Pertussis

Document Sample
Pertussis Powered By Docstoc
					          Pertussis


Kate Goheen
March 25, 2009
Weill Cornell Medical College
Class of 2010
Case Presentation
   4 m.o. male with h/o Klinefelter Syndrome, bilateral
    hip dysplasia and club feet
   CC: cough and difficulty breathing
   HPI: mild cough for one week, worsening, with one
    10-second episode of coughing and cyanosis which
    prompted mother to come to ER
   ER: mild respiratory distress, wheezing and
    retractions
     T 99.1 HR 152 RR 66 O2 sat 99%
   Plan: admit to 4B for bronchiolitis
Hospital Course
   HD#1
       Patient started on
        albuterol Q2
       One witnessed episode of
        coughing and cyanosis
        <10 seconds
       Nebs changed to racemic
        epinephrine and
        levalbuterol
       DFA and cx sent for
        pertussis
       Started on azithromycin
Hospital Course Cont’d
   HD#2
       Febrile to 101.3
       CXR showed RLL infiltrate, WBC 15.1 (N32%,
        L59%)
       Cefuroxime added
       Levalbuterol maintained Q6
   HD#4
       DFA and cultures negative
       Discharged to home on cefuroxime and
        azithromycin
What is Pertussis?

Whooping cough, “The Cough of 100 Days”
   Infants are at high risk of
   complications
Infants accounted for 92% of US pertussis deaths in 2000-2004.
      Infant Pertussis Deaths, 2000-2004


               2
         14

                                     0-1 mo
                                     2-3 mo
                                     4-6 mos
                     76




Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria
Toxoid and Acellular Pertussis Vaccine. Kretsinger, Katrina et al. MMWR Recommendations and Reports
December 15, 2006 / 55(RR17);1-33.
 Annual Reported of Cases of
 Pertussis in the US, 1922-2003




Pertussis- Not Just for Kids. Hewlett, Erik and Edwards, Kathryn. NEJM 352;12
March 24, 2005, p. 1215-1224.
Spread of Pertussis: Then vs. Now
           Why is the Incidence of
           Pertussis Increasing?




   Increased awareness and reporting
   Better tests
   Waning immunity in adults
  Immunized kids also get pertussis
Clinical Presentation of Pertussis by Vaccine Group in
Infants 6-24 Months Old
                                   DT              DTaP
            Cough (days) 61*                       29-33
            Apnea (%)    84.5*                     36-47
            Cyanosis (%) 64.9*                     21-31
            Vomiting (%)           85.6*           56-58
    *P < .001
Clinical presentation of pertussis in unvaccinated and vaccinated children in the first
six years of life. AU Tozzi AE; Rava L; Ciofi degli Atti ML; Salmaso S SO. Pediatrics
2003 Nov;112(5):1069-75.
  Pertussis is milder in immunized
  adults and adolescents
      Persistent cough can be the
       only symptom
          Whooping in 20-40%
          Post-tussive emesis in
           about half
      “Scratchy throat” in 33%
      Sweating episodes in 40-
       50% pts over 30 y.o.

      13-32% of adults with
       cough >6 days have
       serologic evidence of B.
       pertussis infection


Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria
Toxoid and Acellular Pertussis Vaccine. Kretsinger, Katrina et al. MMWR Recommendations and Reports
December 15, 2006 / 55(RR17);1-33.
  Diagnosis and Treatment
     Pertussis can only be
      recovered in first 3-4
      weeks of illness, very
      hard to culture
     Do culture and PCR
     Tx: 5 days of
      azithromycin for
      patients and contacts
Centers for Disease Control and Prevention.
Recommended antimicrobial agents for the
treatment and postexposure prophylaxis of
pertussis. 2005 CDC guidelines.
MMWR 2005; 54:10.
Vaccine Schedule:
Expanded to Adults!
   DTaP
       2, 4, 6 months
       15-18 months
       4-6 years
   Tdap
       11-12 years
       One dose between 19-
        64 (instead of Td)
       Any adult in contact
        with infant <1 y.o.
Conclusions
   Pertussis is still around!
   Infants have high
    morbidity and mortality
   Suspect pertussis in
    any patient with a
    prolonged cough, even
    if vaccinated
   Encourage parents and
    grandparents to get
    Tdap boosters
Thank you!



  Questions?
  Comments?

				
DOCUMENT INFO