounced, making the correct diagnosis does not present any difficulties.

What happens if whooping cough is not treated: complications

Is it true that the greatest health risk is not the disease itself, but the complications after it? Why do doctors often insist on hospitalization even when the child’s condition is quite satisfactory?

Stabilization of the temperature, general improvement in well-being and a significant decrease in the severity of coughing attacks do not yet indicate that the child has recovered. Whooping cough is a very insidious infection, so you need to approach your doctor’s recommendations with all possible responsibility. The body of a baby who has barely survived a serious illness will not be able to effectively resist infection, since the immune system is extremely weakened. Moreover, the slightest violation of the regime can provoke extremely dangerous complications for health and life, which often have nothing to do with the lungs or the ear-nose-throat area.

Prolonged bronchitis.
Pneumonia.
Otitis.
Spasm of the bronchi or blood vessels.
Pertussis encephalopathy. This is a severe lesion of the central nervous system, manifested by fainting, convulsions, visual and hearing impairment. If you notice any of these symptoms, seek medical help as soon as possible.
Hernias and rectal prolapse. An annoying, severe cough is to blame for this, which can significantly increase intra-abdominal pressure.
Atelectasis (collapse of alveoli) of the lung. This condition often develops very quickly and leads to acute respiratory failure. How to deal with this? Call an ambulance immediately.
Stroke and retinal detachment. Such conditions are explained by sudden surges in pressure resulting from a severe coughing attack. The likelihood of such complications is extremely low, but if you encounter characteristic symptoms, you should not delay consulting a doctor.

Can you really die from whooping cough?

Rumors that this disease is fatal are very far from the real state of affairs. Even in the 19th century, when virtually nothing was known about the potential for vaccination, the mortality rate from whooping cough did not exceed 55-60 cases per 100,000 people. After the experiments of Edward Gener (he first inoculated cowpox into humans in 1796) were recognized by doctors, and Louis Pasteur developed methods of vaccination against other diseases, the mortality rate from whooping cough decreased significantly - to 11-13 cases per 100,000 people.

But if you take into account newly born children, the situation will no longer be so rosy. They do not yet have their own immunity against whooping cough, and they will receive the first vaccination only at 3 months. Moreover, if you use a low-quality vaccine (or grossly violate its storage conditions), the likelihood of serious side effects will increase significantly.

In other words, if during pregnancy you followed all the recommendations of doctors, were revaccinated in a timely manner, gave your baby all the required vaccinations according to schedule and did not expose his body to excessive stress, the likelihood of death will be extremely low.

How is whooping cough different from parawhooping cough?

Both of these diseases have a similar clinical picture, but it would be a big mistake to consider them different manifestations of the same pathological process. If we discard subtleties that are of little interest to the average person, then it can be argued that parawhooping cough is a lite version of ordinary whooping cough. It is much easier, does not cause complications and does not always require any specific treatment.

Distinctive features:

Pathogen: parapertussis bacillus (Bordetella parapertussis), which produces a toxin less potent than Bordetella pertussis.
Risk group: children 3-6 years old.
Contagious period: no more than 14 days.
Main symptom: cough (3-5 weeks). In this case, the child most often remains in normal health, and fever and severe attacks with repeated episodes and vomiting are practically not observed.
Incubation period: from 7 to 15 days.
Treatment: symptomatic.
Duration of quarantine: 15 days.
Active immunization: not carried out.
Prognosis: always (!) favorable.
Chance of re-infection: none.

Similarities with common whooping cough:

potential source of infection;
transmission routes;
pathogenesis;
methods and methods of diagnosis.

Is it possible to get whooping cough on the street?

It is quite possible. You must understand that the pertussis bacterium outside the host’s body is extremely unviable and dies very quickly. Therefore, the chance of infection on the street through casual contact is quite small, although it still cannot be called zero.

If we talk about the possibility of infection in public places (theaters, schools, kindergartens, various sections and clubs), where the duration of potential contact with a Bordetella pertussis carrier is much longer, the situation will not be so rosy. In any room with insufficient ventilation and the absence of direct sunlight, the bacterium can remain viable for a long time, as a result of which it will sooner or later “find” a new host.

But it does not at all follow from this that the baby needs to be kept at home throughout his childhood, only allowed out on special occasions. If you get preventive vaccinations in a timely manner and teach your child to follow basic hygiene rules, the likelihood of infection can be significantly reduced.

Re-infection

Does DTP guarantee that a vaccinated child will never get whooping cough again? Does it make sense to refuse vaccination if whooping cough may still return?

If your child has already had whooping cough, then doctors categorically do not recommend refusing routine DPT vaccinations. The fact is that the immunity they provide is not permanent. Sooner or later, it will no longer “recognize” Bordetella pertussis, and the likelihood of re-infection will increase significantly (on average, DTP lasts no more than 5-6 years). According to statistical studies, about 12% of all cases are adolescents over 15 years of age and adults, although whooping cough is considered exclusively a childhood disease.

It should be clarified that re-infection rarely leads to any serious consequences, and the disease itself is much milder. Therefore, you should not refuse preventive vaccinations: they “work” in any case, as they significantly alleviate symptoms.

Can whooping cough be treated with antibiotics?

There is no clear answer to this question. The pertussis bacillus exhibits the greatest activity in the host’s body only during the first 10-12 days. Therefore, if you give the child antibiotics at this time (we remind you that only a doctor should prescribe them!), Bordetella pertussis will be completely destroyed and the child will begin to recover quickly.

But the main problem of this method of treating whooping cough is that it is almost impossible to diagnose the disease at the very beginning of its development without laboratory tests. There is no cough, there are no specific symptoms, and visible clinical manifestations most likely indicate ARVI or bronchitis. And if the district pediatrician has no particular reason to suspect whooping cough, he will prescribe the small patient ordinary vitamins or tonics that will not affect Bordetella pertussis in any way.

After the 12th day, a paroxysmal period begins, characterized by severe coughing attacks. It can last quite a long time, sometimes up to 2-3 months. Antibiotics, even very strong ones, turn out to be practically powerless, which is why the prescribed treatment is most often symptomatic.

In this situation, doctors recommend consulting a doctor at the first signs of a cold. Modern laboratory diagnostic methods make it possible to identify whooping cough bacillus in less than an hour. And if, immediately after confirming the diagnosis, you give the child a light and safe antibiotic (for example, erythromycin), it will suppress the proliferation of bacteria and make the recovery process much faster.

Disease risk for adults

Is it possible to become infected with whooping cough if you have already graduated from school and are raising children yourself? Why can the risk of infection last almost a lifetime?

Theoretically, this is possible (especially if the patient’s body’s defenses are weakened), but the likelihood of this is extremely low. The immunity provided by standard vaccines is not very durable - only 5-6 years. Therefore, doctors recommend that after this period, repeated vaccinations are given not only to children, but also to adults.

Contents:

Where does whooping cough come from? How can a person become infected with it?

The causative agent of whooping cough is a microbe (bacterium), which in medicine is called Bordetella pertussis(Bordetella pertusis).

Once in the human body, this bacterium produces toxins (poisonous substances) that cause severe inflammation and irritation of the surface of the respiratory tract. Outwardly, this manifests itself as prolonged bouts of painful, dry cough.

Epidemiological studies have found that the infection that causes whooping cough can only spread among people. For this reason, a healthy person (adult or child) can only become infected with whooping cough from another person who has the disease.

As will be shown below in the chapter on the symptoms of whooping cough, quite often in adolescents and adults this disease occurs in a mild form, in which a person only has a mild cough. People who get sick with this form of whooping cough often believe that they have a common cold and therefore rarely go to the doctor, and even in those cases when they do go to the doctor, they are not always prescribed tests that can identify this infection. Because of this, people with whooping cough can infect other people around them with whooping cough for many weeks, not knowing that they are spreading a dangerous infection.

Whooping cough is transmitted by airborne droplets. This means that a healthy person can become infected with this infection by inhaling particles of mucus and saliva that are released into the air when a sick person sneezes or coughs.

It is believed that to become infected with whooping cough it is enough:

Stay in the same room with a sick person for more than 1 hour;
Contact with saliva, sputum, or nasal discharge of a sick person;
Talk to a sick person while staying less than 1 meter away;

How long is the incubation period for whooping cough?

Incubation period Incubation period- this is the period of time between the moment the infection enters the human body and the moment the first symptoms of the disease appear.
For many viral respiratory tract infections, such as influenza, the incubation period is 1-3 days (that is, the first symptoms of the disease appear 1-3 days after infection with the virus). For other infections, the incubation period can vary from a few days (less often hours) to several weeks, months or years. with whooping cough can last from 5-7 days to 3 weeks.

When does a person with whooping cough become contagious and how long does he remain contagious?

A person with whooping cough becomes contagious as soon as the cough begins and may remain contagious for 2 to 4 weeks or more if not treated with antibiotics.

People who start taking antibiotic treatment (which antibiotics are active against whooping cough are discussed below) are no longer infectious within the first 5 days of treatment.

How long should you keep your child at home?

If your child gets whooping cough, he needs to stay home from daycare or school (quarantine) for at least 5 days if he is receiving antibiotic treatment, and for at least 3 weeks if he is not receiving antibiotics.

Why do adults and children who have been vaccinated against this disease get whooping cough?

In medicine, the whooping cough vaccine is called DPT.

According to the national vaccination calendars adopted in Russia and many other countries, the DPT vaccine is given to children in the form of 4 doses at the age of 3 months, 4.5 months, 6 months and 1.5 years.

Observations of large groups of children who received all 4 doses of DPT showed that this vaccination is really effective and makes about 80-85% of children who received it immune to whooping cough (in the remaining 15-20% of children, the vaccine forms immunity, allowing the development of only mild forms of the disease ).

However, studies have shown that immunity against whooping cough does not last a lifetime, but only for a period of 4 to 12 years after receiving the last dose of the vaccine.

It is for this reason that, a few years after vaccination, many children (and even more so adults) can get whooping cough again (in a milder form than people who have never received the vaccine) and become spreaders of this infection.

In this regard, in some countries, DTP vaccination is recommended not only for children, but also for adolescents (aged 11-12 years) and adults (especially pregnant women).

What are the symptoms and signs of whooping cough?

Symptoms and signs of whooping cough depend on the age of the person who has it, whether they have been vaccinated against the disease, and what treatment they receive. Below we will explain this in detail

The first symptoms of whooping cough often resemble those of a common cold: runny nose, slight increase in body temperature (up to 38.5 C), sore throat, rare coughing, malaise.

1-2 weeks after the onset of these symptoms, when it seems to the person that he has almost recovered, the main symptom of whooping cough appears: a dry, suffocating cough that comes in the form of attacks lasting for 1-2 minutes.

Coughing attacks with whooping cough can be repeated several times an hour and occur especially often at night.

The cough of whooping cough can be so severe that after several attacks, the person with the disease may vomit or lose consciousness.

Medicine also describes cases where a person’s ribs broke during a strong cough.

When the coughing attack passes, a person infected with whooping cough can look normal and feel practically healthy.

A few weeks after the onset of the disease, the cough begins to subside. In general, whooping cough cough can last up to 6-10 weeks or even more.

In children and adults who have received a whooping cough vaccine, this disease can develop in the so-called “atypical” or “erased” form, in which the sick person is only bothered by a dry cough (without a runny nose, without fever), lasting several weeks. It should be noted that even with “erased” forms of whooping cough, despite the mild development of the disease, a sick person can infect other people around him with it (including children who do not yet have immunity to this infection and who may become ill with more severe forms of this disease ).

Symptoms and signs of whooping cough in young children

Most often, newborns, infants and children of the first years of life become infected with whooping cough from their parents, brothers or sisters who have an erased form of the disease and are unaware that they are the source of the infection.

Sometimes, very rarely, it happens that an adult patient who once had this disease again catches this infection. It must be said that after suffering from the disease, a person’s body remains very strong immunity. But in rare cases, there is a coincidence of a sharp drop in immunity due to other reasons and whooping cough infection. It is in such cases that an adult can get sick again.

It’s another matter if an adult has not had this disease and has not received vaccinations. Then he may well become infected with whooping cough from his children. The disease begins with an unpleasant sensation in the throat. After about two days, a sharp and infrequent cough appears. Every day the cough becomes stronger and after fifteen days attacks are observed almost every hour. The cough is so severe that the patient may shed tears, leak urine, increase blood pressure, and cause blood to rush to the face. Most often, coughing attacks torment the patient in a confined space, in the dark. Twenty days after the onset of the disease, thick mucus appears. Body temperature is slightly increased, in rare cases there are jumps to thirty-eight degrees.

Most often, this disease causes less suffering to adult patients than to children. Almost never does a coughing attack end in vomiting. And for some people, whooping cough goes away almost unnoticed. The danger of such a course of the disease is that the patient is contagious and spreads the infection around himself, to his loved ones, colleagues and people in transport.

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

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

Some statistics

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

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

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

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

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

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

The causative agent of whooping cough and routes of transmission

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical periods of whooping cough

Clinically, the following periods are distinguished during whooping cough:

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

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

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

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

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

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

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

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

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

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

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

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

Criteria for the severity of whooping cough

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

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

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

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

In severe cases of whooping cough, complications often develop.

Complications of whooping cough

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

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

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

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

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

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

Atypical forms of whooping cough

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

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

Whooping cough in patients from different age groups

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

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

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

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

Diagnosis of whooping cough

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

Doctor consultations

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

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

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

Laboratory diagnosis of whooping cough

General blood analysis
Reveals general signs of inflammation in the body.

Increased level of leukocytes
Increased level of Lymphocytes
ESR is normal

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

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

Serological tests

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

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

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

Treatment of whooping cough

Does a patient with whooping cough need bed rest?

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

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

Toys, puzzles and other board games of a non-aggressive nature are used as a distraction.
In addition, sufficient attention should be paid to the patient’s nutrition. For breastfed infants, it is advisable to increase the number of feedings by reducing the amount of food taken at one time. Older children are recommended to drink plenty of alkaline drinks (juices, fruit drinks, tea, milk, alkaline mineral water).

When is inpatient treatment necessary?

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

What medications and physiotherapeutic procedures are used for whooping cough?

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

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

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

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

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

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

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

Traditional methods of treating whooping cough

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

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