A Unique Child: Health - A doctor's diary ... whooping cough
Dr Raj Thakkar
Friday, March 2, 2012
'Doctor, my child has an awful cough, you have to help'
Whooping cough, sometimes referred to by the medical profession as pertussis, is often considered a disease of the past. But nothing could be further from the truth.
There has been a resurgence of whooping cough over the last year and, indeed, a warning has been issued by the Health Protection Agency (HPA) to all GPs in England.
Whooping cough is a disease of the upper airways and is caused by the bacterium bordetella pertussis. Those who haven't been fully vaccinated or who were vaccinated many years ago are at particular risk of contracting whooping cough. In terms of the under-fives, the HPA considers those under three months old as being particularly vulnerable to pertussis and its complications. No age group, however, is immune from the condition.
People usually contract whooping cough by breathing in bacteria carried on microscopic water droplets. The incubation period, defined as the time between exposure to bordetella pertussis and the onset of symptoms, ranges from six to 20 days. This relatively long period may make it difficult to establish from whom the infection originated.
To make matters worse, unless the people affected have taken antibiotics, they will remain infectious for three weeks from the onset of the cough.
STAGES
The initial stage of whooping cough lasts for up to two weeks and can often mimic the common cold. The next phase of the disease is described in some texts as the paroxysmal phase because patients have intermittent bursts or paroxysms of coughing. The paroxysms don't usually last longer than a couple of minutes at a time but, nevertheless, are often distressing for both the patient and their parents or carers. The coughing may be so intense that it forces the patient to draw an intake of breath quickly, which may make a whoop-like sound.
The whoop, which may be absent in young infants, is not required to make a diagnosis of pertussis. The cough may even cause children to vomit. The paroxysmal stage may last for several weeks and can lead to complications. The waning of symptoms heralds the beginning of the recovery phase, which in itself may last several months.
COMPLICATIONS
Most children with whooping cough don't suffer complications and most complications are not serious. These include middle-ear infections, known as otitis media; bruising of the chest wall; burst blood vessels in the face and whites of the eyes; and hernias.
The younger the patient, the more severe the complication tends to be. It is important to remember, however, that severe complications are rare. But in some extremely tragic circumstances, these complications may cause death. The paroxysms of coughing may cause breathing difficulties such as choking or gagging. Some children may even have interruptions in breathing, called apnoeas.
Prolonged apnoeas can cause a child's lips and tongue to turn blue, described as cyanosis. The brain may be deprived of oxygen during paroxysms, causing a seizure or even permanent brain damage. Pneumonia can also complicate whooping cough. Permanent lung scarring, called bronchiectasis, can cause a number of problems later in life such as recurrent infections and coughing up blood. Vomiting can cause dehydration, malnutrition and weight loss.
DIAGNOSIS AND TREATMENT
Children suspected of having whooping cough should always see a doctor for further assessment. The diagnosis may be confirmed by blood tests or by swabs, and in the community or in hospital depending on the individual case.
Treatment depends on a number of factors, including the age of the child, their past medical history and how serious their current condition is. In the main, oral antibiotics are prescribed to reduce the chances of spreading the disease to others and may not be effective if started too late in the course of the illness. Additional treatment may be required, such as supplemental oxygen, intravenous fluids, intravenous antibiotics and steroids.
SPREAD
It is crucial to prevent the spread of whooping cough by isolating affected children until they are no longer infectious and by offering antibiotics, which reduce the infective period from 21 to five days. Without doubt, it is imperative to continue to vaccinate infants and children according to the national schedule. If you have any concerns, always seek medical advice.
MORE INFORMATION
Dr Raj Thakkar BSc(Hons) MBBS MRCGP MRCP(UK) is a full-time GP in Buckinghamshire.
