PertusisPertusis

Soumya Ranjan ParidaSoumya Ranjan Parida Basic B.Sc. Nursing 4Basic B.Sc. Nursing 4thth year year

Sum Nursing CollegeSum Nursing College

IntroductionIntroductionSydenham-1670Sydenham-1670Agent-Bordetella PertusisAgent-Bordetella Pertusis((pleomorphic,fastidious,non-pleomorphic,fastidious,non-

motile,gram –ve,coccobacili,grows best on B.G media)motile,gram –ve,coccobacili,grows best on B.G media)

Pertusis like illnessesPertusis like illnesses B.parapertusisB.parapertusis B.bronchisepticaB.bronchiseptica MycoplasmaMycoplasma Adeno virus -1,2,3,5Adeno virus -1,2,3,5 R.S.VR.S.V Parainfluenza & influenza virusesParainfluenza & influenza viruses EnterovirusesEnteroviruses

EpidemiologyEpidemiologyEndemic, epidemic every 3-4 yearsEndemic, epidemic every 3-4 yearsPeak season-July - OctoberPeak season-July - OctoberStrike rate-80-100 %Strike rate-80-100 %Host –Host –more serious in females, younger agemore serious in females, younger age(50-70% cases<1 yr with most (50-70% cases<1 yr with most

deaths)deaths)

Maternal abs.-not protectiveMaternal abs.-not protectiveimmunity wanes –subclinical immunity wanes –subclinical Reservoir( asymptomatic carriers )Reservoir( asymptomatic carriers )Spread airborne droplet , direct contactSpread airborne droplet , direct contactInfectivity-till cough stops /7 day erythromycinInfectivity-till cough stops /7 day erythromycin

PathogenesisPathogenesisBiologically active substances produced by B.pertusisBiologically active substances produced by B.pertusis FHA (filamentous hemagglutination factor)FHA (filamentous hemagglutination factor) LPF / PT / PertectinLPF / PT / Pertectin Adenyl cyclaseAdenyl cyclase DemonecretinDemonecretin Tracheal cytotoxinTracheal cytotoxin Endotoxin (not imp.)Endotoxin (not imp.)Attachment on resp.epi.- toxin - peribronchial congestion +Attachment on resp.epi.- toxin - peribronchial congestion + mucosal edema +infiltration of lympho.- patchy areas of mucosal edema +infiltration of lympho.- patchy areas of atelectasis & hyperinflation- v/p mismatch-hypoxia, atelectasis & hyperinflation- v/p mismatch-hypoxia, secondary infectionsecondary infection

Clinical featuresClinical featuresIncubation Incubation – 6-20 days (mean 7 days)– 6-20 days (mean 7 days)Clinical stagesClinical stages Catrrhoeal -Catrrhoeal -1-2 weeks, low grade fever , rhinorrhoea ,mild cough1-2 weeks, low grade fever , rhinorrhoea ,mild cough

Paroxysmal- Paroxysmal- 2-4 weeks, repitative bouts ,whoop ,post tussive 2-4 weeks, repitative bouts ,whoop ,post tussive emesisemesis

non life threatening bout-non life threatening bout-<45 sec.red color change,tachycardia /<45 sec.red color change,tachycardia /

bradycardia not < 60 ,oxygen desaturation resolves bradycardia not < 60 ,oxygen desaturation resolves spontaneouslyspontaneously

ConvalescentConvalescent

DiagnosisDiagnosisTypical clinical pictureTypical clinical picture-H/O contact,cough > 2 -H/O contact,cough > 2

weeksweeks whoop , posttussive emesiswhoop , posttussive emesisInvestigationsInvestigations TLC- lymphocytosisTLC- lymphocytosis ESR- decreasedESR- decreased Fluroscent stain of secretionsFluroscent stain of secretions CIEPCIEP ELISA- detects ab.FHA ,PT IgG-PT most specificELISA- detects ab.FHA ,PT IgG-PT most specific DNA probe ,PCR.DNA probe ,PCR.