Whooping cough

Whooping coughWHOOPING cough is an acute infectious disease related to respiratory anthroponoses; characterized by bouts of spasmodic coughing. Occurs mainly in children of early and preschool age. Etiology, pathogenesis. Pathogen - small, ovoid, gram-negative Bacillus that is unstable in the environment. Entrance gate infection - upper respiratory tract, where and vegetates pertussis wand. Formed by the toxin causes irritation to the mucous membranes of the respiratory tract and has a General effect mainly on the nervous system, resulting in developing spastic component (spastic condition of the diaphragm and other respiratory muscles, bronchospasm, the tendency to spasm of peripheral vessels), and in young children - sometimes clinico-tonic spasms of skeletal muscles. In severe forms there is hypoxia. In the pathogenesis of pertussis play a role in allergic mechanisms. The symptoms for. The incubation period is 3 to 15 days (usually 5-7 days). Catarrhal period is small or moderate fever and cough, gradually increasing in frequency and intensity. This period lasts from several days to 2 weeks. The transition in spastic period occurs gradually. Appear bouts of spasmodic or convulsive, cough, characterized by a series of short kas-left aftershocks and subsequent inhalation, which is accompanied with a long a sound (Reprise). There is a new series of coughing aftershocks. This can be repeated several times. At the end of the attack (especially if severe) observed vomiting. Within days of the attacks, depending on the severity of the disease are repeated 20 to 30 times or more. The face becomes puffy, the skin and conjunctiva of the eyes sometimes appear hemorrhage, on the frenulum is formed sore. In severe altitude attack can occur clonic or clinico-tonic convulsions, and the children of the first year of life - stop breathing. In the study of blood revealed leukocytosis (up to 20 - 70 ? 10% or more), lymphocytosis; ESR in the absence of complications normal or reduced. This period lasts 1-5 weeks or more. In the period of resolution, lasting 1-3 weeks, cough loses convulsive character, gradually get rid of all symptoms. Depending on the frequency of the cough attacks and the severity of other symptoms distinguish between mild, moderate and severe pertussis. Observed and deleted forms of pertussis, in which the spastic nature of the cough is not expressed. This form is observed in children who received a vaccination, and adults. Complications: pneumonia (development involving bacterial microflora), atelectasis of the lung, mediastinal emphysema and subcutaneous tissue, and other encefalopatia Difficulties in detection occur mainly when worn form. Must be differentiated from acute respiratory infections, bronchitis. Confirmation of the diagnosis is the allocation of pertussis bacilli of tracheobronchial secretions; for retrospective diagnosis in later periods using serological methods (agglutination reaction, RAC, rnga). The treatment is carried out at home. Hospitalized children with severe forms of the disease, with complications and epidemiological evidence. Recommended for a long stay patient in the fresh air. Young children with severe and moderate forms of the disease or the presence of complications prescribe antibiotics: erythromycin 5-10 mg/kg on admission 3-4 times a day; ampicillin pearlsnow/M25-50 mg/(kg-day) 4 admission, treatment of 8 - 10 days. Also nominated tetracycline 30-40 mg/(kg ? day) for 10-12 days. In severe cases, apply a combination of two antibiotics. In the early stages of the disease effective whooping cough booster gamma globulin (3-6 ml daily for 3 consecutive days). In severe and complicated forms of pertussis apply prednisolone. In order to alleviate spastic phenomena and cough attacks prescribed neuroleptic drugs-aminazin, propazine. During hypoxia shows the oxygen, apnea-long-term artificial ventilation of the lungs. When prolonged reparation prescribed stimulant therapy (plasma, injection of immunoglobulin, physiotherapy, vitamins). The forecast. For children in the first year of life, especially when complications occur, whooping cough is a dangerous disease. Prognosis worsens in the presence of concomitant diseases (rickets and others). Prevention. Immunization with DTP vaccine (see "immunization schedule"). In children during the first years of life in contact with the patient recommend specific gamma-globulin (3 ml twice with an interval of 1 day). Isolation of the patient continues for 30 days after onset of the disease. For children under 7 years of age who were in contact with patients who were not previously ill with whooping cough and unvaccinated, imposed quarantine for a period of 14 days from the date of isolation of the patient. If the insulation is not carried out, this period is extended to 25 days from the day of disease. Final disinfection is not possible..

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