Pertussis natural history, complications and prognosis: Difference between revisions
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<sup>Timeline of pertussis clinical manifestations. Retrieved from Centers of Disease Control and Prevention (CDC) <ref name=CDC> {{cite web |url=http://www.cdc.gov/pertussis/about/signs-symptoms.html |title=Pertussis |date=2015 |website= www.cdc.gov |publisher= Centers for Disease Control and Prevention (CDC) |access-date= Jan 14 2016}}</ref></sup> | |||
==Complications== | ==Complications== | ||
Revision as of 20:25, 14 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]
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Overview
The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent. Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.[1] Complications of pertussis include apnea, pneumonia, seizure, and death. Because neither vaccination nor infection confers long-term immunity, infection of adolescents and adults is also common.[2] Most adults and adolescents who become infected with Bordetella pertussis have been vaccinated or infected years previously. When there is residual immunity from previous infection or immunization, symptoms may be milder, such as a prolonged cough without the other classic symptoms of pertussis.
Natural History
- The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.
- Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor respiratory tract infections.
- The cough, which is initially intermittent, becomes paroxysmal. In typical cases paroxysms terminate with inspiratory whoop and may be followed by post-tussive vomiting. Paroxysms of cough, which may occur more at night, usually increase in frequency and severity as the illness progresses and typically persist for 2 to 6 weeks or more.
- The illness can be milder and the characteristic "whoop" may be absent in children, adolescents and adults who were previously vaccinated. After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
Shown below is a table summarizing the main findings in each stage.[1]
| Stage | Duration | Key features |
| Catarrhal | Usually 7-10 days; range of 4-21 | - Low grade fever - Coryza - Mild occasional cough |
| Paroxysmal | Usually lasts 1-6 weeks, but may persist for up to 10 weeks | - Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree - Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms |
| Convalescent | Usually 7-10 days; range of 4-21 | - Gradual recovery - Less persistent, paroxysmal coughs that disappear in 2-3 weeks - Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis |
Timeline of pertussis clinical manifestations. Retrieved from Centers of Disease Control and Prevention (CDC) [3]
Complications
Pertussis may cause serious and potentially life-threatening complications, especially among infants and young children. Patients who are not fully vaccinated are more predisposed to developing pertussis-related complications.[4][5][6]
- Sleep apnea (most common)
- Epistaxis
- Pneumonia
- Otitis media
- Pneumothorax
- Refractory pulmonary hypertension
- Urinary incontinence
- Hernia
- Rectal prolapse
- Rib fracture
- Seizures
- Subdural hematoma
- Encephalopathy
Prognosis
- Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.[1]
- Treatment with an effective antibiotic (erythromycin or azithromycin) shortens the infectious period but does not generally alter the outcome of the disease; however, when treatment is initiated during the catarrhal stage, symptoms may be less severe.
- Illness is generally less severe, and the typical “whoop” less frequently seen in adolescents and adults.[1]
References
- ↑ 1.0 1.1 1.2 1.3 Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014
- ↑ Hewlett EL, Edwards KM (2005). "Pertussis--not just for kids". New Eng J Med. 352 (12): 1215–1222.
- ↑ "Pertussis". www.cdc.gov. Centers for Disease Control and Prevention (CDC). 2015. Retrieved Jan 14 2016. Check date values in:
|access-date=(help) - ↑ Pertussis (whooping cough). Complications. CDC.gov. Accessed on June 15, 2014
- ↑ Mattoo S, Cherry JD (2005). "Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to 'Bordetella pertussis' and other Bordetella subspecies". Clin Microbiol Rev. 18 (2): 326–82. PMID 15831828.
- ↑ "Pertussis: MedlinePlus Medical Encyclopedia".