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40 Cards in this Set

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classic presentation of 3 stages?
catarrhal: common cold symptoms; paroxysmal: whoop cough commonly followed by vomitting; convalescent: waning of symptoms over weeks to months
presentation in infants under 6 mo?
short/no catarrhal stage then gagging, gasping and APNEA without whoop then prolonged convalescence
duration of pertussis in children? Adolescents?
6-10 wks; 10+ wks
complications in adolescents/adults?
syncope, sleep disturbances, incontinence, RIB FRACTURE, pneumonia
most severe disease in who?
preterm, unimmunized infants
infant complications?
pneumonia, seizures, encephalopathy, and death (in order from most common to least)
age group with greatest risk of death?
under 3 mos
properties of the bacteria B. pertusis?
fastidious, gram (-), pleomorphic bacillus
differential infectious agents that cause prolonged cough illness?
B. parapertussis, Mycoplasma pneumoniae, Chlamydia, resp tract virus esp adenovirus and respiratory syncytial virus
hosts of B. pertussis?
only humans
why are adults getting sick when the classic disease is in kids?
lack of natural booster (exposure) due to vaccine and waning immunity since childhood
is pertussis endemic or epidemic?
endemic usually with periods of epidemia every 3 to 5 yrs
who can become INFECTED with pertussis? Who gets the worst disease?
anyone who is exposed REGARDLESS of immune status (subclinical infection is 80% after exposure). Infants and young children esp non-immunized
factors affecting length of communicability?
age, immunization status or previous episode of pertussis, appropriate antimicrobial therapy
incubation period?
average is 7 to 10 days with a range of 5 to 21 days
gold standard test?
culture
agar used for culture? Swabs used and where do you swab?
Regan Lowe agar. Dacron or calcium alginate swabs from nasopharynx
when can the culture be negative but not exclude a diagnosis of pertussis?
immunized person, antimicrobial therapy has been started, more than 3 wks has elapsed since cough onset.
what test is "on the rise" bc of improved sensitivity and more rapid result?
PCR - NOTE do not use calcium alginate swabs in PCR
what tests usually require "expert readers" and are not commonly used?
direct fluorescence antibody and serological tests
what blood count is seen in infants and young children but NOT in adolescents?
absolute lymphocytosis
treatment for infants under 6 mos?
hospital - asses ability for self rescue after paroxysm (may need resp care), manage apnea, hypoxia, feeding difficulties. Antimicrobials - tricky, FDA has not approved azrithromycin or clarithromycin for <6 mos old. Erthro causes pyloric stenosis in those under 1 mo... RECOMMENDED treatment is azrithro and watch for pyloric stenosis
when is antibiotic treatment effective? When should it be given? What drugs are of choice and what compliance issues exist?
affective only in catarrhal stage but is given to those in ANY stage to prevent spread. Erythromycin (14 days), azithromycin (5 days) or clarithromycin (7 days). Erythro will make you shit everywhere so not many ppl will take the whole dose (I know this from personal experience....) BUT azrithro and clarithro are just as effective without all the shitting
alternative to macrolide treatmen if bug is resistant or if pt. cannot take macrolides?
SMX-TMP (contraindicated in infants under 2 mos)
isolation procedures?
resp isolation (where the mask if you go see them) five days from start of treatment or 21 days if no treatment is given
care of ALL exposed individuals?
immunization rules (this is a bitch): un/underimmunized and under 7 continue/start the recommended schedule. If child received 3rd dose 6 mos or more before exposure get a fourth dose, children who received the fourth dose 3 or more years before exposure and who are under 7 get a 5th dose. The booster shot (Tdap not DTaP) is given to those between 11 and 18 if they have not received it yet. ALL contacts need to start antibiotics regardless of age and immunization status
precautions to take when examining a pt with SUSPECTED pertussis?
we wear the mask - the pertussis condom
what vaccine replaced the old DTP vaccine in the US and why?
DTaP - diptheria, tetanus, and ACELLULAR pertusis bc it has less rxns in those over 7 - note it contains inactivated pertussis toxin and some other crap but not the whole bacterium like DTP
Describe the Tdap vaccine.
for 11 - 18 yo and adults if needed; a booster for exposed with reduced quantities of diptheria toxoid and some pertussis toxin
route of administration of vaccines?
IM
Schedule for routine childhood immunization with DTaP vaccine?
5 doses before school entry - 2 mo, 4 mo, 6mo then 4th dose between 15 and 18 mos, 5th dose before school entry at 4 to 6 yo. If 4th dose is delayed after 4 yo, no 5th dose
what is DTaP-HepB-IPV vaccine?
one shot combining DTaP, Hep B, and inactivated poliovirus
complications that can occur in children with DTaP?
allergic rxn, fever, seizures, encephalopathy
what are the recommendations for giving Tdap?
ALL who completed DTaP are recommended to get it at 11 to 12 (up to 18)… Td booster complicates it (Tetanus and mild diptheria), some ppl get this if exposed to tetanus, it is recommened to get Tdap five years after a Td booster if they have not received a Tdap, however if exposed give them Tdap no matter how long it has been since Td shot bc preventing illness is more important than possible reactions.
should adolescents with a history of pertussis still receive Tdap?
yes
should adolescents who have not been immunized with DTaP/DTP be given DTaP?
no, DTaP is contraindicated always in those over 7, give them a single Tdap (according to previous tetanus immunizations/pertussis exposure protocols… gets confusing as hell I know…)
what is the length of protection after vaccination?
protection begins to wane 3 to 5 years after vaccination and is unmeasureable in after 12 years
who are the current reservoirs?
adults and adolescents that present with just a bad cough and are constantly diagnosed as bronchitis, always suspect pertussis in these groups if cough is over 1 week; the disease will not hurt them but they could give it to a young'en that could die
virulence factors for attachment? For epi damage? Systemic disease?
filamentous hemagglutination, fimbrae and pertactin for attachin. Tracheal cytotoxin, adenylate cyclase and pertussis toxin for epithelial damage. Pertussis toxin for systemic disease
what percentage of adults with a cough that lasts over 1 week have pertussis?
3 to 7%