Whooping Cough : Decoding The Pertussis Cough Causing Disease

What Is Whooping Cough?

Whooping cough, also known as pertussis, is a highly contagious bacterial infection of the respiratory system. The bacterium that causes this disease belongs to Bordetella pertussis and tends to secrete toxins that cause damage and irritation to the inner lining of the airways. The typical characteristic of whooping cough is its severe spasmous cough often followed by the characteristic “whoop” during inhalation as the patient tries to catch up on breath. While this whooping sound is most commonly heard in children, the infection can affect people of all ages, including teenagers, adults, and seniors.

Whooping cough is very severe, especially for vulnerable groups. Infants are the most affected group; they are below six months because, at this time, they may not have received a full course of immunization to give them immunity. Among these infants, whooping cough can easily cause pneumonia, convulsions, or even brain damage due to inadequate oxygen supply during intense episodes of coughing.

Although vaccines are available, “whooping cough outbreaks still occur”, mainly because immunity wanes over time. Immunity from the pertussis vaccine drops after five to ten years and, therefore, booster doses become needed, especially for healthcare workers, pregnant women, or anyone in close contact with infants. Additionally, any individual who is not vaccinated or has an incomplete vaccination schedule is at greater risk of infection.

The infection primarily affects the “upper respiratory tract,” meaning that there is inflammation in the trachea, or the windpipe, and bronchi, which are the big airways of the lungs. It causes a chronic and annoying cough that can last for weeks or even months. So it has been called “the 100-day cough.” The spasms can be exhausting to the patient and may interfere with work, rest, and eating, so it is an irritating illness for both the patients and caregivers. It can begin with early identification and prompt medical treatment that will help control its symptoms and prevent serious complications.

Whooping Cough Causes

The causative agent of whooping cough is the bacterium Bordetella pertussis. This pathogen selectively attacks the human respiratory system and attaches to the lining of cilia in the upper tract. It produces toxins that damage the cilia within the tract, resulting in irritation and swelling with consequent inflammation in the infected area. These effects do not allow the expulsion of mucus and debris from the body, which causes the typical severe coughing fits associated with an attack of whooping cough.

Key Contributing Factors to the Spread of Whooping Cough:

1. Respiratory Droplet Transmission: The whooping cough causative agent is transmitted between individuals by the respiratory route. While an infected person coughs, sneezes or even talks, he/she disperses tiny Bordetella pertussis in the air. Most of these droplets remain suspended in the air for a short period and are inhaled by any individual close by. This is why whooping cough easily spreads, especially in crowded or confined areas like schools, daycares, and nursing homes. Even temporary exposure to an infected person can lead to the spread of the disease; thus, early detection and isolation of cases are crucial.
2. Lack of Vaccination: The pertussis vaccine is very effective in preventing the development of whooping cough. When individuals are not vaccinated, they are exposed to much more risk than vaccinated people. This category encompasses the infants who are underage and so have not had a complete immunization schedule, while other adults will be those who missed booster doses. The imperfect cycles of vaccination usually leave small immunity gaps which facilitate easier spread of the bacteria. Most outbreaks occur within communities with lower degrees of immunization, and hence, it confirms the importance of high coverage in immunization.
3. Waning Immunity: The immunity caused by the pertussis vaccine is not permanent. It usually lasts from five to ten years after immunization. Booster doses are, therefore, recommended especially in some age groups like adolescents and adults. In the absence of booster doses, the immunity wanes, and hence a person becomes susceptible to infection. This is particularly risky in the case of health professionals and caregivers who are exposed to infants or elderly people under their care who may be more susceptible to severe complications.
4. Close Contact with Infected People: Since whooping cough is one of the most contagious diseases, it spreads rapidly among people whose interaction with each other is close. The risk of getting the disease is much higher among family members and caregivers and even those in health care if they have close contact with an infected person. Infants are usually infected by their parents, siblings, or any other family member unknowingly carrying the bacteria. Adults having mild symptoms may just not pay much importance to the cough as mere flu and not take any kind of medication or treatment, which inadvertently transmits the disease to others, particularly the defenseless groups like neonates and geriatrics.

Whooping Cough Symptoms

Whooping cough is a very contagious bacterial infection resulting from the respiratory pathogen. The symptoms may appear in stages or phases, and therefore, they may resemble those of other common infections of the respiratory tract, especially in the initial phases. More about whooping cough stages:

Catarrhal Phase or Early Stage

The early stage of whooping cough looks almost like a common cold and is easily mistaken for a mild viral infection. There is a runny nose, mild fever, sneezing, and a dry cough. These symptoms are usually very mild and come and go unnoticed, although this is the most infectious stage of the disease, and people can easily pass on the bacteria to others. This stage lasts about one to two weeks. By then, the bacterium is rapidly multiplying and can easily spread through the air when the infected person coughs or sneezes. This is the most contagious period for whooping cough. A person might be highly contaminated before the heavy coughing fits.

Paroxysmal Stage

After the cold’s initial symptoms fade, the infection enters the paroxysmal stage. This stage is the hallmark of whooping cough. This phase is marked by severe, rapid coughing spasms. After a deep breath in, a distinct “whooping” sound follows the cough. The coughing is very severe and can induce vomiting or a hitch in breathing. This stage usually lasts between 1 to 6 weeks and is most fatal when it occurs in infants and young children due to the higher cases of complications. It may become so intense that it causes sleep interruption and makes it hard to eat or take liquids. At this stage, the infection is most stubborn. Hospitalization may be needed, especially in vulnerable groups.

Convalescent Stage

Pertussis’s final stage is the convalescent or recovery stage. At this stage, coughing does start to decline. But, it is very slow. In many people, it can last for weeks, even a month, after the worst, painful episodes have passed. Even though the cough is decreasing, there could still be an exhaustion sense and a mild dry cough because the body is still recuperating. This stage, with lower immunity, peaks the risk of secondary infections like pneumonia and ear infections. One must be cautious with secondary illnesses, especially in the young, the elderly, and those with weak immune systems.

Whooping Cough Diagnosis

A proper diagnosis of whooping cough, or pertussis, is vital. It ensures timely treatment and helps limit the infection’s spread. Since the infection often starts with mild symptoms, a proper diagnosis is crucial for confirmation. There are many methods by which healthcare providers determine a diagnosis:

History and Symptom Review

The physician starts by finding out when the symptoms began, how long they lasted, and how the patient progressed from mild cold-like symptoms to terrible fits of coughing. The health provider will check for close contact with anyone diagnosed with whooping cough. This disease is very contagious. This way, the provider knows how likely this can be and thus what the next step should be in diagnosis.

Physical Examination

On physical examination, the doctor might hear some particular “whooping” sound after a patient has a coughing paroxysm. This loud noise, made during inhalation after a cough, suggests pertussis, especially in infants and young children. A full examination also checks for difficulty in breathing or even exhaustion.

Laboratory Tests

Nasal Swab A sample is obtained from the nasal area or back of the nose and throat by using a swab. This specimen is then analyzed for the presence of Bordetella pertussis, the bacterium that is known to cause whooping cough. In that case, a positive result is a diagnosis of an infection.

Also Read : What Is Throat Culture Test?

Blood Tests

Blood tests can be employed to determine the presence of antibodies against Bordetella pertussis. Antibodies indicate a recent infection. They aid in diagnosis. Blood tests are helpful in the disease’s later stages. By then, the bacteria may be in lower quantities in the respiratory tract.

Chest X-ray

In some cases, the provider might do a chest X-ray. This is to check for complications, like pneumonia, from the pertussis cough. Additionally, an X-ray may assist in trying to rule out other conditions that may be presenting with similar symptoms.

Why Diagnosis Matters:

Accurate diagnosis and early detection of whooping cough are important. They allow effective use of antibiotics. This can reduce symptoms and prevent the spread of the disease. Quickly identifying the infection can help prevent complications. This is vital for vulnerable groups like infants, older adults, and the immunocompromised.

Also Read : Coughs and Fevers – Are You Treating Or Overtreating the Symptom?

Whooping Cough Treatment

The main treatment for whooping cough is to reduce symptoms, shorten the illness, and limit its spread. Whooping cough is caused by a bacterium. So, treatment usually involves antibiotics and supportive care. Treatment for whooping cough generally involves the following:

1. Antibiotics:

Antibiotics are indeed the hallmark of treatment in whooping cough, especially when taken early in the course of illness. The most prescribed antibiotics for whooping cough are a class of antibiotics that are used to treat bacterial infections. Contact your doctor to know the correct antibiotic for you. Antibiotics of this class specifically target the Bordetella pertussis bacteria causing the infection. Antibiotics, if given early, will reduce symptoms and prevent the spread to others. However, antibiotics are less effective at the end of whooping cough, especially if severe spasms have developed.

2. Supportive Care:

Antibiotics fight bacterial infections. But, supportive care is vital. It helps manage symptoms and stabilize the patient.

• Rest and Hydration: Adequate rest, along with proper hydration, can help the body heal. Coughing is very tiring for the body, so rest will contribute to keeping energy levels up and the immune system active.
• Humidification: Applying a humidifier or vaporizer in a house can help heal sore airways, which makes the fits of coughing subside. Moist air keeps the throat and lungs moist. It avoids a dry throat and irritation that cause more coughing.
• Avoid Irritants: Irritants such as smoke, strong perfumes, dust, or cold air can worsen a cough and make the situation more unbearable. It is always essential to stay clear of irritants as much as one can to reduce the number of coughing fits.

3. Hospital Admission:

Admit serious cases to the hospital. This is vital for infants, kids under two, and the immunocompromised. Hospital treatment ensures close monitoring and other aggressive treatments.

• Oxygen Therapy: Since coughing fits are very severe for infants and young children, they could face issues with breathing. Oxygen therapy will ensure they get enough oxygen during coughing fits.
• Intravenous Fluids: If the patient is dehydrated from vomiting or coughing, we may give them IV fluids to maintain hydration.

In severe cases, some children may need mechanical ventilation or other breathing support. This is to help the most vulnerable, younger ones and prevent complications like pneumonia.

4. Prevention and Vaccination:

While treatment forms a part of the management of whooping cough, the best way to prevent this illness is through vaccination. The DTaP vaccine will be given to infants and children. It provides protection against diphtheria, tetanus, and whooping cough. The Tdap booster is recommended for both adolescents and adults. Pregnant women should take the Tdap vaccine in every pregnancy. It protects the newborn, who is most at risk of severe complications from the disease.

Also Read : Natural Remedies For Toddler Cough And Cold

Whooping Cough Prevention

Prevention is key in controlling the spread of whooping cough, especially since it is highly contagious.

Major Preventive Measures are:

Vaccination

• DTaP is administered to the child in the form of several doses starting from 2 months.
• Tdap vaccination, Tdap is utilised as a booster vaccine for teenagers and adults who often come into contact with those young children.
• The Tdap vaccine should be administered to pregnant women in every pregnancy to safeguard the infant.

Good Hygiene Practices

• Mouth and nose should be covered when coughing or sneezing.
• Regular hand washing to reduce the spread of the bacteria.

Avoid Close Contact

• Giving as much space as possible to infected people can help. It reduces the risk of passing on the infection. This is especially true for vulnerable groups, like infants and older adults.

How to Stop Whooping Cough at Night

Nighttime can be particularly raucous with whooping cough, preventing restful sleep. Some strategies for managing nighttime symptoms include:

• Elevate the Head: Sleeping with the head up can help open the airways and reduce coughing.
• A cool-mist humidifier adds moisture to the air. It may help reduce irritation in the respiratory tract.
• Honey and Warm Drinks: For kids over 1, give honey mixed with warm water or tea. It soothes an irritated throat and relaxes cough spasms.
• Avoid irritants: The room must be free from irritants such as dust, smoke, or strong smells that can trigger the cough.

Whooping Cough : When to See a Doctor

One of the most important things is to seek a doctor. This is especially true if you or a family member has symptoms of whooping cough, such as:

• Coughs for over two weeks.
• Severe cough fits, which hinder breathing or make your headache from persistent vomiting.
• An infant or young child.
• You have been in contact with a case of whooping cough.

Its symptoms start early. This allows for early diagnosis and treatment. It reduces the severity and complications of the illness.

Also Read :  Dry Cough and Its Effective Remedies

Whooping Cough : Conclusion

Whooping cough is a serious respiratory infection. It can affect anyone, but vaccination has reduced its incidence. Outbreaks still occur, so it is vital to stay alert and seek prompt treatment. Timely medical attention and prevention can manage symptoms. This reduces the public health impact.

References:

1. Pertussis. World Health Organization [Internet]. https://www.who.int/health-topics/pertussis#tab=tab_1. Accessed Nov. 10, 2024.
2. Whooping Cough (Pertussis): Symptoms, Treatment & Prevention. HealthyChildren.org[Internet]. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Whooping-Cough.aspx . Accessed Nov. 12, 2024.
3. Pertussis (whooping cough). European Centre for Disease Prevention and Control[Internet]. https://www.ecdc.europa.eu/en/pertussis-whooping-cough. Accessed Nov. 07, 2024.
4. Pertussis (whooping cough).  Department of Health and Aged Care, Australian Government[Internet]. https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough. Accessed Nov. 20, 2024.
5. Whooping Cough (Pertussis) Is on the Rise: What to Know. Yale Medicine[Internet]. https://www.yalemedicine.org/news/whooping-cough-pertussis. Accessed Nov. 23, 2024.