Introduction
Pertussis is a highly contagious bacterial respiratory tract infection common in children and adults. The incubation period is 7-21 days.
Complications of Pertussis
Complications of Pertussis include:
- Subconjunctival haemorrhage
- Otitis media
- Apnoea
- Pneumonia
- Bronchiectasis
- Activation of latent tuberculosis
- Dehydration
- Fever
- Convulsions
- Rectal prolapse, and
- Malnutrition.
Patients should be admitted to hospital when complications are present.
Pertussis can be prevented by the “five-in-one” immunisation recommended for all children (See ‘Immunization’).
In the event of a child developing pertussis before immunisation, the “five in one” vaccine should still be given to protect against the four other diseases.
Pertussis during epidemics, or when there is a clear history of contact in a child with catarrh, appropriate antibiotics may help reduce the period of infectivity and transmission.
All cases should be reported to the District Disease Control Officer.
Cause of Pertussis
- Pertussis is caused by Bordetella pertussis
Symptoms of Pertussis
Catarrhal Phase: Initial 1-2 weeks
- Low grade fever
- Nasal discharge
- Mild cough
Paroxysmal phase: within the following 6-10 weeks
- Episodes of violent repetitive cough ending with inspiratory whoop or vomiting (whoop may be absent in babies and adults)
Recovery (convalescent) phase: next 2-3 weeks
- Gradual reduction in bouts of coughing
Signs of Pertussis
- Apnoea (long pause in breathing) common in babies
- Cyanosis
Investigations
- FBC high total lymphocyte count
- Chest X-ray (to exclude other causes of chronic cough)
Treatment for Pertussis
Objectives
The treatment objectives of pertussis are:
- To reduce transmission
- To prevent complications
Non-pharmacological treatment
- Feed frequently between coughing spasms
- Encourage adequate oral fluid intake
Pharmacological treatment
A. Patients and close contacts within 14 days of onset of symptoms
1st Line Treatment
Evidence Rating: [A]
Erythromycin, oral,
Adults: 500 mg 6 hourly for 7 days
Children:
- 8-12 years; 250-500 mg 6 hourly for 7 days
- 2-8 years; 250 mg of suspension 6 hourly for 7 days
- 6 months-2 years; 125 mg of suspension 6 hourly for 7 days
- < 6 months; not recommended (risk of pyloric stenosis). Consider Trimethoprim/ Sulphamethoxazole instead
Or
Evidence Rating: [B]
Azithromycin, oral,
- Adults: 500 mg daily for 3 days
- Children: 10 mg/kg body weight daily for 3 days
Children < 6 months: Not recommended because of a risk of pyloric stenosis).
- Consider Trimethoprim/ Sulphamethoxazole instead.
Or
Evidence Rating: [C]
Clarithromycin, oral,
Adults: 500 mg 12 hourly for 7 days
Children: 7.5 mg/kg 12 hourly for 7 days
2nd Line Treatment
Evidence Rating [C]
Trimethoprim/Sulphamethoxazole, oral,
Adults: 160/800 mg 12 hourly for 7 days
Children: 4/20 mg/kg 12 hourly for 7 days
B. Oxygen therapy when oxygen saturation <92%
Oxygen, intranasal or face mask, (if the patient has difficulty in breathing or is cyanosed)
Referral Criteria
Refer infants who have an episode of apnoea or cyanosis after initial resuscitation to a specialist.