1 / 15

Pertussis

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

fancy
Télécharger la présentation

Pertussis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pertussis Kate Goheen March 25, 2009 Weill Cornell Medical College Class of 2010

  2. 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

  3. 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

  4. 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

  5. What is Pertussis? Whooping cough, “The Cough of 100 Days”

  6. Infants are at high risk of complications Infants accounted for 92% of US pertussis deaths in 2000-2004. 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.

  7. 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.

  8. Spread of Pertussis: Then vs. Now

  9. Why is the Incidence of Pertussis Increasing? • Increased awareness and reporting • Better tests • Waning immunity in adults

  10. Immunized kids also get pertussis Clinical Presentation of Pertussis by Vaccine Group in Infants 6-24 Months Old *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.  

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. Thank you! Questions? Comments?

More Related