Transcript 07 Strouse

Jill M. Strause, RN BSN OCN
Nursing 870
Pennsylvania State University
 Whooping Cough or 100 day cough
 Acute and infectious
 Highly contagious respiratory disease
 Uncontrollable, encumbering cough  difficulty breathing
 Caused by the bacteria Bordetella pertussis
 PREVENTABLE!!
(Center for Disease Control and Prevention, 2015b)
 Causative agent of pertussis
 Gram negative bacterium
 Aerobic coccobacillus
 Encapsulated
 Multiple antigenic and biologically
active products
 Incubation is 6-10 days
(Center for Disease Control and Prevention,
2015h)
(Pertussis bacteria picture, 2016)
How
Bordetella
pertussis
Invades
• Primarily a toxin-mediated disease
• Bacteria attach to cilia of respiratory epithelial cells
• Produce toxins  paralyzing the cilia
• Causing inflammation of the respiratory tract
• Inflammation interferes with the clearing of pulmonary secretions
• Eliciting paroxysmal coughing that often ends in a characteristic
inspiratory gasp (whoop)
(Center for Disease Control and Prevention, 2015h)
(Pertussis, 2016)
Airborne droplets
Direct contact with
infected individual
Coughing & sneezing are
the most common modes
of transmission
COVER YOUR COUGH!!
 Symptoms usually present 5
to 10 days after exposure
 Possibly as far out as 3
weeks
 Insidious onset
 Initial s/s indistinguishable
from minor URI’s.
 Cough is initially intermittent
and becomes progressively
worse
 3 stages: catarrhal,
paroxysmal, & convalescent
(Pertussis, 2016)
(Center for Disease Control and Prevention, 2015g)
 Catarrhal phase characteristics:
̴ Coryza  inflamed mucous membranes of the nasal cavity
̴ Low-grade fever
̴ Mild, occasional cough (which gradually becomes more severe)
 Paroxysmal phase characteristics:
̴ Paroxysmal coughing attacks
̴ Long aspiratory effort w/ high-pitched "whoop" at the end
̴ Cyanosis
̴ Exhaustion and vomiting
 Convalescent phase characteristics:
̴ Less persistent, paroxysmal coughs
̴ Gradual recovery
(Center for Disease Control and Prevention, 2015g)
(Center for Disease Control and Prevention, 2015d)
Nasopharyngeal (NP)
swab or aspirate for
culture and sensitivity
Polymerase Chain
Reaction (PCR)
Serologic assay
(Center for Disease Control and Prevention, 2015f)
Differential Diagnoses
 Asthma
 GERD
 Postnasal drip syndrome
 Pneumonia
 Interstitial lung disease
 COPD
Red Flags
 Sudden onset with SOB
 Relentless progression
 Recent travel outside of the
U.S.
(Goroll & Mulley, 2014)
VACCINATE!!
(Pertussis vaccine, 2016)
(Center for Disease Control and Prevention, 2015c)
Age
No. of Cases
%
Age Incident
/100,000
< 6 mos
3,330
(10.1)
169.0
6-11 mos
875
(2.7)
44.4
1-6 yrs
6,082
(18.5)
25.1
7-10 yrs
5,576
(16.9)
34.0
11-19 yrs
11,159
(33.8)
29.6
20+ yrs
5,839
(17.7)
2.2
Unknown
110
(0.3)
N/A
Total
32,971
(100.0)
10.4
 2014: 32,971
 PA: 6.4 incidence/100,000
 PA: 813 cases
 Highest incidence: Montana with
48.7
 Highest # cases: California with
8,723
 Last peak yr. 2012: 48,277
Age
Deaths
< 3 mos
8
3-11 mos
1
1-4 yrs
2
55+ yrs
2
Total
13
(Center for Disease Control and Prevention, 2015a)
(Center for Disease Control and Prevention, 2015c)
 Early detection
 Post-exposure antimicrobial prophylaxis:
Azithromycin
Clarithromycin
Erythromycin
Trimethoprim-sulfamethoxazole
(Center for Disease Control and Prevention, 2015e)
Treatment of Pertussis:
 Azithromycin
 Clarithromycin
 Erythromycin
 Trimethoprim-sulfamethoxazole
 Symptom support/control
Considerations to Treatment:
 Potential adverse events and drug
interactions
 Tolerability
 Ease of adherence / compliance
 Cost
(Center for Disease Control and Prevention, 2015e)
 Natural Immunity
 Secondary infections – 23% get pneumonia
 Death
(Center for Disease Control and Prevention, 2015e)
Alnotes - Pertussis. (2016). Retrieved from https://ainotes.wikispaces.com/Pertussis
Center for Disease Control and Prevention. (2015a). cdc.gov. Retrieved from
http://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2014.pdf
Center for Disease Control and Prevention. (2015b). Pertusis: Whooping cough: Fast facts. Retrieved
from http://www.cdc.gov/pertussis/fast-facts.html
Center for Disease Control and Prevention. (2015c). Pertussis: Surveillance case reporting and trend
definition. Retrieved from http://www.cdc.gov/pertussis/surv-reporting.html
Centers for Disease Control and Prevention. (2015d). Pertussis. Retrieved from
http://www.cdc.gov/pertussis/about/signs-symptoms.html
Center for Disease Control and Prevention. (2015e). Treatment. Retrieved from
http://www.cdc.gov/pertussis/clinical/treatment.html
Center for Disease Control and Prevention. (2015f). Diagnostic testing. Retrieved from
http://www.cdc.gov/pertussis/clinical/diagnostic-testing/index.html
Center for Disease Control and Prevention. (2015g). Clinical features. Retrieved from
http://www.cdc.gov/pertussis/clinical/features.html
Center for Disease Control and Prevention. (2015h). Disease specifics. Retrieved from
http://www.cdc.gov/pertussis/clinical/disease-specifics.html
Frank, R. (2016). Child care today - A report on whooping cough or pertussis. Retrieved from
http://www.cdc.gov/pertussis/about/signs-symptoms.html
Goroll, A. & Mulley, A. (2014). Primary Care Medicine: Office evaluation and management of the adult
patient (7th ed.). Philadeplphia, Pennsylvania: Wolters Kluwer Health.
Pertussis. (2016). Retrieved from
https://www.google.com/search?q=pertussis&biw=1242&bih=565&source=lnms&tbm=isch&sa
=X&ved=0ahUKEwjmvI76mtTKAhVM7GMKHYRYDVcQ_AUICCgD#imgrc=_
Pertusis bacteria picture. (2016). Retrieved from google.com:
https://www.google.com/search?q=pertussis+bacteria+picture&biw=1242&bih=565&source=ln
ms&tbm=isch&sa=X&ved=0ahUKEwietMfXvdTKAhUH1mMKHe42C_0Q_AUIBigB#imgrc=_
Pertussis vaccine. (2016). Retrieved from
https://www.google.com/search?q=pertussis&biw=1242&bih=565&source=lnms&tbm=isch&sa
=X&ved=0ahUKEwjmvI76mtTKAhVM7GMKHYRYDVcQ_AUICCgD#tbm=isch&q=pertussis+vaccine
&imgrc=_