Pertussis

Question 1

what is the pathogen in whooping cough?

Answer 1

bordetella pertussis

bacteria

Question 2

what is the main symptom of pertussis?

Answer 2

violent coughing spells

Question 3

what is the cause of the whooping cough sound?

Answer 3

swollen airways

Question 4

is bordetella pertussis gram negative or positive?

Answer 4

gram negative

Question 5

how is pertussis transmitted? (2 ways)

Answer 5

1) airborne droplets
2) touch infected surface like doorknob (can survive for days)

Question 6

how does pertussis attach to the epithelial cells?

Answer 6

it releases toxins that help the bacteria to anchor

Question 7

what do certain pertussis toxins do to the cilia of epithelial cells? what is the consequence?

Answer 7

paralyzes cilia -> mucus builds up -> trigges violent cough reflex

Question 8

what does pertussis toxin do to T cells?

Answer 8

proliferate, and blocks them from entering the tissue

Question 9

what does pertussis toxin do to histamine?

Answer 9

make vessels and tissue more sensitive to histamine -> swelling of airway

Question 10

how long is the incubation period of pertussis?

Answer 10

1 week

Question 11

what happens during incubation period of pertussis?

Answer 11

bacteria are in the respiratory system, but haven’t multiplied enough to create damage

Question 12

which phase comes after the incubation phase? what are the symptoms?

Answer 12

catarrhal phase: cough, nasal congestion, low-grade fever

(during this phase bacteria have multiplied and damaged the respiratory tract)

Question 13

how long does the catarrhal phase last?

Answer 13

2 weeks

Question 14

during which phase is a patient the most contagious?

Answer 14

catarrhal phase

Question 15

what comes after the catarrhal phase?

Answer 15

paroxysmal phase

Question 16

how long does the paroxysmal phase take?

Answer 16

1-6 weeks

Question 17

what causes the symptoms during the paroxysmal phase?

Answer 17

the damage already done by bacteria

Question 18

what is the main symptoms during the paroxysmal phase?

Answer 18

uninterrupted fit of coughing with a whooping sound

Question 19

which part of the airway is swollen that causes the whooping sound?

Answer 19

the glottis (part of the larynx that contains the vocal cords)

Question 20

what are accompanying symptoms during the paroxysmal phase?

Answer 20

vomiting, collapsed lung, broken rib, petechiae in face

Question 21

what are accompanying symptoms during the paroxysmal phase, specifically for children? (5 things)

Answer 21

• gasping
• cyanosis
• apnea
• apparent life threatening events
• decreased O2 levels

Question 22

what can be the result of decreased O2 levels in children with pertussis?

Answer 22

• seizures
• encephalopathy
• death
• increased risk of pneumonia

Question 23

what comes after the paroxysmal phase?

Answer 23

convalescent phase

Question 24

how long does the convalescent phase last?

Answer 24

2-3 weeks

Question 25

what happens during the convalescent phase

Answer 25

coughing improves, whooping fades away, airway heals

Question 26

when is it best to diagnose pertussis? why?

Answer 26

during catarrhal phase -> use antibiotics to kill bacteria and reduce damage

Question 27

how to diagnose pertussis? (2 ways)

Answer 27

nasopharynx swab -> identify bacteria in culture serology (detectable after few weeks)

Question 28

through which lab outcome can you specifically determine the severity of pertussis? (especially in children)

Answer 28

degree of lymphocytosis

Question 29

is there a vaccine for pertussis?

Answer 29

yes (in NL in DKTP = difterie kinkhoest tetanus polio)

Question 30

how effective is the vaccine for pertussis?

Answer 30

>90%

Question 31

where do you see outbreaks of pertussis? (3)

Answer 31

- countries with low access to vaccines - unvaccinated communities - elderly (less ab's -> boosters needed)

Question 32

how to treat pertussis?

Answer 32

antibiotics (macrolides like azitromycin)

Question 33

how to prevent transmission? (2) (outside vaccination)

Answer 33

isolate patient, give ab prophylaxis to household contacts

Question 34

when to vaccinate pregnant women? why?

Answer 34

in 3rd trimester -> mother creates ab's that get passed through placenta and provide baby with passive immunity for months after birth

Question 35

what are the 3 phases of pertussis?

Answer 35

- catarrhal phase: cough, contagious (2 wks) - paroxysmal phase: whooping (1-6 wks) - convalescent phase: improves (2-3wks)