Whooping cough: clinical picture, diagnosis, treatment. Blood test for whooping cough antibodies

Translated from French, whooping cough means “crow of a cock.” Children make a similar sound during a coughing attack - the main symptom of this disease. It is a long-lasting cough with good health that forces parents to consult a pediatrician.

How does whooping cough manifest?

Due to infection of the body with the whooping cough bacillus (its other name is the Bordet-Gingou bacillus, named after the authors who studied its properties). The stick is transmitted from a patient with whooping cough by airborne droplets. Preschool children are very susceptible to this disease, especially in the autumn-winter period.

Children under one year of age are at greater risk of getting whooping cough than others. The fact is that the child does not yet have his own antibodies, and with the mother’s milk, even if she has immunity, it is not transmitted. At this age, whooping cough is very dangerous. It is difficult. Before the whooping cough vaccine was invented, the mortality rate for children under 1 year of age was 50-60%.

Getting with microscopic droplets of saliva and mucus on the membrane of the upper respiratory tract to a healthy child, the infection penetrates the mucous membrane, penetrates the blood and then spreads throughout the body, while actively multiplying.

The first symptom of whooping cough is a high body temperature and a severe attack of spasmodic cough, which ends with a characteristic wheezing inhalation. But the last symptom appears only a week after the person became infected. So during this time, a patient with whooping cough manages to infect his loved ones. So, the first thing parents should remember is that the baby is contagious to others one week before the cough appears and three weeks after.

How is whooping cough diagnosed?

The first manifestations of whooping cough in a child: malaise, refusal to eat, slight runny nose and dry cough, temperature rises to 39 C (usually in the evening, and by morning it becomes normal). The cough gets worse over the days, occurs in attacks and eventually turns into a convulsive cough. The pertussis bacillus secretes a specific toxin. It affects the nerve endings, blocks them, and as a result, impulses enter the cough nerve center. They cause the manifestation of this type of cough.

If neighboring nerve centers are involved in the process, vomiting may occur. At night, the frequency of coughing attacks increases; he doesn't let the baby sleep. During an attack, the sick baby cannot breathe in air, and as soon as he does this, the cough begins again. Such an attack can last 4-5 minutes and repeat, depending on the severity of the disease, up to 20 times a day. As convulsive narrowing of the glottis occurs, the child develops noisy breathing. Sputum with whooping cough is viscous and sticky, coughing up is difficult.

After the coughing fit finally subsides, the child may complain of chest and abdominal tenderness. Most sick children experience coughing attacks for one and a half to two weeks, in rare cases they last up to 2 months. At the same time, they undergo certain changes: at the beginning the disease is severe, but gradually becomes easier and appears less and less often until it completely disappears.

Complications of whooping cough

Whooping cough is dangerous due to complications. This disease is accompanied by others, no less severe, such as pneumonia and encephalopathy. And, of course, the main difficulty is to immediately identify the disease and not confuse whooping cough with other diseases of the upper respiratory tract. The methods of their treatment are completely different, and if treated incorrectly due to erroneous or untimely diagnosis, it can only harm the patient. It is possible to confirm that the baby really has whooping cough only after laboratory tests - if the whooping cough bacillus is detected.

Of course, it is almost impossible to diagnose whooping cough from the first day of illness. Children are treated for a long time for acute respiratory viral infections, bronchitis, and tracheitis. But conventional remedies don't help. A lingering cough forces parents to consult doctors again and again. And only here, after a thorough interview with the parents, does the pediatrician suspect whooping cough. During the examination, the doctor will definitely try to provoke an attack in order to listen to the child cough. These points are decisive in making the correct diagnosis. If the baby has an erased, that is, mildly expressed form of the disease, laboratory examination methods come to the rescue. This is a study of mucus from the back of the throat to detect Bordet-Gengou bacillus and blood sampling from a vein to detect antibodies to whooping cough.

Treatment and prevention of whooping cough

If you suspect whooping cough in a child or adult, call a doctor at home. He will determine whether to leave the “suspect” at home or send him to a hospital. Treatment is with antibiotics. To ease cough attacks and spasms, antitussives and mild sedatives are prescribed. If the disease can be detected at an early stage, anti-pertussis gamma globulin is prescribed. And, of course, you can’t do without vitamin therapy and physiotherapeutic procedures. A child with whooping cough needs as much fresh air as possible.

Therefore, during treatment he should be in a well-ventilated area. Be sure to stay in bed during the period when the temperature rises. Meals should be fractional (small portions, but often), varied and complete. Dishes are easier to digest in the digestive tract of a sick baby in liquid, semi-liquid, or mashed form.

The only preventive measure today is vaccination, in other words, DTP vaccination. It is done in the first year of a child’s life. Therefore, a reasonable decision for parents is not to refuse immunization. The vaccine is given only to healthy children, without any symptoms of disease: runny nose, fever. Those babies who do get sick with whooping cough acquire lasting immunity, as a rule, for life.

Traditional medicine in the treatment of whooping cough:

• If you have a strong cough, you can use pork fat mixed with garlic to rub your chest. To prepare this product, you need to take 1 part of garlic, crushed to a pasty state, and 2 parts of pork fat, mix thoroughly. Rub the resulting mass onto the child’s chest once a day, preferably in the evening, before bedtime; After rubbing, wrap the chest well.

• An infusion prepared from the following collection will help to liquefy viscous sputum and thereby make it easier for the child to cough: leaves of stinging nettle (1 part), leaves of coltsfoot (1 part), leaves of great plantain (1 part). To prepare the infusion, you should take 1 tablespoon of this dry mixture, pour 200 ml of cold water over the raw material, leave for 2 hours, then bring to a boil once, let cool and strain. Drink the infusion in 4 doses throughout the day.

Whooping cough in children is one of the most dangerous and protracted infections. Currently occurs sporadically. The disease poses a danger to weakened children, who may suffer from airway obstruction. Typical symptoms and signs allow parents to promptly seek help from a pediatrician. Moreover, timely treatment of whooping cough in children leads to complete recovery.

Modern diagnostics using a special analysis can detect infection at various stages. Active prevention of infection through vaccinations has also been developed. All these issues are discussed in detail in this article.

Etiology of the disease and causative agent of whooping cough

The etiology of the disease is always infectious. The known causative agent of whooping cough is the pertussis bacillus, which has good resistance in the external environment. The clinical picture was first described in the fifteenth century. Not only the respiratory system is affected, but also the central nervous system, and the regulation of the breathing process is disrupted. A characteristic symptom is a paroxysmal cough, which is difficult to relieve with standard mucolytic and antitussive drugs.

The causative agent of whooping cough, Bordetella pertussis, has the ability to feed on hemoglobin. It is a rod with a length of up to 2 microns, it is immobile and is sown on human blood added to glycerin agar. When sown it gives very slow growth. Bacterial laboratory diagnostics takes at least 5 days. Suppression of the growth of accompanying bacterial flora by spraying penicillins is required. This group of antibiotics has no effect on whooping cough bacillus. After the end of the growth period in Petri dishes, it forms round colonies that resemble droplets or balls of mercury in appearance.

The route of transmission in the external environment is airborne. The source of infection is a ball child. Patients are most at risk in the first and second weeks of illness. Then the virulence of the isolated forms of bacteria gradually decreases. A child who has recovered from the disease ceases to be dangerous 35 days after the onset of clinical symptoms. With effective use of antibiotics, infectivity is lost after 25 days.

Infectiousness is very high. The situation is aggravated by the fact that clinical diagnosis is difficult in the first days after the onset of symptoms. They resemble ARVI. Only during the convulsive period do suspicions arise and bacterial diagnostics are carried out. Testing for whooping cough is mandatory for all children with colds if there are epidemiological indications. Quarantine measures are being introduced in preschool institutions.

High susceptibility to such an infection is due to the fact that the bacterium is released in large quantities, and immunity is reduced under the influence of toxins. Current forms of vaccination do not provide complete immunity. Moreover, it is not stable and requires periodic revaccination. In adults, susceptibility to whooping cough is quite high, but due to vaccination, erased clinical forms develop. Such patients pose a huge potential danger to children. Currently, whooping cough is diagnosed more often in adults than in children.

How does whooping cough develop in children and adults?

How do pathological changes develop? Typically, whooping cough in children and adults affects the respiratory system and the nervous structures responsible for the body's humoral response. The primary introduction of pertussis bacillus occurs in the structures of the mucous membranes of the upper respiratory tract. This is accompanied by clinical signs of ARVI. Literally from the first day it begins to release typical endotoxin. It irritates the mucous membranes and causes coughing with whooping cough. The spasmodic nature of the attacks leads to disruption of the patency of the alveoli. The first signs of gas exchange disturbances in the lung tissues appear. With incomplete ventilation capacity, hypoxia and emphysema are formed. During this period, the tissues of the heart, brain, and central nervous system are affected.

After the catarrhal (inflammatory) period has passed, constant irritation of the vagus nerve by toxins occurs. It transmits continuous signals to brain structures. In response to this, incessant bouts of reflex cough with scanty sputum production occur. In children, this may be accompanied by convulsive syndrome, repeated vomiting, and nervous agitation.

Symptoms and signs of whooping cough in a child (periods of illness)

Symptoms and signs of whooping cough appear only after the incubation period has ended. From the moment of infection to the development of the clinical picture in a child, it can take from 3 to 7 days. In adults, the incubation period for whooping cough can reach 12-15 days. Periods of illness are distinguished, characterized by certain clinical manifestations. Let's look at the symptoms according to these phases.

The first period of whooping cough, both in children and adults, is called the catarrhal phase. Here the symptoms of inflammation of the mucous membranes of the respiratory tract predominate. I am worried about a strong dry cough, nasal congestion without fever and headache. All this can continue for 14 days. It is impossible to cure catarrhal cough with whooping cough; you can only reduce the frequency of its attacks with the help of antitussives (thermopsis grass, codeine, Sinekod).

The second period of whooping cough is the spasmodic or convulsive phase. A distinctive feature is the presence of a so-called “aura” or a harbinger of an attack of spasmodic convulsive cough, which can last up to 20-30 minutes. Previously, the big one feels a strong dryness in the throat, soreness. Then short coughing bursts begin as you exhale, interspersed with reprises as you inhale. A spasm of the glottis produces a strong whistle or wheezing when inhaling. After the attack ends, mucus with a transparent glassy structure may be released. In some patients, a coughing attack during whooping cough causes vomiting.

In severe cases, a paroxysm of attacks is observed with a minimal period of calm between them. During the day, from 12 to 20 cough spasmodic attacks can be observed, which significantly worsens the patient’s condition.

Manifestations of a whooping cough attack:

• swelling of the veins in the child’s neck;
• change in color of the skin of the face (redness and then cyanosis);
• puffiness of the oval of the face;
• tongue with a bluish tint, protruded from the mouth as much as possible;
• profuse lacrimation and redness of the eyeballs.

Upon examination, an increase in blood pressure, an increase in heart rate, and an expansion of the right borders of the myocardium are determined. The X-ray image shows the so-called basal triangle at the base of the diaphragm. The spastic period of whooping cough can last up to 2 months with a gradual transition to the resolution phase.

It is characterized by a gradual decrease in the frequency and intensity of coughing attacks. The condition is gradually normalizing. The total duration of whooping cough in children reaches one and a half months.

Laboratory diagnosis of whooping cough: tests and studies

Laboratory diagnosis of whooping cough is mandatory in any suspicious cases. A bacterial analysis for whooping cough is carried out - for this purpose, inoculation is done on casein medium with the addition of agar. After 5 days, the laboratory technician will be able to say with confidence whether a similar pathogen is present in the child’s body.

X-ray examinations of the lungs are also performed. In difficult cases, bronchoscopy may be required. Typical changes are present in the general detailed blood test. This is pronounced leukocytosis and lymphocytosis against the background of a normal ESR level.

For the purpose of early diagnosis, an immunological analysis for whooping cough is carried out using the associated agglutination and complementation reaction (RA and CCR). These studies show the highest titer at the beginning of the convulsive period of the disease. With the preliminary use of antibacterial therapy to treat bronchitis, these reactions remain negative and have no diagnostic value.

An allergic skin test with a specific antigen also gives a positive result only in the phase of spastic cough attacks. For whooping cough, administration of 0.1 ml of the drug results in the development of papules more than 1 cm in diameter.

Treatment of whooping cough and prognosis for life

Currently, the prognosis for life is favorable. Mortality is low due to the use of modern means of early diagnosis and the use of specific antibacterial drugs.

The disease poses the greatest danger to infants who have not received specific vaccinations. They develop cerebrovascular accident and may die from acute heart failure.

Treatment of whooping cough in children and adults includes the mandatory use of antibiotics. Levomycytin is prescribed in tablets, the daily dosage is calculated at 0.2 mg per kg of weight, divided into 4 doses. The duration of the course of treatment is 10 days. In the spastic period, it is more advisable to use Ampicillin (25 mg/kg) and Erythromycin 10 mg per kg of weight 3 times a day. Combinations of antibacterial drugs are used only on the basis of bacterial culture data with determination of bacterial sensitivity.

In the early stages, a positive effect is observed when using γ-globulin with anti-pertussis specific effects. Prescribed for intramuscular administration according to the following scheme:

• the first 3 days – 3 ml 1 time at the same time;
• 5th, 7th, 9th day, 3 ml once intramuscularly.

In case of severe respiratory failure, oxygen therapy is indicated in a specialized hospital. Symptomatic therapy is also prescribed to support the cardiovascular system. During the convulsive period, neuroleptics (Aminazin, Propazin) are used - they reduce the frequency of coughing attacks and improve the activity of the central nervous system. It is possible to use corticosteroids to reduce inflammation in areas of infection.

The use of mucolytic agents is not effective. To combat coughing attacks, you can use “Sinekod” - the syrup is given 1 teaspoon 4 times a day. The drug has a calming effect on the cough center.

Enormous influence should be given to the daily routine of a sick child. Long stays in the fresh air are recommended. In winter, going out into the cold air often allows you to completely stop a cough attack. Distract the child with games and activities. Frequent split meals with pureed dishes should be organized. Give plenty of warm liquid.

Prevention of whooping cough: vaccination and revaccination

Active implementation of preventive measures allows you to completely protect yourself and your child from this dangerous infectious disease. Vaccination against whooping cough is carried out as part of the national vaccination calendar. This is a mandatory event. The DTP vaccine is first administered to a child at the age of 3 months. Repeated revaccination is indicated at 4.5, 6 and 8 months of life. Then revaccination is carried out every 2 years.

Prevention of whooping cough also includes a number of measures aimed at carrying out quarantine in groups where cases of infection have been identified. A child who has recovered from the disease is allowed to attend kindergarten only 6 weeks from the moment the first symptoms are detected.

Infectious disease doctor Mirzagimova R.G.

Not all parents can say with confidence how to identify whooping cough in a child. Meanwhile, this disease is extremely dangerous and often leads to serious complications.

However, in fairness, it is worth noting that in recent years this infectious disease, which requires long-term treatment, has been relatively rare. First of all, this state of affairs is due to mass vaccination. But the trouble is that this ensures the formation of immunity only for a certain period - a maximum of 12 years. In this regard, cases of whooping cough infection are increasingly being recorded in adolescents.

Parents should understand when deciding whether to vaccinate their child or not that unvaccinated babies are extremely vulnerable and often suffer the disease quite seriously. Moreover, in infants the risk of death is very significant.

Of course, the preventive measure mentioned above does not provide a 100% guarantee, but a vaccinated child always recovers and his illness lasts half as long as in other cases.

The incubation period in children lasts on average a week. The insidiousness of whooping cough is that this infection at the first stage is in no way different from the common cold. Because of this, parents are not particularly worried and often do not even consider it necessary to consult a doctor. The symptoms of the catarrhal stage are quite vague and look like this:

• low temperature;
• chills;
• slight runny nose;
• weakness;
• the mucous membranes of the nasopharynx swell;
• aching joints.

The disease is always quite acute in its initial phase. Here whooping cough can be identified by coughing. It does not subside for a long time and cannot be treated by any means.

The catarrhal period lasts an average of ten days. If a doctor examines a small child, he is forced to limit himself solely to interviewing the parents (since the baby will not be able to tell him about his problems) and the data of objective examinations. In addition to the above signs, they also find the following:

• painful pallor of the skin;
• rapid pulse;
• frequent shallow breathing.

At the same time, it is worth knowing that in an infant, the disease progresses much faster and is often severe. The second stage (convulsive cough) often appears within a few days.

During this period, the symptomatic picture changes quite significantly. The patient has:

• labored breathing;
• sore throat;
• sensation of a foreign object in the throat;
• cough that comes in attacks, at the end of which thick sputum is released;
• reprise (inhale with a whistle).

Often, attacks of dry cough provoke vomiting and lead to the following problems:

• to bleeding in the eyes,
• rupture of capillaries in the corners of the mouth and nose;
• rectal prolapse.

Sometimes ulcerations are found on the tongue. The child's face looks puffy. At the same time, tachycardia is often detected in children.

Causes

Whooping cough is an extremely contagious disease transmitted through the air from person to person. Its causative agent is the Bordet-Gengou bacterium (or in other words, Bordetella).

As practice shows, children most often get sick in the presence of the following negative factors:

• malnutrition;
• avitaminosis;
• regular hypothermia;
• weak immune defense;
• being in a team;
• passive smoking.

A characteristic difference between whooping cough and ARVI is the gradual intensification of cough, with an increase in the frequency and intensity of attacks. Sometimes there are up to 20 seizures per day. If at the beginning the symptoms resemble bronchitis, then later the similarity disappears.

In the second period of the disease, cough is often provoked by:

• conversations;
• laughter;
• light;
• emotional stress.

The symptoms are generally the same in both vaccinated and unvaccinated children. The only difference is that in the first case, the course of whooping cough is much milder. The symptoms here are smoothed out.

In other cases, cough causes:

• vomiting;
• seizures similar to epileptic ones;
• rupture of the ocular vessels;
• cerebral hemorrhages (they are rare, but they do happen).

Diagnostics

As previously noted, in most cases, parents do not seek medical help in the first period of the disease. However, it is at this time that treatment is much more beneficial. Prescribed antibiotics quickly destroy the pathogen and can significantly mitigate the course of the second phase.

The baby must be taken to see one of the following specialists:

• pediatrician;
• infectious disease specialist;

According to reviews, it is always possible to identify whooping cough:

• by blood test;
• sputum culture;
• other types of diagnostics.

If you asked for help already at the second stage, then the main task here is to mitigate coughing attacks. For this, the patient is provided with fresh air. The room is regularly ventilated. In addition, the child should be outside if he does not have complications or a runny nose. In the summer, it is better for him to spend most of the day outdoors (in a park or near a pond).

During the recovery period you will also need to take certain medications.

Various vitamin complexes are suitable for this:

• Hyper;
• Mystic;
• Lifepack Junior Plus;
• Bisque;
• Chromevital Plus, etc.

If antibacterial agents have been prescribed, probiotic preparations will be needed:

• Linux.

Adaptogenic herbal medicines are also useful:

• Aralia;
• Eleutherococcus;
• Ginseng.

Immunomodulators of nonspecific action:

• Sodium Nucleinate;
• Dibazol.

How are blood tests done for whooping cough in children and how accurate are laboratory test results? These and similar questions are always of concern to parents who want the disease to be detected in a timely manner, and that after treatment the child does not experience any complications. Fortunately, in most cases, diagnosing whooping cough is not difficult: symptoms and laboratory tests allow an accurate diagnosis.

At the initial stage of the disease, the child experiences:

• runny nose;
• rare dry cough;
• hyperthermia up to 38⁰.

During this period, the disease is difficult to differentiate from manifestations of acute respiratory infections. At this stage, the whooping cough bacillus actively multiplies and the patient, by coughing, becomes an active distributor of pathogenic microorganisms. The main difference from acute respiratory infections is that traditional treatment for a viral infection is ineffective.

As the disease progresses, after 2 weeks children experience a deterioration in their condition and develop a whistling, painful cough.

Cough shocks are accompanied by a characteristic whistle and the duration of the attack can be several minutes. In this case, children may experience the following symptoms:

• blue discoloration of the skin in the face and neck;
• stopping breathing.

After the attack ends, a small amount of sputum appears. The number of coughing attacks can reach up to 50 times a day.

To make coughing easier, children always stick their tongue out far and often bite it.

Even if you have been vaccinated, 100% protection against the disease is not provided. Children who develop antibodies to the whooping cough bacillus do not develop quickly enough become ill.

What blood tests are used for diagnosis?

The need for a specific blood test for whooping cough in children does not always arise. The disease has a number of characteristic signs, and diagnosis is often made after an external examination and auscultation of the patient. To determine the child’s condition, the following is prescribed:

• General blood analysis. This study shows a significant increase in the number of leukocytes with a predominance of lymphocytes in the leukocyte formula. If the child has not been vaccinated against whooping cough and his immune system reacts normally, then these signs are observed from the first days of the disease. With symptoms of an inflammatory process, the ESR in the blood remains within normal limits or even decreases slightly. In case of weakened immunity or after vaccination, changes in the leukocyte formula appear only in the acute period along with coughing attacks.
• Biochemical analysis. If the disease is not accompanied by the development of complications, then the biochemical parameters of the blood serum do not change.

In cases where the symptoms of whooping cough are blurred or the disease develops against the background of another pathology, children may be prescribed specific blood tests to detect antibodies to the whooping cough bacillus.

What are immunological tests

Starting from the 3rd week of illness, the child’s body produces antibodies to pertussis bacillus (IgM immunoglobulins). They reach their maximum concentration by the end of the 4th week and remain in this quantity for 3 to 4 months after recovery. Then their content gradually decreases, but IgM remains in the blood for several years. The disadvantage of this study is that reliable data can only be obtained after the 3rd week of illness. There are several laboratory diagnostic methods:

• Serodiagnosis. A microbial concentrate is added to the blood serum. The agglutination that occurs will indicate the presence of antibodies.
• Immunoenzymatic. The method consists in determining the protein compounds of the IgM immunoglobulin to the pertussis bacillus. It may be uninformative if the immune response is weak (a small amount of antibodies gives a questionable result on the reaction with the pathogen).
• Serological. The concentration (titers) of IgM immunoglobulins is calculated. With regular testing and a normal immune response, the patient should experience a gradual increase in the number of antibodies.
• PCR (polymerase chain reaction) is one of the most informative and accurate methods. Molecular research makes it possible to detect the DNA of the pertussis pathogen in biological material with almost 100% accuracy.
• ELISA (enzyme-linked immunosorbent assay) makes it possible to reliably determine antibodies produced in response to the accumulation of pertussis toxins in the body. It is effective only in the 4th week of the disease and is used mainly to confirm an already made diagnosis.

Which technique is most suitable? The answer depends on the child's age and health. Which analysis is more effective is determined only by the doctor. If diagnosis is difficult, a study using several methods may be prescribed to obtain a complete picture of the state of the immune system.

When is immunology needed?

Despite the fact that the symptoms of whooping cough are specific, in some cases it becomes necessary to differentiate it among the following infectious and non-infectious pathologies:

• prolonged course of acute respiratory infections;
• pneumonia;
• bronchitis;
• measles;
• bronchial asthma;
• bronchoadenitis;
• cystic fibrosis;
• foreign body in the respiratory tract.

Most often, dubious symptoms of this disease occur when the child’s immunity is weakened or the vaccination did not provide sufficient protection against the virus entering the body. In this case, the signs of the disease appear weakly and are more like a prolonged acute respiratory viral infection or bronchitis.

Also, the need for immunology arises in early childhood, when there is no cough reflex yet and anxiety in the form of choking crying can be either a symptom of pertussis infection or a sign of another ailment. In children, immunodiagnosis is carried out, even if the symptoms correspond to the manifestations of whooping cough.

Sometimes, with a severe course of the disease, it may be necessary to conduct several serological tests with a short time interval. This is necessary in order to find out how the child’s immune system resists the pathogen.

An immunology test can also be prescribed to healthy children. This is necessary to find out whether the child has previously had whooping cough infection.

Decoding laboratory data

The resulting analysis can have only 2 results:

• The presence of IgM immunoglobulins was detected (for some types of research, the number of antibacterial titers may be indicated). In this case, the presence of the pathogen in the blood is confirmed and laboratory indicators are considered positive.
• No antibodies were detected. In this case, another disease has a whooping cough-like course, but the cause of the disease is not the whooping cough bacillus.

A false positive result is also possible. This happens in children who have already had whooping cough and have the appropriate antibodies to the pathogen in their bodies. In case of whooping cough-like conditions, if there is no reliable data about the disease already suffered, an incorrect diagnosis may be made.

Parents should remember that whooping cough infection occurs only once in a lifetime. If the child has already had whooping cough, then you need to inform the doctor about this when receiving a referral for laboratory diagnostics.