Whooping Cough Infection

Whooping Cough

• Whooping cough is a highly contagious respiratory tract infection.
• It is characterized by a severe hacking cough followed by a high-pitched intake of breath that sounds like a "whoop."
• The organism responsible for the infection is Bordetella pertussis.
• The infection is spread through droplet infection.
• Whooping cough affects mainly children under 5 years old (90%).

Clinical Features of Whooping Cough

• Catarrhal Stage: lasts for about one week, characterized by highly infectious upper respiratory catarrh, conjunctivitis, rhinitis, and unproductive cough.
• Paroxysmal Stage: characterized by severe bouts of coughing, more severe at night, with each paroxysm consisting of a succession of short sharp coughs, ending in a deep inspiration during which the characteristic whoop may be heard.
• Convalescence Stage: cough becomes less frequent, and sputum less tenacious.

Complications of Whooping Cough

• Respiratory complications:
  • Bronchopneumonia
  • Atelectasis
  • Bronchiectasis
• Other complications:
  • Convulsions
  • Conjunctival hemorrhage
  • Prolapse of rectum

Investigations of Whooping Cough

• Blood CP: WBC count is 15000-20000/uL, 60-80% of which are lymphocytes.
• Diagnosis is established by isolating the organism from a nasopharynx swab culture.

Management of Whooping Cough

• Antibiotics: Erythromycin 500 mg 6-hourly for 10 days, or Clarithromycin or Azithromycin.
• Cough suppressants: e.g., Methadone.
• Maintenance of nutrition.

Prevention of Whooping Cough

• DPT vaccination for infants.
• Erythromycin for prophylaxis in children and adults.

Diphtheria

• Diphtheria is an acute infection caused by Corynebacterium diphtheriae.
• It usually attacks the respiratory tract but may involve any mucous membrane or skin wound.
• Spread by respiratory secretions, food, or water contaminated by feces from a patient or carrier.
• Age: typically a disease of childhood, but increasingly affecting adults due to non-immunization in childhood.

Pathology of Diphtheria

• Vibrio cholerae multiply in the lumen of the small bowel and are non-invasive.
• They secrete a powerful exotoxin (enterotoxin) that activates adenylyl cyclase in intestinal epithelial cells, producing hypersecretion of water and chloride, causing massive diarrhea.
• Severe dehydration follows rapidly.

Clinical Features of Diphtheria

• Stage of evacuation: sudden onset with frequent loose motions, initially yellow, soon becoming colorless, watery, and typical "rice-water" stools.
• Stage of collapse: intense dehydration, leading to:
  • Muscular cramps due to electrolyte depletion
  • Cold, clammy, and wrinkled skin
  • Sunken eyes
  • B.P. falls
  • Pulse not palpable
  • Urine output diminished

Diagnosis of Diphtheria

• Diagnosis is usually clinical.
• Presence of rapidly motile vibrio's in fresh stool by dark-field illumination is diagnostic.
• Culture of stool or rectal swabs should be taken.

Management of Diphtheria

• Replacement of fluid and electrolytes:
  • ORS in mild cases
  • Ringer lactate 2-3 liters in the first hour, followed by normal saline one liter/hour until the pulse and blood pressure return.
• Drugs: Ciprofloxacin (Novidat) infusion IV twice daily.

Tetanus

• Tetanus is an infection caused by the bacterium Clostridium tetani.
• Spores of Clostridium tetani are present in feces of herbivorous animals and men, and therefore also found in soil.
• Any kind of damage to skin or mucous membrane may cause entrance of spores to underlying tissue.
• Spores germinate and bacilli multiply only in anaerobic conditions, which occur in areas of tissue necrosis.
• The bacteria release an exotoxin with an affinity for motor nerve endings and motor nerve cells.

Clinical Features of Tetanus

• Prodromal symptoms: non-specific, such as fever, headache, and irritability.
• Presenting symptoms:
  • Trismus: spasm of the masseter muscles, causing difficulty in opening the mouth and in masticating.
  • Rigidity: affecting the muscles of the face, neck, and trunk, producing pain and stiffness in the neck and back.
• Symptoms of established disease:
  • Rigidity: affecting the erector spinae and abdominal muscles, producing an exaggerated lumbar lordosis, neck retraction, and abdominal rigidity.
  • Muscle spasm: spasm of facial muscles, producing a typical facial appearance with raised eyebrows, tightly closed eyes, and drawing back of the lips to expose clenched teeth.

Treatment of Tetanus

• Neutralize absorbed toxin: Human tetanus antitoxin 3000 IV.
• Prevent further toxin production:
  • Debridement of the wound.
  • Benzylpenicillin 600 mg 6-hourly.
  • Metronidazole if allergic to penicillin.
• Control spasms:
  • Nurse in a quiet room.
  • Avoid unnecessary stimuli.
  • Diazepam IV if spasms continue; paralyze the patient and ventilate.
• General measures:
  • Maintain hydration and nutrition.
  • Treat secondary infections.

Prevention of Tetanus

• Active immunization: Tetanus toxoids are administered as two doses 4-6 weeks apart, with a third dose 6-12 months later, and booster doses every 10 years.
• Passive immunization: Passive immunization should be used in non-immunized persons and whenever a wound is contaminated or likely to have devitalized tissue.
• Destruction of spores: Destruction of spores in operation theatres by filtered ventilation and by use of antiseptics on floors and walls.
• Treatment of wounds: Debridement + penicillium.

Anemia

• Anemia occurs when there are not enough red blood cells or the red blood cells do not work as they should.
• Red blood cells carry oxygen throughout the body, providing energy to cells.
• Without healthy red blood cells, the body does not get the energy it needs to function.
• Left untreated, anemia can be life-threatening.

Diabetic Foot

• Foot problems are common in people with diabetes.
• They can occur over time when high blood sugar damages the nerves and blood vessels in the feet.
• Nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in the feet.
• If there is no feeling in the feet, it may not be possible to detect cuts, blisters, or ulcers.
• Wounds may not heal well due to poor blood flow, which can lead to gangrene or amputation.

Diabetic Foot Care

• Check feet every day.
• Wash feet every day.
• Ask the doctor how to remove corns and calluses safely.
• Trim toenails straight across with a clipper.
• Always wear well-fitting shoes and socks or slippers to protect the feet when walking.
• Protect feet from heat and cold.
• Keep the blood flowing in the feet.
• Get feet checked at health care visits.

Spinal Cord Disorders

• Spinal cord disorders are injuries and diseases that damage the spinal cord, which carries signals between the brain and the rest of the body.
• Damage to the spinal cord can disrupt these signals, affecting bodily functions and causing permanent disability.
• Some spinal cord disorders originate outside the spinal cord, including disorders caused by spinal injuries or compression of the spinal cord.