The diagnosis of Pertussis is made based on the history, symptoms, signs, blood tests, cultures, chest X-rays, chest examination, etc (Mayo Clinic. 2006). The condition may be easily diagnosable in children due to the characteristic whoop formation. In adults and infants the condition may be difficult to diagnose. Even in children, during the catarrhal stage, the condition may be difficult to diagnose (A. D. M. Bryceson. 1996, pp. 122). The history may demonstrate exposure of the individual to a person who had been suffering from the disease.
Blood tests conducted in children demonstrate a rise in the lymphocyte count and the leucocytes count. ELISA helps to detect the presence of negative cases. Blood tests are also conducted to demonstrate the presence of IgG and IgA antibodies in response to the presence of FHA and the Pertussis toxin. Due the acute stages of the disease, and the convalescent phase, the immunoglobulins are increased to a greater extent. Antibody studies can help to differentiate infections of B. Pertussis from B. Parapertussis (James D. Cherry.1998, pp. 1430).
However, the white blood cell counts are not raised until the disease becomes established (A. D. M. Bryceson. 1996, pp. 122). The diagnosis of Pertussis is usually confirmed through culture of the throat or nose swab to determine the presence of the bacteria. Specific antibody tests are conducted on these samples (James D. Cherry. 1998, pp. 1430). Pertussis is treated by administering an appropriate antibiotic to the infected child. Erythromycin was one of the most efficient drugs in treating Pertussis.
When administered during the initial stages of the infection, the bacteria is destroyed within the upper respiratory tract, thus preventing further complications and also reducing spread of the infection to other individuals. Children are administered the drug in does of 50 mg / kg body weight, four times a day for about 2 weeks. Adults are administered 2 grams of Erythromycin every day, for about 14 days. Individuals who are allergic to erythromycin can be administered Trimethoprim and Sulfamethoxazole combinations. In 1994, a version of B. Pertussis that was resistant to erythromycin was identified in the US (James D. Cherry. 1998, pp.1431).
Amoxicillin can also b effective in treating the symptoms of Pertussis. However, antibiotic may not seem to be so beneficial when they are administered during the later stages of the disease (David A. Kaufman. 2006). Cough suppressants such as methadone can help to reduce the severe bouts of coughing during the paroxysm period (A. D. M. Bryceson. 1996, pp. 122). In some children, episodes of cough may persist for about 6 to 8 weeks. Children should be given plenty of fluids and the fever should be controlled utilizing anti-pyretic agents. The child is at a risk of getting dehydrated due to loss of fluids through vomiting (NHS.2007).
Infants with severe infection may require hospitalization, as Pertussis can lead to ‘sudden infant death syndrome’. Their breathing should be constantly monitored, as it can stop following the cough episodes (David A. Kaufman. 2006). The use of corticosteroids in the treatment of Pertussis is a bit controversial. One study demonstrated the use of corticosteroid may be associated with a higher infant mortality rate, whilst another study demonstrated that short-term use of corticosteroids could help reduce the severity of the symptoms during the paroxysm stage (James D.Cherry. 1998, pp. 1431).
It may be very difficult to feed the child during Pertussis infection. The child is bound to become weak as the cough episodes are very exhaustive and can prevent them from consuming adequate nutrition. Children should usually be feed after the cough episode, once they vomit (A. D. M. Bryceson. 1996, pp. 122). However, if it is still difficult to feed the child, an intravenous line may be required. The outcome of Pertussis infection varies depending on the age of the child.
Compared to younger children, older ones are able to tolerate the infection better. In infants, the fatality rate is very high due to the development of serious complications. The infant is at the risk of suffering from brain damage and seizures which could result in cognitive problems, later (James D. Cherry. 1998, pp. 1431). The condition of the infant affected with the disease should be carefully be monitored. A variety of complications may occur following Pertussis infection.
In the UK, between the years 1977 and 1979, the most common complications reported included loss of weight, acute bronchitis, bronchopneumonia, bronchiectasis, frenum ulcerations, bleeding from the respiratory tract or nose, collapsed lungs, difficulty in breathing, atelectasis, seizures, infection of the middle ear, encephalitis, squint, bleeding from the nose, hemopytsis, malnutrition, encephalopathy, damage to the brain (due to decreased oxygen supply), mental retardation, drop in the oxygen levels in the blood (hypoxia), hemorrhages present below the conjunctiva, coma, death (occurs once for every 500 infantile cases), etc (James D.
Cherry. 1998, pp. 1426). In some children, the coughing may be so severe, that bleeding within the skill may develop leading to seizures, cognitive disturbances and permanent rain damage (NHS. 2007). Many children develop symptoms that could be termed as serious, requiring hospitalization (James D. Cherry. 1998, pp. 1426 and David A. Kaufman. 2006). The risk of complications is usually higher in infants and younger children, and is less in adults and teenagers.
About 67 % of all infants require hospitalization, and a smaller but significant fraction of this may require intensive care support. Fatalities usually occur following respiratory failure or pneumonia (NHS. 2007). In adults, due to excessive coughing, the muscles of the chest may get damaged, leading to hernias (Mayo Clinic. 2006).
References: A. D. M. Bryceson and C. A. Soutar. “Diseases due to Infection. ” Davidson’s Principles and Practice of Medicine. Ed. Edwards, C. R. W. , Bouchier, I. A. D. , and Chilvers, E. R. Edinburgh: Churchill Livingstone, 1996. 121-122. http://www.bmj.com/