Pertussis natural history, complications and prognosis: Difference between revisions
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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 30%" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Duration'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Key features''' | ||
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| | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left | Catarrhal || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Usually 7-10 days; range of 4-21 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |- [[Low grade fever]]<br> - [[Coryza]] <br> - Mild occasional [[cough]] | ||
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| Paroxysmal || Usually lasts 1-6 weeks, but may persist for up to 10 weeks || | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Paroxysmal || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Usually lasts 1-6 weeks, but may persist for up to 10 weeks || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |- Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree.<br> | ||
Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree.<br> | - Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms<br> | ||
Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms<br> | - Cyanosis<br> | ||
Cyanosis<br> | - [[Vomit]]ing and exhaustion<br> | ||
[[Vomit]]ing and exhaustion<br> | - Paroxysmal attacks occur frequently at night, with an average of 15 attacks per 24 hours.<br> | ||
Paroxysmal attacks occur frequently at night, with an average of 15 attacks per 24 hours.<br> | - Paroxysmal attacks increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease. | ||
Paroxysmal attacks increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease. | |||
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| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Convalescent || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Usually 7-10 days; range of 4-21 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Gradual recovery <br> Less persistent, paroxysmal [[cough]]s that disappear in 2-3 weeks<br> | ||
Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis. | Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis. | ||
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Revision as of 00:49, 16 June 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
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Overview
The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent. Because neither vaccination nor infection confers long-term immunity, infection of adolescents and adults is also common.[1] 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. Shown below is a table summarizing the main findings in each stage.[2]
| 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. |
Catarrhal Stage
Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor respiratory tract infections.
Paroxysmal Stage
- The cough, which is initially intermittent, becomes paroxysmal. In typical cases paroxysms terminate with inspiratory whoop and can be followed by posttussive 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" absent in children, adolescents and adults who were previously vaccinated.
Convalescent Stage
After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
Complications
This disease results in high morbidity and mortality in many countries every year. Complications of the disease[3] include:
- Pneumonia
- Encephalitis
- Pulmonary hypertension
- Secondary bacterial superinfection[4]
- Pneumonia
- Convulsions
- Nose bleeds (epistaxis)
- Ear infections (otitis )
- Encephalitis
- Bleeding in the brain (cerebral hemorrhage)
- Mental retardation
- Slowed or stopped breathing (apnea)
- Death
Prognosis
- Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.[2]
- Illness is generally less severe, and the typical “whoop” less frequently seen in adolescents and adults.[2]
References
- ↑ Hewlett EL, Edwards KM (2005). "Pertussis--not just for kids". New Eng J Med. 352 (12): 1215–1222.
- ↑ 2.0 2.1 2.2 Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014
- ↑ "Pertussis: MedlinePlus Medical Encyclopedia".
- ↑ 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.