Whooping cough (pertussis): symptoms, causes and how to treat it

Definition

What is pertussis (whooping cough)?

Whooping cough or pertussis is a highly contagious cough caused by a bacterial infection Bordetella pertussis in the respiratory tract. This condition can last for 4-8 weeks so it is also known as a hundred days cough. Apart from prolonged coughing, pertussis is also accompanied by wheezing inhalations (wheezing sounds). At first the cough is mild, but gets worse and can be accompanied by several other health problems, such as nasal congestion, watery eyes, dry throat, and fever. Pertussis can be transmitted quickly among children and adolescents and has the potential to cause complications or dangerous health effects. Fortunately, you can prevent whooping cough or pertussis by giving the DPT vaccine (diphtheria, pertussis, and tetanus).

How common is this condition?

Children and toddlers are the age group most vulnerable to catching whooping cough. Especially infants aged 12 months and young children aged 1-4 years who are not vaccinated. In research published in The Lancet in 2017, there are 24.1 million cases of whooping cough per year worldwide, which generally affect children. The World Health Organization (WHO), estimates that there are at least 300,000 cases of death in children in developing countries caused by pertussis each year. However, babies who are less than 12 months old cannot get the pertussis vaccine. Therefore, she is more likely to catch whooping cough if the mother did not vaccinate during pregnancy. Although pertussis cough is more common in children, it is also possible in adults.

Signs and symptoms

What are the signs and symptoms of pertussis (whooping cough)?

The signs of health problems that mark whooping cough usually appear about 5-10 days after being infected by the bacteria. In children, the symptoms of pertussis can be more specific, such as shortness of breath when lying down or sleeping. The stages of whooping cough infection consist of three phases, each of which shows different symptoms.

1. Symptoms of phase 1 pertussis

The signs and symptoms of whooping cough in the early stages that last for 1-2 weeks are usually mild and similar to the symptoms of the common cold, such as:

• Runny / stuffy nose
• Red and watery eyes
• Fever
• Cough with phlegm

2. Symptoms of phase 2 pertussis

After more than 2-3 weeks, the signs and symptoms of whooping cough will get worse. The second phase of pertussis bacterial infection is also known as the paroxysmal phase. In this phase the cough gets more intense and sometimes can't stop for 10 minutes. This condition can recur up to 10-15 times a day. This phase can last from 1-6 weeks. In adults, during the coughing period there is an elevated breath sound (whooping) will sound clearer. The mucus production in the respiratory tract also increases and becomes thicker, making it harder for the cough to stop. The second phase of infection also poses a greater risk to the safety of babies and children. Babies can experience shortness of breath that gets worse over time. Here are other symptoms that often appear during the second phase of a bacterial infection that causes whooping cough:

• Nausea
• The face turns pale blue (usually in children) or reddens
• Feeling extreme fatigue
• Chest pain when coughing
• The wheezing sound gets higher, especially when you inhale after coughing

3. Symptoms of phase 3 pertussis

The final phase is the healing phase which generally lasts 1-3 months. The health problems experienced usually begin to improve, the frequency and duration of coughing periods begin to decrease. Even though in this phase the sufferer is no longer transmitting bacteria, they are still at risk of infection from other viruses or bacteria, which slows down the healing process. Whooping cough has no specific symptom characteristics that can distinguish it from other types of cough. Moreover, not all pertussis sufferers make a wheezing sound when coughing or when they have difficulty breathing. Therefore it is sometimes difficult to determine that a prolonged cough that you have is whooping cough.

When should I see a doctor?

The first phase of the development of pertussis cough is a time when the infection is very susceptible to infection. Even so, parents need to be very careful and not to delay medical treatment, especially when symptoms have shown the development of infection in the second phase. The reason is, the highest risk of death from pertussis occurs in this paroxysmal phase. If you suspect that your symptoms are a sign of pertussis, check with your doctor even if the cough is still mild. In addition, you should also contact your doctor immediately if you or your little one experience the following symptoms:

• Gag
• The face becomes reddish or bluish
• Difficulty breathing
• Breath getting shorter

Cause

What causes whooping cough?

Whooping cough occurs due to an infection of the respiratory tract caused by bacteria Bordetella pertussis. Pertussis is a type of cough that is very easy to pass from one person to another. Transmission of pertussis to adults can come from exposure to bacteria in the environment. Bacteria Bordetella pertussis can pass through droplets or sputum / mucus droplets that are released when an infected person coughs, sneezes, and talks. Patients who have not been given treatment are most at risk of transmitting the bacteria during the first phase, which is for 2-3 weeks the cough symptoms last. The bacteria that causes coughing enter the body through the nose, mouth or eyes. The bacterial infection that causes whooping cough then takes place on the surface of the respiratory tract, namely in the trachea and bronchi. Both are parts of the windpipe that function as channels that carry air into the lungs and into the alveoli (sacs) of the lungs. The moment after Bordetella pertussis In the respiratory tract, these bacteria begin to multiply, producing toxins that paralyze the cells responsible for clearing mucus in the walls of the lungs. As a result, there is a buildup of phlegm in the respiratory tract. During breeding, B. pertussis produce various kinds of antigenic substances as well as toxic substances such as pertussis toxin (PT), filamentous hemagglutinin (FHA), agglutinogens, adenylate cyclase, pertactin, and tracheal cytotoxin. These toxins are responsible for the inflammation and swelling that occurs in the respiratory tract. In addition, the toxins from the bacteria that cause whooping cough can also attack the immune system. As the bacterial infection gets worse, so does the amount of phlegm. As a result, the cough will be more frequent. Over time, the sufferer will find it increasingly difficult to breathe because the air circulation in the respiratory tract is increasingly obstructed due to accumulated phlegm. Air that cannot fully enter the lungs will produce a wheezing sound when the patient breathes.

Risk factors

What increases the risk for whooping cough?

Pertussis is a type of cough that is highly contagious. There are a number of conditions that can increase a person's chances of contracting this disease. People with the following conditions are more at risk of developing a cough with pertussis:

• Infants under 12 months who still cannot receive the vaccine
• People who interact closely and frequently with people with pertussis
• People with weakened immune systems, such as pregnant women, autoimmune sufferers or who are on medications that reduce the work of the immune system

Diagnosis

How is whooping cough diagnosed?

In the early stages of diagnosis, your doctor will perform a physical exam, analyze your medical history, and try to identify any health problems that mimic the symptoms of pertussis. From here, doctors can make the wrong diagnosis because in many cases the symptoms that appear are similar to the common cold or flu. Therefore, the doctor will usually start looking for a comparative analysis by asking how bad the cough is or listening to a cough to detect a wheezing sound. To get a more definite diagnosis, the doctor will usually ask you to undergo several medical tests as follows:

• Sputum or sputum test: laboratory examination to analyze mucus samples taken from the throat and nose so that bacteria can be found or not Bordetella pertussis in the body.
• Blood test: to determine the number of elements of blood cells, especially white blood cells. If the number is high, it indicates the presence of several infections.
• Chest X-ray: take an image of the inside of the chest using an X-ray to check for inflammation or fluid in the lungs.

Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How to treat whooping cough?

Treatment of pertussis should be done as soon as possible for at least the first 1-2 weeks before more serious symptoms appear. Because whooping cough or pertussis is caused by a bacterial infection, antibiotics are the right type of drug to use. According to the Centers for Disease Control and Prevention (CDC), types of antibiotics that are effectively used as drugs to eradicate bacterial infections that cause whooping cough are the macrolides, such as:

• Azithromycin
• Clarithromycin
• Erythromycin

These three antibiotic drugs for whooping cough will work effectively, especially when the infection is still in its early phase (2-3 weeks). However, these drugs are only safe to administer to patients who are 1 month old or older. The use of this pertussis drug in babies under 1 month old requires special medical treatment. It is very important to take whooping cough medicine according to the dosage given by your doctor because it is more effective at stopping bacterial infection. In addition to antibiotics, doctors usually can also provide additional drugs to treat the symptoms of whooping cough, such as corticosteroids, which can help reduce inflammation in the respiratory tract. While non-prescription cough medicine or over-the-counter (OTC) should not be used as a substitute for antibiotics for whooping cough. The reason is, non-prescription cough medicines only function to relieve coughs, pain in the throat or thin out phlegm. This drug does not work directly to kill the bacteria that cause the infection.

What are some of the home remedies for whooping cough?

Pertussis treatment can be done on an outpatient basis, especially in patients who do not show severe symptoms. Hospitalization is usually only required by children or adults who experience complications from whooping cough such as pneumonia. The recovery process can go faster if while taking whooping cough medicine, you also take supportive care as a way to cure a cough like this at home:

• Reduce strenuous activity and get plenty of rest.
• Watch for signs of dehydration. Prevent dehydration by getting enough fluids through drinking water, eating fortified foods, or drinking vitamin fruit juices.
• Adjust your meal portions to prevent vomiting after coughing. If necessary, divide your meal into smaller but frequent portions.
• Clean the air in the room by using humidifier to clean the air from dirty particles that trigger coughs such as pollution, cigarette smoke, and chemical compounds.
• Prevent disease transmission by washing your hands regularly and wearing a mask when you are with other people.

Complications

What complications might whooping cough have?

Whooping cough also has the potential to cause other, more serious health problems or complications for the sufferer. Common health problems caused by whooping cough in adults include:

• Difficulty sleeping at night or insomnia
• Difficulty breathing while sleeping
• Weight loss
• Pneumonia

Children are more susceptible to complications caused by pertussis. A persistent cough that lasts for a few minutes can cause decreased work on the lungs. The child has temporarily stopped breathing (apnea) and is in a more severe condition. If it continues, the brain can experience hypoxia, which is a lack of oxygen supply. About half of babies under 1 year old who are infected with cough pertussis are admitted to hospital due to serious respiratory complications such as pneumonia or brain dysfunction. In addition, a study from the University of Aarhus N Denmark also revealed that babies who get whooping cough are at a higher risk of developing epilepsy later in childhood. The most fatal complication is that prolonged whooping cough can result in rupture of blood vessels, causing bleeding in the brain.

Prevention

How to prevent whooping cough?

Children are the age group most susceptible to catching whooping cough and are at an increased risk of developing complications. That's why they need to get immunized to prevent whooping cough. Vaccines for whooping cough can be obtained in the basic immunization program for diphtheria, pertussis, and tetanus (DPT) or the pentavalent vaccine which also builds immunity against hepatitis, pneumonia and meningitis, namely the DPT-HB-Hib vaccine. According to the Indonesian Ministry of Health, routine immunization for diphtheria in children is usually given in 3 doses, namely when the baby is 2, 3 and 4 months old. Advanced diphtheria immunization is carried out when the child is 18 months and 6-7 years old. Whooping cough or pertussis can cause dangerous complications in children if it is not treated immediately with proper medical treatment. However, this disease is prevented by immunization to provide protection from bacterial infections that cause pertussis from an early age.