whooping cough

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whooping cough

or

pertussis,

highly communicable infectious disease caused by the bacterium Bordetella pertussis. The early or catarrhal stage of whooping cough is manifested by the usual symptoms of an upper respiratory infection with bronchial involvement. After about two weeks the cough becomes paroxysmal; 10 to 15 coughs may follow in rapid succession before a breath is taken, which is the characteristic high-pitched crowing "whoop." An attack of coughing is accompanied by a copious discharge of mucus and, often, vomiting. Antibiotics and hyperimmune human serum are valuable in treatment. Rest and proper nutrition (especially if there is frequent vomiting) are important.

Whooping cough is a serious disease, especially in children under four years of age, since it may give rise to such complications as pneumonia, asphyxia, convulsions, and brain damage. For these reasons, it is recommended that all infants be actively immunized beginning at as early an age as possible (one to two months). The whole-cell pertussis vaccine available in the United States since the 1940s (see vaccinationvaccination,
means of producing immunity against pathogens, such as viruses and bacteria, by the introduction of live, killed, or altered antigens that stimulate the body to produce antibodies against more dangerous forms.
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) became the subject of controversy when it was learned that a toxin contained in it occasionally caused serious side effects. A newer, acellular vaccine, which uses only the parts of the bacterium that stimulate immunity and is less likely to cause side effects, was approved for use in 1996. Five doses are administered over 4 to 6 years, with the first three doses given by 6 months of age. The acellular vaccine, however, is less persistent than its predecessor. It is now believed that adults whose childhood vaccinations are no longer completely effective and whose symptoms are less diagnostic may be the main carriers for the disease; the number of cases in the United States has increased significantly since the introduction of the acellular vaccine. Booster vaccinations are recommended for 11- and 12-year-olds and adults as a means of ameliorating this situation; persons with routine contact with infants should be vaccinated.

Whooping cough

An acute infection of the tracheobronchial tree caused by Bordetella pertussis, a bacteria species exclusive to infected humans. The disease (also known as pertussis) follows a prolonged course beginning with a runny nose, and finally develops into violent coughing, followed by a slow period of recovery. The coughing stage can last 2–4 weeks, with a whooping sound created by an exhausted individual rapidly breathing in through a narrowed glottis after a series of wrenching coughs. The classical disease occurs in children 1–5 years of age, but in immunized populations infants are at greatest risk and adults with attenuated (and unrecognized) disease constitute a major source of transmission to others. Bordetella pertussis is highly infectious, particularly following face-to-face contact with an individual who is coughing. The disease is caused by structural components and extracellular toxins elaborated by B. pertussis. Multiple virulence factors produced by the organism play important roles at various stages of pertussis.

A vaccine produced from whole B. pertussis cells and combined with diphtheria and tetanus toxoids has been used throughout the world for routine childhood immunization. Concern over vaccine morbidity has caused immunization rates to decline in some developed countries. These drops in immunization rates have often been followed by widespread outbreaks of disease, including deaths. Considerable effort has been directed toward the development of a vaccine which would minimize side effects but maintain efficacy. A new acellular vaccine is available and has fewer side effects than the whole-cell vaccine. See Diphtheria, Vaccination

Although B. pertussis is susceptible to many antibiotics, their use has little effect once the disease reaches the coughing stage. Erythromycin is effective in preventing spread to close contacts and in the early stage.

Whooping Cough

 

(French, coqueluche), an acute infectious disease characterized by attacks of a unique paroxysmal cough. Most of its victims are children. The pathogen is the Bordet-Gengou bacillus, which was named after the Belgian scientist J. Bordet and the French scientist O. Gengou, who described it for the first time in 1906. It is discharged with sprays of sputum when infected individuals cough or sneeze, and it causes the disease in healthy persons if it comes into contact with the mucous membranes of the upper respiratory tract. Outside the human body the microbe is unstable and dies quickly. The contagious period lasts from the first days of the disease to the third or fourth week of spasmodic coughing—that is, about 40 days. Children are highly susceptible to whooping cough from the first months of life. Stable immunity is developed after one attack of the disease. A microbe similar to the whooping cough bacillus—the parapertussis microbe—was isolated in 1937. Although the disease caused by it resembles a mild form of whooping cough, it does not impart immunity.

The incubation period (the time from infection to the appearance of the first symptoms) lasts for an average of seven to nine days. The course of the disease is marked by three phases: catarrhal, paroxysmal, and convalescent. The catarrhal phase is characterized by an atypical dry cough, runny nose, and sometimes, a slightly elevated temperature. (In some cases the temperature rises to 38.5°-39°C.) Subsequently, the cough gradually intensifies, and in ten to 14 days the disease enters the paroxysmal phase. During this period the patient suffers attacks of coughing—a series of short, quick coughs ending in a whistling, convulsive inspiration (reprise), followed by more coughs and another reprise. (Sometimes the sequence may occur as many as ten times in rapid succession.) The paroxysm ends with the discharge of sticky, transparent sputum and often with vomiting. The patient’s face becomes puffy. Sometimes there is hemorrhaging into the skin, conjunctiva, and eyelids. During the paroxysmal phase changes take place in the respiratory organs (distension of the lungs, affection of the bronchi), in the cardiovascular and nervous systems (elevated blood pressure, increased excitability, and irritability), and in the composition of the peripheral blood.

The paroxysmal phase lasts for two to eight weeks or more. It is followed by convalescence, when the coughs occur less frequently and become weaker, gradually ceasing. In infants, complications of whooping cough occur fairly often. (Protracted pneumonia, lesions of the nervous system [encephalopathy], paresis of the cranial nerves, and loss of hearing, speech, or sight are among the many possible complications of the disease.)

Treatment should include a long stay in fresh air, proper care, a regimen that spares the nervous system, and a high-calorie diet (small but frequent meals). Antibiotics are usually prescribed, and at an early stage of the disease specific anti-whooping cough gamma globulin is administered. Hyperbaric oxygen therapy is quite effective.

Spread of the disease may be prevented by the prompt isolation of patients for the duration of the 40-day contagious period and by enforcement of a quarantine. At age five, six, and seven months children are ready for active immunization with whooping cough vaccine and diphtheria and tetanus anatoxin (whooping cough-diphtheria-tetanus anatoxin or polyvalent pertussin-diphtheria-tetanus vaccine). They should be given booster shots nine to 12 months later and again every two to three years until they reach age 14.

REFERENCE

Nosov, S. D. Infektsionnye bolezni u detei, 3rd ed. Moscow, 1966. Pages 208–25.

R. N. RYLEEVA and M. IA. STUDENIKIN

whooping cough

[′hu̇p·iŋ ‚kȯf]
(medicine)

whooping cough

an acute infectious disease characterized by coughing spasms that end with a shrill crowing sound on inspiration: caused by infection with the bacillus Bordetella pertussis