Disease Pathology Clinical Impression: Pertussis

Disease Pathology

Clinical Impression: Pertussis

Bases:

age of the child - 5 weeks old, infants are very susceptible in acquiring this disease

day history of choking spells which began with repetitive coughing until he was gasping for breath post-tussive vomiting in respiratory distress - respiratory rate = 72/min and heart rate of 160 beats/min leukocytosis - 15,500/ul - increased WBC count is one of the laboratory findings in pertussis nasopharyngeal swab culture - Gram (-) bacilli. Pertussis is a Gram negative bacilli that inhabits respiratory epithelium from the nasopharynx to the bronchioles.

Were this child's clinical course and chest radiograph consistent with his infection? Explain.

The child's clinical course and chest radiograph is inconsistent with his infection since a patient with pertussis may have an abnormal chest radiograph that show perihilar infiltrate, (butterfly appearance), peribronchial cuffing and variable atelectasis due to hypersecretion of the respiratory mucosa and increased inthrathoracic pressure brought about by coughing. The patient is an infant and does not fit the classical pertussis which has usually a 6-week clinical course and is divided into catarrhal, paroxysmal and convalescent stage. He may have been in the paroxysmal stage which is marked by the onset of coughing. The coughing is usually a dry, intermittent, irritative hack that evolves into paroxysm. In infants, manifestation of pertussis in the paroxysmal stage include choking, gasping, flailing the extremities with face reddened.

2. How might this disease be prevented?

Active immunization against pertussis (diphtheria - tetanus - acellular pertussis or DTaP) is the best standard measure against this disease which is given to children at 2, 4, 6, 15 to 18 months of age and at 4 to 6 years. However, since the patient is a 5-week-old male, he should be kept away from anyone who is coughing since they are at higher risk of life-threatening consequences.

3. What therapy would you suggest for this patient?