ICD-10-pertussis code
A37.0 Whooping cough with Bordetella pertussis
A37.1 Whooping cough with Bordetella parapertussis
A37.8 Whooping cough due to other Bordetella species
A37.9 Whooping cough, unspecified

Whooping cough (also called pertussis, popularly Stick cough) is a bacterium by Bordetella pertussis, Bordetella parapertussis rarely triggered by highly contagious infectious disease. After an initial stage of nonspecific runs it regularly for several weeks. After an uncharacteristic start erkältungsartigem cough, the stage catarrhale called, joined the stage convulsive typical seizure-like attacks on stakkatoartige cough. In infants, the cough may be atypical seizures as respiratory arrest, and thus express life lost. Finally, the coughing attacks in number and severity of the stage decrement gradually. A causal therapy is only possible in the early stages. For prophylaxis, there is a generally recommended effective vaccination. In Some parts of the world there is a reporting obligation in the event of death.

Excitation

Bordetella pertussis, the agent of whooping cough, is an immovable, aerobic, gram-negative rods but bekapseltes bacterium. It produces many different protein substances which partly as toxins cause the disease symptoms, partly responsible for this are that the pathogen in the gut mucosa of the respiratory tract are attached and there proliferate (virulence). Infection with Bordetella parapertussis leads only to less than one fifth of the cases to the clinical picture of whooping cough 40% of the infections run silent and another 40% as simple bronchitis.

Epidemiology

The only pathogen reservoir for Bordetella pertussis is the man. Through a systematic coverage of human disease could be eradicated in principle. Bordetella parapertussis is also used in sheep as a reservoir found. Despite effective vaccines diseased 2003 worldwide approximately 17 million people in whooping cough, 90% of them in developing countries. Deaths were in the same year about 280,000 can be reported. In the year 2004, the frequency (incidence) at 12.3 illnesses per 100,000 inhabitants, ten years earlier there were 3.4 cases per 100,000 population. In the GDR, there was a vaccination. After the reunification of Some parts of the world, the immunization rates declined accordingly.

The transmission occurs through large droplet ausgehustete in close contact. The Bordetellen have an extraordinarily high infectivity. 80-100% of the persons who are the agents comes in contact, ill. The incubation period is 7-14 (to 21) days. The infection starts at the end of the incubation period is during the stage catarrhale highest in stage and sound convulsive gradually. It should be noted that no vaccine or the disease through a life-long immunity guarantee. In countries with high immunization favored ill adolescents and adults. They play as vectors of pathogens play an important role.

Symptoms

The disease typically passes through three stages: stage catarrhale, convulsive stage and stage decrement. In the newborn and infant age as well as in adolescents and adults also atypical histories before.

Stage catarrhale

The disease begins with nonspecific flu-like symptoms with colds and coughs untypical. Fever may occur. The duration is approximately 1-2 weeks.

Stage convulsive

Only in the second stage, the typical sudden onset of coughing attacks stakkatoartige with herausgestreckter tongue. The seizures close with a cheer at the next inhalation (“Reprise”), from. Vitreous Hochwürgen of mucus often accompanies attacks and vomiting accompanied. You can be very numerous, are piling up in the night and can be selected by external events such as physical exertion trigger. The convulsive stage lasts 2-6 weeks.

Stage decrement

In the last stage, the coughing attacks start slowly in number and severity of ultimately from. It will take again about 3-6 weeks without antibiotic therapy including 6-10 weeks.

Atypical histories

In infants under six months is the stage convulsive not with the typical coughing attacks. Rather, the attacks may be exclusively in the form of respiratory standstill (apneas) express. Even among adolescents and adults the disease is often not recognized clinically, because it except for a persistent dry cough have no symptoms.

Complications

The most common complications are pneumonia (15-20%) and a middle ear inflammation caused by a secondary infection with Haemophilus influenzae or pneumococcus causes. Secondary infections are at a fever rise and rise of signs of inflammation in the blood recognizes. Seizures are also at about 2 a.m. to 4 p.m. an unusual complication. After all, occurs in 0.5% of the brain damage (Encephalopathy), which is often permanent damage behind. The exact cause is still unclear. Due to the strong cough caused Einblutungen hides the binding in the eyes and navel bars or breaks can sometimes occur. One of 1000 patients died of the disease, mostly young infants.

Diagnosis

The diagnosis is made because of clinical suspicion is often only at the stage convulsive asked. A pathogen detection to confirm the diagnosis is made from the secretions of the nose and throat area is possible in principle. It must however be noted that the Bordetella bacteria are very sensitive to desiccation and cold are. This can reduce the sensitivity (sensitivity, hit rate) limit. Therefore, the specificity (percentage of healthy individuals, where the investigation is negative) at 100%. The Anzüchtung of B. pertussis also takes at least three of the B. parapertussis two days. A rapid diagnosis can be achieved by the detection of pathogen-specific genetic material (DNA) using the polymerase chain reaction (PCR) to reach. Since this method has very few germs can be positive and even dead bacteria, for example, after initiation of treatment with an antibiotic cover, the PCR is also very sensitive, but also complex and expensive as the pathogen growth. Specific antibodies against B. pertussis appear earliest at the beginning of the stage convulsive in serum. It is a blood test for early diagnosis is not suitable. When pertussis is also typical changes in blood with an increase in the total number of white blood cells (leukocytosis), from the relatively lymphocytes are particularly affected (relative lymphocytosis). These blood changes occur in approximately 20 to 80% of patients also only at the stage convulsive on.

Differential Diagnosis

In stage catarrhale come to the delimitation against all pathogens of a pertussis infection of the upper airway, such as rhinovirus or para-influenza viruses in question. Except Bordetellen can also RSV, adenoviruses, Moraxella catarrhalis, mycoplasma pneumonia, or Chlamydia pneumonia, a pertussis-like illness cause. In infants also Chlamydia trachomatis as a possible pathogen in question. In adolescents and adults should be in every chronic cough, the suspicion of whooping cough can manage, of course, a number of other infectious and non-differential diagnoses to be considered. These include tuberculosis, a bronchial asthma, chronic obstructive pulmonary disease (COPD), and foreign bodies in the respiratory tract or tumors.

Therapy

Since the typical coughing attacks mainly by the bacteria formed by the toxins caused by a treatment with an antibiotic the disease only shorten or mitigate, if it already at the stage catarrhale (1-2 week) or at least in the early stages convulsive administration. Nevertheless, even with a late diagnosis with erythromycin or another antibiotic from the chemical group of the macrolides for two weeks in high dose treatment, the infection chain to break. Secondary infections may necessitate adequate treatment with another antibiotic is necessary. The frequency and severity of coughing attacks may be possible through the use of steroids or substances that stimulate the sympathetic nervous system (sympathomimetics) will be favorably influenced. However, dosage, duration and type of application have not yet been reliably clarified. Major General measures are a poor environment attractive, ample fluid intake and frequent small meals.

Prevention

Vaccination

For primary prophylaxis exists an effective (protection rate of 80-90%) and well-tolerated vaccine. Today, acellular vaccines, which are much better, tolerated than the previously used Ganzkeimimpfstoffe. They no longer contain the entire germ, but only those elements of the pathogen, the immune response in the body of the vaccinated child’s cause. The Permanent Impfkommission at the Robert Koch Institute recommends three vaccinations in the first year of life, beginning in the 9th Weeks and a booster between 12 and 15 Month of life (primary immunization). In addition to children with 5 a.m. to 6 p.m. years and adolescents between 9 and 18 Birthday routinely a booster against whooping cough will receive. If they are in infancy or not yet sufficiently been vaccinated, the basic immunization also is replaced. Vaccination within one to three days, such as painful swelling and redness at the injection site, as well as an increase in temperature can occur. They are an expression of the normal division of the body with the vaccine. Flu-like symptoms or Gastro-intestinal complaints occur occasionally. In some exceptional cases, screaming babies and young children in response to the shrill and persistent vaccination. Adults have occasionally after vaccination Muskelkater similar complaints and muscle swelling. Hypersensitivity reactions are very rare to observe. Other side effects such as convulsions, which may accompany a fever may occur, are rare and have no consequences. Antipyretic drugs in children may be leading to febrile reactions tend to significantly reduce these side effects. Since the introduction of acellular vaccines, the number of vaccinations against whooping cough is increasing but is still not enough. There are combination vaccines are used simultaneously against pertussis, tetanus, diphtheria, and, if necessary, to protect against polio. A passive immunization with antibodies against pertussis bacteria to protect people, who had contact with patients, has proven to be not effective and is no longer in commerce.

Chemo prophylaxis

After close contact with persons of keuchhustenempfänglichen pertussis ansteckungsfähigen patients is antibiotic treatment in the same way as in the case of illness to prevent the outbreak of the disease make sense. With only fleeting contact or question is an accurate observation is sufficient. On the occurrence of cough symptoms should immediately undertake a study on pertussis pathogen and antibiotic treatment initiated.

Isolation

Patients are still up 5 to 7 days after initiation of antibiotic therapy and should ansteckungsfähig for this period will be isolated. Without proper treatment, the infection ability far to enter into the stage convulsive exists. Therefore, such patients visit again only four to six weeks after the diagnosis of community facilities. It may be in these patients the ability to further infection before re-admission to a community clinic by an Erregeranzüchtung investigated.

History

First descriptions of whooping cough are the French physician Gallium de Baillou ascribed and dated from the 16th Century. He limited the tussus quinta (Latin fifth cough), inter alia, from Krupp cough. A century later dealt with other doctors, the famous English physician Thomas Sydenham under the name of pertussis with pertussis. Only in the context of large epidemics in the 18th Century, the whooping cough as an independent clinical picture defined. There followed a century of purely clinical descriptions until 1906 The Belgian bacteriologist Jules Bordet, together with his colleagues Octave Gengou later named after him whooping cough could isolate pathogens. This paved it last but not least; the way to a 1933 first introduced vaccination.