Whooping cough Flashcards
3-year-old boy presents with bouts of coughing ending with vomiting, these are worse at night and after feeding. Discuss your provisional diagnosis and management.
Impression
concerned about whooping cough given bouts of coughing followed by emesis.
Triad of
- paroxysms of coughing
- post-ptussive whoop
- post-ptussive emesis
ddx;
- infective: croup, bronchiolitis, pneumonia
- other: foreign body, viral induced wheeze, asthma, anaphylaxis
Whooping cough - History
History
- Catarrhal stage: 1 wk of classic URTI sx with rhinorrhoea that remains watery
- Paroxysmal: 2-8 weeks of paroxysms of coughing
- Convalescent: 1-2 wks where sx reside
- PC: characterise cough, nature of vomits, quantity, frequency, etc
- other: fevers, rigors, chills, other resp symptoms, bowel/urine changes, fluid balance, feeding, irritability, etc
- risk: close contacts, incomplete vaccinations, maternal infection, age <6 months
- pmhx, underlying lung disease
- Developmental, growth, concerns>
Whooping cough - Examination
Examination
- general obs
- vitals
- respiratory examinaiont: usually normal (may ben between coughing episodes), may hear focal crackles if pneumonia
- sub-conjunctival haemorrhage (due to intense coughing)
Whooping cough - Investigations
Investigations
largely a clinical diagnosis
otherwise
- nasopharyngeal aspirate for PCR which has high sensitivity and specificity
consider
- CXR
- Bloods: CRP, UEC, LFT, FBC, etc
Whooping cough - Management
Management
- initial assessment and acute management if HD unstable
Definitive
- azithromycin or clarithromycin if diagnosed within 3 weeks of onset of symptoms. also given as prophylaxis to close contacts at increased risk.
- notifiable disease: contact PHU
- patient should isolate
- vaccination with DTP if not already done so.
Supportive care is mainstay;
- fluids
- analgesia
- NG if ongoing poor feeding, etc - therefore consider admission
- supplemental 02 as required
