whooping cough

Brief description: whooping cough

• What is whooping cough exactly? A very contagious, bacterial upper respiratory tract infection.

• symptoms: barking, staccato cough with wheezing after the attacks

• Infection: via droplet infection when sneezing, coughing, talking or kissing

• Treatment: Antibiotics, inhale, drink well, spare; Risk patients such as infants should be treated in hospital.

• Vaccination: from the second month of life; must be refreshed after ten to 20 years at the latest

• Forecast: Whooping cough may persist for several weeks or months, but usually heals completely. Dangerous complications are possible especially in small children.

Whooping cough – symptoms

Whooping cough (medically: pertussis) typically occurs in three phases in children:

If you have been infected, it is very likely that you do not notice anything about whooping cough. The symptoms are in the so-called cold-like phase still unspecific and resemble – hence the name – those of a cold. Only later do you notice typical whooping cough symptoms. Classically, pertussis infection occurs in three stages, each accompanied by other symptoms.

1. cold phase (Catarrhal stage): It lasts one to two weeks. At this first stage, the whooping cough symptoms are still non-specific. They are therefore rarely interpreted correctly. Most of the complaints are considered a common cold. Whooping cough symptoms of the first stage are:

• to cough
• Sneeze
• Sore throat
• runny nose

2. Seizure stage (Convulsive stage): This stage lasts up to six weeks. It shows here the classic signs of whooping cough: spasmodic coughing fits to breathlessness (hence the Voksmund also speaks of “stick cough”). The cough attacks occur especially at night. After a seizure, the patients breathe in with a wheezing sound. It is caused by a cramping of the larynx.

A coughing attack often lasts for minutes and can be repeated up to 50 times a day. It takes place staccato-like and is therefore also called Staccato cough designated. He is often accompanied by vomiting. At least, however, many patients strangle viscous phlegm (expectoration).

At this stage of the disease, most patients also have no appetite and little or no sleep at all. Fever, on the other hand, rarely occurs.

3. Recovery stage (Stadium decrementi): This last phase of the disease lasts up to ten weeks. During this time, the coughing fits are gradually weakening, and the patients soon feel fitter again.

Whooping cough in baby and toddler

The younger a child, the more dangerous is whooping cough. In the first year of life, children have not yet established complete vaccination coverage. Therefore, whooping cough is often severe at this age. In addition, babies and toddlers can not sit up to cough better.

Another difficulty: infants often show no typical symptoms. Pertussis attacks are often not very strong and not staccato-like. Often you only notice a beeping or a flushed face. In the foreground there are often breathing pauses (apneas): the little ones stop breathing for a second. Due to the shortness of breath, the skin may partially discolor bluish (cyanosis).

Other possible complications include pneumonia, otitis and encephalitis with seizures). Unpopulated infants under six months of age, premature babies and babies of very young mothers are particularly susceptible to a severe whooping cough disease.

Whooping cough: Symptoms of comorbidities

The typical whooping cough symptoms may be accompanied by further complaints when patients develop concomitant disease. This happens in about a quarter of all patients. The reason is usually that the whooping cough is diagnosed and treated late. The bacteria have then often spread in the body. Possible comorbidities and secondary symptoms of whooping cough are:

• Middle ear and pneumonia: They arise when the whooping cough bacteria migrate up the auditory canal or down into the lung tissue.
• Rib fracture and inguinal hernia: They are caused by particularly strong coughing fits. Often, these fractures are recognized much later, when, for example, severe pain during exercise.
• heavy weight loss: This is especially true in children. Whooping cough is often associated with lack of appetite.
• incontinence: It is primarily a problem of children and the elderly. Every time you cough, a lot of pressure builds up in your body. Then, uncontrollably, some urine may go off. But incontinence is not a permanent problem. It disappears as soon as the whooping cough symptoms disappear.

Whooping cough: risk of infection and incubation period

Whooping cough is contagious, even very! Without vaccine protection, 80 to 90 percent of people who come into contact with the pertussis pathogen. Pertussis is transmitted over droplet infection: When infected people talk, cough or sneeze, tiny droplets of saliva spread in the area – within a radius of one meter. There are pertussis bacteria in these small droplets. If they reach the mucous membrane of a healthy person (eg by inhalation), this too becomes infected.

About kisses also a whooping cough infection is possible. This is also true if you use the same cutlery as a sick person.

Even if you are vaccinated against whooping cough and do not become ill yourself, you may become a carrier of the bacteria for a short time. In this way, you can pass the germs unnoticed to other people.

Whooping cough: incubation period

As with most infectious diseases, it may take some time for whooping cough to show first symptoms after infection. This so-called incubation period is about seven to 20 days with whooping cough. Those affected are contagious from the onset of the first symptoms (cold phase) and then for another five to six weeks. Exception: Treatment with antibiotics shortens the period of infection. For example, a patient is no longer infectious five days after the start of therapy.

It is best to protect yourself against whooping cough by avoiding contact with diseased persons. For diseases in the family you should pay attention to a careful hygiene.

Whooping cough in adults

Whooping cough was long considered a “childhood disease”. But he is not anymore. Increasingly, adolescents and adults are also becoming ill:

In 2008, the mean age of whooping cough patients was stated to be around 42 years. Ten years earlier, it was around 15 years old. Meanwhile, two-thirds of all whooping cough cases affect people over the age of 19! That’s because, according to medical experts, adults are often the necessary ones Forget about a booster doseAlmost all children (95 percent) are vaccinated against whooping cough during their enrollment. This vaccine must be refreshed after ten to a maximum of 20 years. If you do not, you will get pertussis at the next opportunity and you will probably get sick.

Whooping cough in adults often takes one untypical course: The symptoms are weaker, the coughing fits less strong and more continuous than attacking. The suffocation risk is low.

However, this does not make the infection any less dangerous, on the contrary: many sick adults simply consider the whooping cough to be a particularly stubborn but common cough. You therefore do not go to the doctor. Without treatment, the whooping cough germs can spread in the body. In rare cases this leads to Complications and sequelae, Often, for example, lung or otitis media as well as rib fractures are the result of whooping cough.

In addition, adults who develop pertussis are often a danger to others. They are considered a serious source of infection for infants and the elderly. In these, whooping cough can be severe and dangerous.

Whooping cough & pregnancy

A whooping cough disease during pregnancy does not endanger the child. However, severe attacks of coughing prematurely trigger labor. In addition, the infection weakens the expectant mother.

Therefore, women who want to have children should get vaccinated against whooping cough up to three months before pregnancy. If this is no longer possible, a whooping cough vaccine should definitely be made up in the first days after birth. It also means a certain protection for the baby if the mother can not get pertussis.

Pregnant women who are not vaccinated should avoid any contact with patients. If you suspect a contagion, the doctor may prescribe you an antibiotic (erythromycin) as a precautionary measure. This alleviates pertussis symptoms.

It is very unlikely that whooping cough bacteria are transmitted from an infected pregnant woman to the unborn child.

Whooping cough: causes and risk factors

The cause of whooping cough is the bacterium Bordetella pertussis, It affects the nose, throat, trachea and lungs and irritates the mucous membranes. This triggers the spasmodic coughing fits.

The bacterium also secretes various poisons. These damage on the one hand the surrounding tissue (especially the cilia of the mucous membranes in the respiratory tract). On the other hand, they weaken the immune system. As a result, the body can not defend itself sufficiently against the bacteria. The germs can multiply so undisturbed. If left untreated, whooping cough can cause serious complications and even fatal.

In addition to Bordetella pertussis, only a few related species can cause a whooping cough-like disease. This is Bordetella parapertussis and Bordetella holmesii, Most infections with these pathogens are shorter and less severe.

Whooping cough: investigations and diagnosis

To clarify the suspicion of whooping cough, the doctor will first raise the medical history (anamnesis) of the patient. He converses with the patient or – in small children – with the parents about the symptoms. Typical questions are:

• How long has the cough been?
• Is phlegm coughed off or is the cough dry?
• Do you have problems breathing after the cough attacks?
• Are there other complaints (fever, sore throat, chest pain, etc.)?

The doctor will also physically examine the patient. This includes tapping his ribcage and listening to his lungs. He also takes a look in the throat. If he presses with the spatula on the tongue, he triggers the characteristic coughing fits in whooping cough.

If the typical whooping cough symptoms (in children) are present, this facilitates the diagnosis. For confirmation, laboratory tests should be performed (see below).

Even more important are such laboratory tests when whooping cough runs untypically. This is mostly the case with babies, but also with adolescents and adults. The latter are now the most common age group among whooping cough patients.

laboratory tests

The type of laboratory tests used depends on the stage of the disease.

In the first two to three weeks after the onset of cough, an attempt is made to stop the To detect whooping cough pathogens directly, The doctor either takes a smear from the deep pharynx or sucks some bronchial mucus, which is transported upwards when coughing.

In the laboratory, the sample can be applied to a nutrient medium to culture the germs (Bacterial culture) and then determine. Alternatively, the genome of germs contained in the sample can be analyzed by polymerase chain reaction (PCR) and then identify. Even so, the whooping cough exciter – if present – can be detected.

Another possibility in addition to the direct pathogen detection is the so-called serum diagnosis, The blood serum of the patient is examined for antibodies against the whooping cough pathogens. However, this method is only possible in advanced disease stages: Only about three weeks after the onset of cough such specific antibodies are detectable.

If the doctor suspects complications or sequelae of whooping cough (such as otitis media or pneumonia), appropriate further investigations are necessary.

Whooping cough is notifiable

Since 2013, there is a reporting obligation for whooping cough in Germany: If suspected whooping cough and proven disease, the doctor must give the name of the patient at the relevant health department. Death by pertussis must also be reported.

Whooping cough: treatment

As with other diseases, pertussis also applies: therapy and healing depend on the stage and the severity of the disease.

Whooping cough therapy in children

Whooping cough in children can usually be treated at home if the disease is mild. In severe cases, treatment in the hospital is advisable. The same applies if a child has pre-existing conditions in the heart or lungs.

Infants with whooping cough should always be treated in hospital. In the clinic the bronchial mucus can be sucked off – babies are not able to cough up the mucus. In addition, action can be taken quickly and professionally if respiratory distress threatens or occurs.

Sick children should generally receive a lot of attention and affection. Strict bed rest is not necessary for whooping cough. It is enough, yourself to protect physically, Walks in the fresh air and quiet games are allowed and can even do good. But watch out for one low-stimulus environment.

Soothe the child with cough attacks. It can also be helpful to set it up or carry it around. Inhale Over a bowl of hot water and sea salt can relieve discomfort in older children. For infants, there are inhalers in the pharmacy that they can not scald with.

Warm chest wraps Also, with lemon juice at bedtime, whooping cough symptoms can also ease a bit.

The room air should not be too dry. For example, you can breathe regularly or hang damp cloths over the heater. That increases the humidity.

The patients should drink enough, Prepare prefer liquid or pulpy foods to. There are several small meals spread throughout the day more advisable than a few great dishes. For children with whooping cough are prone to gagging and vomiting.

Make sure your child does not meet other children or the elderly during the period of infection. These are particularly susceptible to infection as well as possible severe courses and complications.

antibiotics can relieve the duration and severity of coughing attacks in whooping cough. However, this only works if they are given as early as possible, that is: before or in the first one to two weeks after the onset of cough.

Under certain circumstances, however, antibiotic treatment may still be useful: the symptoms can hardly be influenced. However, you can use antibiotics to break the chain of infection: About five days after receipt of patients are no longer contagious. You may then visit again community facilities such as school and kindergarten.

Examples of antibiotics used are erythromycin and clarithromycin. Depending on the active ingredient, they are taken for a few days to two weeks.

Cough Syrup Helps with whooping cough usually little or not at all. If the formed mucus in the bronchi is very tough, sometimes can expectorant medication help.

Whooping cough therapy in adults

Pertussis in adults is treated similarly to children. Antibiotics are given preferentially in early disease stages. In later stages, they serve to reduce the risk of infection for other people. This is especially important in adolescent and adult patients. It is often they who infect babies. And for those whooping cough can be life threatening.

In addition to antibiotics, general measures support the treatment of whooping cough. These include, for example, inhalations, chest wraps, adequate hydration and moisturized room air.

Employees of community facilities (such as teachers, educators, nurses, etc.) may not return to work until the attending physician permits. Only he can judge whether or not the patient can transmit pertussis pathogens to others.

Whooping cough vaccination

Before whooping cough you can protect yourself with a vaccine. The whooping cough vaccine is recommended in early childhood. It can be administered from the second month of life. Regular booster vaccinations keep the vaccine against whooping cough, even in adulthood. Especially the following groups of people should be vaccinated against whooping cough:

• Women of childbearing age
• close contact persons of pregnant women in the same household and caregivers (eg child minders, parents, siblings) preferably four weeks before the birth of the child
• Caring parents of a whooping cough sick child
• Employees in the health service as well as in community facilities

Read more in the article whooping cough – vaccination.

Whooping cough: course and prognosis

Whooping cough may last for weeks to months. In some patients, the disease is relatively mild, while others are severe. As a rule, pertussis heals completely without permanent damage.

However, about every fourth whooping cough patient develops complications. These include especially pneumonia and otitis media. Children are more affected than adults.

Especially for infants under six months, whooping cough can be very dangerous. Breathing can cause a significant lack of oxygen, which damages the brain. Possible consequences include permanent damage such as paralysis, visual or hearing impairment and mental disorders. Very rarely, the little patients even die. That’s why infants should be with whooping cough as a precaution, always be treated in hospital.

Additional information

guidelines:

Guideline “Diagnosis and Therapy of Adult Patients with Acute and Chronic Cough” of the German Society for Pulmonology and Respiratory Medicine (2010)