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=_