whooping cough

Synonyms in a broader sense

Medical: pertussis

English: pertussis

definition

Whooping cough is an infectious disease of the respiratory tract that is caused by bacteria. In children, this disease is characterized by staccato coughing attacks. Often these coughing attacks end in vomiting.
Whooping cough usually affects children, but adults who either have not been vaccinated or have never had whooping cough can also develop the disease.
Unfortunately, immunity against these pathogens does not last for life and it can also affect adults who have had whooping cough before.

Summary

Whooping cough isn't always one Teething.
She is going through bacteria caused the surface of the respiratory tract damage. The transmission, i.e. the infection, takes place from person to person via droplet infection.
There are three stages of this disease, the middle of which is distinguished by the Coughing fits excels. The first most inconspicuous initial stage, however, is also the one in which there is the greatest risk of infection for others. Complications are also possible. The therapy takes place through Antibiotics. To avoid whooping cough as much as possible, infants should be vaccinated at 3 months of age. Unfortunately lies through that vaccination no secure lifelong protection against.

causes

Whooping cough is caused by a bacteria called Bordatella pertussis. The bacteria only multiply on the surface of the respiratory tract.
The pathogen itself and the toxins it releases lead to damage to this surface.
More precisely, the so-called ciliated epithelium is damaged. The ciliated epithelium is normally used to transport foreign bodies (e.g. dust) out of the body. This is particularly effective when coughing. The fine hairs always hit in the direction in which the dirt should be carried, i.e. outwards.

The bacteria are transmitted by droplet infection, for example when coughing or sneezing. The transmission takes place only from person to person. The disease then breaks out in around 70 percent of the cases. Young children are most at risk.

incubation period

The incubation period for whooping cough is generally about five to twenty days, mostly however ten to fourteen days. Through them the Time between infection and onset of the disease designated. During this time, the pathogen begins to multiply in the body of the infected person without causing symptoms (the infected person is "asymptomatic"). As a rule, infection of other people is not to be expected during the incubation period. The risk of infection, on the other hand, usually begins with the onset of the first symptoms.

Course and symptoms / complaints

After the incubation period, whooping cough runs according to a classic scheme in three stages. These stages can be seen in almost all cases in children infected with whooping cough. In adults and infants, a clear division into stages may not be possible.

Read more on the topic: Symptoms of whooping cough

The three stages:

1. Prodromal or catarrhal stage "
   This stage begins about 5 to fourteen days after infection and manifests itself like a banal infection. This is where the risk of infection is highest because the infection can hardly be recognized as a whooping cough. Most of those affected suffer from the typical cold symptoms (runny nose, cough, sore throat) and moderate fever (below 40 ° C). In rare cases, conjunctivitis of the eye can develop. The stage lasts one to two weeks.
   The first stage is also characterized by the fact that at this point in time the greatest amount of bacteria is in the affected person's system. The risk of infection is greatest at this stage, and there is practically no risk in the later stages. Therapy with antibiotics also only makes sense at this stage. Later the bacteria were usually fought by the affected person's immune system and the symptoms only come about through the bacterial poison and the damage that has already occurred.
   
2. Convulsive stage ("Convulsive")
   The coughing attacks typical of whooping cough begin in the second stage: first, a deep breath is taken, followed by several coughs. The face turns red first, then bluish. The impression is given that the patient is in danger of suffocating, before air is sucked in again with loud, drawing breaths. These coughing fits mostly occur at night. There is no longer a fever because the bacteria have usually already disappeared from the affected person's organism. The symptoms are likely caused by damage to the lungs and airways that has already occurred.Since the bacteria have already been fought, there is usually no longer any risk of infection and antibiotic therapy can unfortunately no longer relieve the symptoms or accelerate recovery. Many of the complications of whooping cough have to do with the severe coughing fits. For example, sticking out the tongue when coughing may result in a ligamentous ulcer developing in the presence of teeth. Due to the violent coughing attacks, even the smallest vessels of the conjunctiva can burst, which are harmless in themselves. The convulsive stage usually lasts for four to six weeks.
   Infants under 4 months of age are particularly at risk from life-threatening attacks of respiratory failure!
   
3. Stage decrementi ("Decreasing")
   The transition to the third stage is fluid. Gradually, the symptoms improve. E.g. coughing attacks less frequent and weaker. This comes about through the slow repair of the lungs and the attacked cells. It can take a long time until the symptoms have completely subsided and the person affected is completely healthy again. As a rule, the decrementi stage lasts three to four weeks, but at least one week and usually no longer than ten weeks.

For more general information, see our article on the subject Cough in child

You can find further information under our topic: Course of whooping cough

How can you recognize whooping cough yourself?

Identifying whooping cough in adults, infants or incipient whooping cough (catarrhal stage) in children is generally difficult and is sometimes misunderstood even by experienced doctors. Especially in children, if you have a fever with cold symptoms, you should definitely consult the pediatrician; whooping cough is suspected in children who have not been vaccinated. In the second stage of the disease in children (in some cases also in adults) whooping cough can be recognized primarily by the classic coughing attacks. The seizures are severe, often convulsive. Those affected take a deep breath, followed by a "staccato" cough, in which the tongue is often stuck out and thick mucus is coughed up or choked out. Often those affected get hardly any air during the coughing attacks, which can be seen in a blue coloration of the lips and tongue (cyanosis). The first coughing attack is often followed by a second, weakened coughing attack, the so-called reprise.

Read more on the topic: Cold in the baby

Duration of illness

The duration of a whooping cough infection can, depending on various factors, vary, but generally you can have a duration of about four to fourteen weeks from the time of infection, i.e. the infection. Most of time the duration is approx six to seven weeks. Is included in this time also the time without symptoms (asymptomatic), in which the pathogen multiplies in the body of the infected person (the host) without triggering symptoms of the disease. This is also called "incubation period“Means and usually lasts at least five to a maximum of twenty days on.
The symptoms then begin in the so-called "catarrhal stage", which changes to the "convulsive stage" after one to two weeks with changed symptoms. This "stage convulsivum", in which the classic for whooping cough Coughing fits occur usually lasts two to six weeks. Eventually the disease goes into the "stage decrementi" in which the Symptoms subside and the sick person's condition improves. This recovery phase, during which symptoms still occur, lasts at least a week, but can also last for over ten weeks. These are general statements that result from observing the disease. For particularly difficult or easy courses, or special circumstances, such as an altered immune system of the sick person, the illness can last longer or shorter. However, these special cases only make up a negligible proportion of whooping cough infections.

Complications

The most common complications include bronchitis and pneumonia, which, however, are caused by other pathogens. Other possible complications are:

• Otitis media
• Lung damage (burst of Alveoli)
• Seizures / epilepsy

diagnosis

Is the disease already in Stage conculsivum the diagnosis is easy to make based on the coughing fits.
The bacteria If necessary, a throat swab (e.g. the Nasal mucosa) be detected. Formed by the body antibody against the pathogen can only be detected in the blood after 2 - 4 weeks after the onset of the disease.

Risk of contagion

The whooping cough bacteria will via droplet infection transfer. Droplets, sometimes invisible to the naked eye, from the airways (lungs, windpipe, larynx, mouth and throat and nose) of infected people contain bacteria. If enough of it gets into the respiratory tract of a healthy person, it can become infected. Also about Nasal secretions, saliva or droplets that land on your hand when you cough can cause the infection, so to speak from hand to handto be passed on. Unfortunately the disease is especially contagious in the first, very unspecific stage. Often the But diagnosis only in the second stage, in which the classic coughing fits occur, posed. At this point in time, the person concerned had already had a lot of contact with people who could have been infected.
To the risk groups belong baby (since the disease is often severe or even fatal for them), Small children and school childrenbecause they are more likely to get infected in kindergarten or school. Also People with many children in the work environment (e.g. kindergarten teachers) have an increased risk of infection.

Whooping cough in adults

Although whooping cough is considered a childhood disease, adults also get whooping cough time and again. Generally one takes Whooping cough infection in adults the same course as in children , however, often shows up with slightly different symptoms. The symptoms that are generally easy to recognize as dangerous even by laypeople, such as high feverthat occur in children, often absent in adults. Also those typical of whooping cough Coughing fits are much less common in adults before than in children and infants. Also is that Division into the typical stages mostly in adults not possible. This fact means that whooping cough is often not recognized correctly or in time in adults, which can lead to an increased rate of complications. Typical symptoms in adults are Nausea, gag reflex and vomiting. General exhaustion, loss of appetite and sleep disorders can also occur. In principle, however, the disease proceeds as in adults significantly less dangerous and heavier than in toddlers and especially infants. As a rule, an adult with a normally functioning immune system will only have one mild course, or even a Course without symptoms (clinically inapparent) expected.

Why is there more whooping cough also in adults?

In the western world, whooping cough diseases occur again and again in adults, although whooping cough is a typical childhood disease. On the one hand, this is due to the fact that a childhood disease describes a disease, which long timebefore widespread vaccinations were possible, only in children occurred. There are two reasons for this. Either the children survived the disease well and then developed a specific immune defense against the pathogen (cf. chickenpox) or the illness was so severe that the children died.
Nowadays most children are vaccinated, which is why severe courses have become rarer due to the rarer occurrence of the disease (however, infant mortality from whooping cough is still around 70%!). The However, the effect of the vaccination may wear off after years, which is why infections can recur. Are particularly at risk here parents and People who work with many children (e.g. kindergarten teachers), because the Infection can also be transmitted from vaccinated children can without them becoming ill themselves. Prophylactic administration of medication to adults can therefore make sense in the event of contact with infected people, despite supposed vaccination protection. Even an infection that has gone through only offers protection against infection for about ten to twenty years.

Illness in pregnancy

In general, if the mother has whooping cough, it occurs during pregnancy no harm to the baby, because the pathogen cannot reach the placenta and the circulation of the unborn child via the blood (the pathogen does not cross the placenta). Nevertheless, if there is a clear whooping cough infection, a Treatment of the mother with an antibiotic (usually the antibiotic which is harmless to the child "Erythromycin") Should be aimed for. Especially with frequent, strong coughing attacks, it can in individual cases to a Premature birth come. But it should always be attending gynecologist consulted become. If a pregnancy is planned, it should be checked whether a vaccination is available or whether it is available Vaccination refreshed should be. This is necessary in order to prevent the transmission of pathogens to the newborn in the future. Other people in the household (such as the father) should also be vaccinated. If you are already pregnant, you will not need a vaccination (you want to avoid strong reactions of the immune system), instead you should be vaccinated as soon as possible after birth.

therapy

Whooping cough is treated with antibiotics, which interrupts the infection. Complications are also less common with antibiosis. Infants at the stage characterized by coughing fits should be observed and treated in hospital. Preparations that stop coughs or dissolve phlegm do not help here.

In severe cases, hospital treatment is necessary. Emergency therapy may be needed for infants.

When do you need an antibiotic?

An antibiotic should only be taken if prescribed by a doctor. In the case of whooping cough, it is important that the antibiotic as early as possible is taken. The antibiotic has the most favorable influence on the course of the disease if it is already there in the first stage (Stage catarrhale) is taken, since here the least damage has been caused by the bacterium and the bacteria multiply at the same time and reach their highest number. If you missed the first stage and you already have coughing attacks (typical for the second stage), you should still consult a doctor quickly, as there may still be bacteria in the body and one Administration of antibiotics in the early second stage can have a positive effect on the further course of the disease.

Home remedies for whooping cough

In general, sick people should save and stay at home. A lot of rest is important, although absolute bed rest does not have to be observed. The room air should be kept cool and humid. The goal is above all to loosen tough mucus and thus make breathing easier. Here the Inhalation of hot water (possibly mixed with salt, chamomile extract or similar) help. Irradiation with the help of Red light lamps, which has an expectorant effect, can provide relief. The Rubbing the chest with essential oils, Thyme or eucalyptus oil can also help (please do not use essential oils with babies), as well as Tapping massages on the back from bottom to top. There is nothing against the administration of cold teas with honey, but should hot lemon should be handled with careas the lemon can further irritate the throat. Caution should be exercised with all types of (hot) drinks, as children in particular can choke quickly because of the coughing attacks. The most important measure remains one adequate intake of fluids (preferably in the form of tea) and sufficient meals - several small meals spread over the day are particularly useful. Other alternatives for home treatment are Quark wrap, hot wraps with thyme or eucalyptus, onion wraps, elderberry syrup and various lozenges (e.g. Icelandic moss).

homeopathy

Homeopathy can be used as supportive therapy be consulted. However, the current guidelines recommend primary antibiotic therapy if directed by a doctor. In general, certain globules from the field of homeopathy are offered as supportive therapy (Drosera rotundifolia D 30 - two globules twice a day until the symptoms have improved significantly). Especially if you are very exhausted Carbo vegetabilis C15 offered to improve breathing and relieve the feeling of suffocation. Belladonna can protect against strong irritable cough attacks and Allium cepa works with cold-like symptoms. Also Corallium rubrum C9 can help - 5 globules should be taken after each coughing attack. However, there are many other homeopathic remedies that are believed to have beneficial effects.

Read more about the topic here: homeopathy

Vaccination and prophylaxis

According to the recommendation of the STIKO (Standing Vaccination Commission of the Robert Koch Institute), whooping cough vaccination (also: pertussis vaccination) should be included in the Basic immunization together with vaccination against diphtheria and tetanus respectively. This should in principle within the first year of life (in exceptional cases also later). As a rule, vaccination takes place as part of the U examinations by the pediatrician after completing the 2nd, 3rd, 4th and 11th-15th Month of life. In childhood and adolescence should two more vaccinations as a booster occur, usually between the ages of five and six and between the ages of twelve and seventeen. A booster vaccination can also be recommended for adults, for example at Pregnant women or people who have regular contact with newborns to have. Vaccination of the surrounding area does not finally protect the newborns from the infection, since vaccinated people can also be carriers without becoming ill themselves, but it significantly reduces the likelihood of infection. The Boosting in adults should not take place before ten years after the last vaccination occur. A vaccination can still be useful even after an infection has passed, as the survived infection only protects against re-infection for about ten to twenty years, after this time the immune system loses the stored information about the pertussis pathogen.
In Germany the vaccine is acellular, which means that it does not contain any killed or weakened bacterial cells, but only different ones Building blocks of bacteria (e.g. proteins from the bacterial surface, on the basis of which the immune system can recognize the pathogen). Also contains the vaccine Pertussis toxin, a substance that is produced by whooping cough bacteria and is seen as the main reason for the typical symptoms. However, the doses are so small that the pertussis toxin does not have any harmful effect on the body, but merely serves as a template for the formation of antibodies that protect against the poison. The vaccine will be a good effectiveness with very few side effects attributed, which is why it is now generally recommended for vaccination.

If infants or children are not vaccinated and have come into contact with an infectious person, a so-called chemoprophylaxis can take place. An antibiotic is given to prevent or reduce the onset of the disease.