Whooping cough is an acute infectious disease. Whooping cough

Lecture No. 13

Topic: "Nursing care for tonsillitis, scarlet fever, whooping cough"

Angina (acute tonsillitis) -

This is an acute infectious disease with a predominant lesion of the palatine tonsils.

Etiology : staphylococcus, B-hemolytic streptococcus of group A, but there may be other pathogens (viruses, fungi).

Transmission routes:

1. Airborne

2. Alimentary.

3. Contact household.

Source of infection :

1. Exogenous (i.e. from patients and bacteria carriers).

2. Endogenous (autoinfection - that is, infection occurs from the oral cavity of the patient himself in the presence of chronic inflammation of the palatine tonsils or carious teeth).

Predisposing factors : local or general hypothermia.

Clinic:

1. Syndrome of general intoxication : (fever up to 39-40, headache, chills, general malaise).

2. Sore throat when swallowing .

3. Local changes on the tonsils depend on the form of angina.

Distinguish:

1. Catarrhal

2. Follicular

2. Lacunar

Angina catarrhal. The syndrome of intoxication is not expressed, the temperature is subfebrile. When examining the pharynx, swelling and hyperemia of the palatine tonsils and arches are noted. Regional lymph nodes are enlarged and painful on palpation. Catarrhal angina can be the initial stage for another form of angina, and sometimes a manifestation of a particular infectious disease.

Angina follicular and lacunar. They are characterized by more pronounced intoxication (headache, sore throat, temperature up to 39 °, chills).

Inspection of the pharynx with follicular angina: festering follicles are visible in the form of white or yellowish peas, translucent through the mucous membrane. Sometimes there are yellow or grayish, dense plugs in the lacunae, which have an unpleasant putrefactive odor.

Examination of the pharynx with lacunar angina: liquid yellowish-white purulent deposits are formed in the lacunae, which can merge, covering the entire surface of the tonsils. These raids are easily removed with a spatula. In both cases, the tonsils are hyperemic, edematous.

Complications of angina:

1. Local

Quinsy,

paratonsillar abscess,

Swelling of the larynx (laryngitis),

cervical lymphadenitis,

Otitis, etc.

2. Infectious-allergic:

Rheumatism, glomerulonephritis

Treatment

- bed rest until temperature returns to normal

Plentiful warm drink

Antibiotics (cefuroxime, azithromycin, josamycin) - 5 days

Antihistamines

Rinsing the throat with saline, decoctions of herbs (chamomile, calendula, eucalyptus)

Irrigation of the pharynx with preparations of ingalipt, bioparox, joks, hexoral and others.

Site supervision:

If the child is not hospitalized, then on the first day, before prescribing antibiotics at home, a swab is taken from the throat and nose for diphtheria (on BL). In the first three days, the patient is actively monitored at home by a doctor and nurse. Home mode 10 days.

After recovery:

The patient is administered intramuscularly bicillin-3 once for the prevention of rheumatism and nephritis,

General blood and urine tests are done. A month later, the patient should be examined by a doctor again (so as not to miss complications). If necessary, repeat blood and urine tests.

Scarlet fever

This is one of the forms of streptococcal infection, accompanied by fever, tonsillitis, punctate rash, prone to complications.

Etiology: Caused by group A beta-hemolytic streptococcus.

sources of infection:

1 patient with scarlet fever up to 7-8 days from the onset of the disease;

2 patients with angina.

Transmission way:

Airborne and contact-household, very rarely food.

Incubation period 2-7 days.

By the end of the 1st day, 3 main signs of the disease are formed:

1. Syndrome intoxication

2. inflammation at the entrance gate (angina)

3. small rash on the skin.

Intoxication manifested by an increase in temperature to high numbers of 38.5-39, a violation of well-being, headache, often vomiting.

Angina- complaints of sore throat. When examining the pharynx, there is a bright hyperemia and swelling of the tonsils, arches, and soft palate. Angina can be catarrhal, lacunar, follicular and even necrotic.

Regional l/nodes increase.

A characteristic appearance in scarlet fever is the tongue - in the first 2-3 days it is lined in the center with a white coating, dryish. The tip of the tongue is crimson, from 2-3 days the tongue begins to clear, becomes crimson, with pronounced papillae. " Crimson" language - Lasts 1-2 weeks.

By the end of the first, the beginning of the second day, at the same time, all over the body appears small, thick rash on hyperemic background of the skin. The skin feels hot, dry, rough (shagreen skin). A favorite place for localization of the rash is in the inguinal folds, elbows, lower abdomen, in the armpits, in the popliteal fossae. The nasolabial triangle always remains free from the rash.

All symptoms reach a maximum by day 3, and then gradually fade away.

When the rash subsides, most patients develop large-lamellar peeling of the skin especially pronounced on the fingers and toes.

- infectious- otitis media, sinusitis, laryngitis, bronchitis, pneumonia, paratonsillar abscess.

- allergic- glomerulonephritis, rheumatism, infectious - allergic myocarditis.

Treatment:

At home, hospitalization is subject to children from closed institutions, severe

and complicated forms, children under 3 years old.

-mode bed for the entire acute period.

-BUT/ b penicilline row(amoxicillin, augmentin, flemoxin solutab), macrolides(erythromycin, azithromycin), or cephalosporins 1 generation (cephalexin, cefazolin and others).

Antihistamines (tavegil, fenkarol) - according to indications

Symptomatic (antipyretic, gargling).

-specific No;

- nonspecific - consists in isolating patients for 10 days, if recovery has not occurred by day 10, then the period increases.

Those who have recovered are discharged to kindergartens and schools after 21 days (to avoid complications such as myocarditis, glomerulonephritis). Children who have been in contact with a patient with scarlet fever at home and in kindergartens are observed for 7 days (temperature, skin, pharynx).

Anti-epidemic measures riiya in remote control(children's institution)

1. quarantine for 7 days, final disinfection is carried out in the group, contacts are examined daily (skin, pharynx, thermometry).

Whooping cough

Etiology:

whooping cough is a gram-negative bacillus Bordetellapertussis). 4 serotypes are known, which in the process of growth and development form exo- and endotoxins. The CNS (respiratory and vasomotor centers) is most sensitive to toxins. In the external environment, the rod is unstable and quickly dies because. sensitive to heat, sunlight, drying, exposure to disinfectants.

Source of infection - Patients with typical and atypical forms of whooping cough.

Transmission route - airborne, infection occurs with close and sufficiently long contact (the radius of dispersion of the pathogen is 2-2.5 meters). Whooping cough affects children of all ages, including newborns.

The main clinical manifestations of whooping cough

1. Incubation period from 3 to 14 days.

2. catarrhal period 1-2 weeks-

the patient's condition is satisfactory, the temperature is normal or

subfebrile. The cough is dry, obsessive, gradually increasing, there may be a runny nose.

3. Period of spasmodic cough from 2-3 weeks to 2 months.

A coughing fit is a coughing shock following one after another on exhalation, interrupted by a whistling, convulsive breath - reprise. The attack ends with the discharge of thick, viscous vitreous sputum or vomiting. With a typical attack of coughing, the appearance of the patient is characteristic: the face turns red, then turns blue, becomes purple-red, the veins of the neck, face, head swell, lacrimation is noted. The tongue protrudes from the mouth to the limit. As a result of friction of the frenulum of the tongue against the teeth, an anguish or sore formation occurs. Outside the attack, puffiness of the face, swelling of the eyelids, and pallor of the skin persist. Hemorrhages in the sclera and petechial rash on the face and neck are possible.

4. Permission period from 2 to 3 weeks -

cough loses its typical character, occurs less and less often, but attacks can be provoked by emotional stress or physical exertion. Within 2-6 months, the increased excitability of the child remains, trace reactions are possible (return of a paroxysmal, convulsive cough with the addition of SARS).

Features of modern whooping cough- the predominance of mild and atypical forms due to mass pertussis immunization.

Features of whooping cough in young children:

Shortened periods 1 and 2, 3 - extended to 50-60 days;

Coughing fits can be without reprises, but are often accompanied by respiratory arrest, there may be convulsions;

Complications occur more often: (diarrheal syndrome, encephalopathy, emphysema, pertussis pneumonia, atelectasis, cerebrovascular accident, bleeding and hemorrhages in the brain, retina, umbilical or inguinal hernia, rectal prolapse, and others).

Laboratory diagnostics:

1) the "cough plate" method

2) a smear from the posterior pharyngeal wall - a tank of sowing on Borde-Gangu medium (potato-glycerol agar with the addition of blood and penicillin) or AMC (casein-coal agar).

3) RPHA - for the diagnosis of whooping cough in the later stages or when examining the focus. Diagnostic titer 1:80.

4) molecular method - PCR (polymer chain reaction).

5) OAK - leukocytosis with lymphocytosis (or isolated lymphocytosis) with normal ESR.

Treatment:

Hospitalizations are subject children with severe forms, with complications, with a non-smooth course, an unfavorable premorbid background, with an exacerbation of chronic diseases and young children. According to epidemic indications - children from closed institutions.

Mode- sparing, with obligatory individual walks.

Diet- in severe forms, feed more often and in small portions,

supplement after vomiting.

Etiotropic therapy: antibiotics- erythromycin, roxithromycin (rulid), azithromycin (sumamed) for 5-7-10 days, effective in the early stages of the disease.

Pathogenetic therapy:

P / convulsive (phenobarbital, chlorpromazine);

Calming (valerian);

Dehydration therapy (diacarb or furosemide);

Mucolytics and antitussives (tussin plus, broncholithin, libexin, tusuprex, sinekod);

Antihistamines (claritin, suprastin);

Vitamins with trace elements;

In severe forms - prednisolone;

Oxygen therapy, with apnea - mechanical ventilation;

Eufillin (with bronchoabstruction and cerebrovascular accidents);

Physiotherapy, chest massage, exercise therapy;

P / pertussis immunoglobulin (children under 2 years old).

Prevention

-specific- DTP (tetracoccus) from 3 months 3 times, with an interval of 45 days, revaccination at 18 months.

-non-specific

Isolation of the patient for 14 days. Children who have been in contact with the patient are observed for 7 days, a double bacteriological examination is carried out for children from the family hearth when treating a patient with whooping cough at home. Contact children of the first year of life and unvaccinated children up to 2 years of age should be given antitoxic antipertussis immunoglobulin.

With whooping cough, the actions of a nurse will depend on her profile (district nurse, hospital nurse, kindergarten nurse, etc.).

Actions of the hospital nurse:

Creation of a protective regime in the ward, department;

Providing physical assistance to the child during a coughing fit (support the child, soothe);

Organization of walks in the fresh air;

Control over the feeding regimen (frequent, small portions);

Prevention of nosocomial infection (control of the isolation of the child);

Providing emergency care for fainting, apnea, convulsions.

Actions of the site nurse:

Monitor compliance of the child's parents with the isolation regime within 30 days from the moment of illness;

Inform parents of other children about whooping cough;

Identify possible contacts of the child (especially in the first days of illness) with healthy children and ensure observation of them within 14 days from the moment of contact;

Be able to provide emergency care for apnea, convulsions, fainting;

Timely inform the doctor about the deterioration of the child's condition.

The leading action of the kindergarten nurse in case of whooping cough, quarantine measures will be carried out within 14 days from the moment of isolation of a sick child (early isolation of all children suspected of whooping cough; not to allow transfers of children to other groups, etc.).

The most common problem in all children with whooping cough is the risk of developing pneumonia.

The purpose of the nurse (district, hospital): prevent or reduce the risk of pneumonia.

Nurse actions:

Careful monitoring of the child's condition (timely notice changes in behavior, changes in skin color, the appearance of shortness of breath);

Counting the number of breaths, pulse per minute;

Body temperature control;

Strict adherence to medical prescriptions.

The most common laboratory confirmations of whooping cough are leukocytosis up to 30x10 9 /l with severe lymphocytosis and bacteriological examination of pharyngeal mucus.

Children in the first year of life and children with severe disease are usually hospitalized in DIB.

The period of isolation of patients with whooping cough is long - at least 30 days from the moment of illness.

With the advent of spasmodic cough, antibiotic therapy is indicated for 7-10 days (ampicillin, erythromycin, chloramphenicol, chloramphenicol, methicillin, gentomycin, etc.), oxygen therapy (the child's stay in an oxygen tent). Also apply hyposensitizing agents(diphenhydramine, suprastin, diazolin, etc.), mukaltin and bronchodilators (mukaltin, bromhexine, eufillin, etc.), inhalation of aerosols with sputum thinning enzymes (trypsin, chymopsin).

Since the problem of all children is the risk of whooping cough, and the main goal of the nurse is to prevent the disease, her actions should be aimed at developing specific immunity in children.

For this purpose, it can be applied DTP vaccine(adsorbed pertussis-diphtheria-tetanus vaccine).

Timing of vaccination and revaccination:

vaccination is carried out from 3 months three times with an interval of 30-45 days (0.5 ml IM) to healthy children who have not had whooping cough;

revaccination - at 18 months (0.5 ml / m, once).

At all times, when treating patients with whooping cough, doctors paid great attention to general hygiene rules - regimen, care and nutrition.

In the treatment of whooping cough, antihistamines are used (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, mukaltin.

Mostly children of the first half of the year with a pronounced severity of the disease are subject to hospitalization due to the risk of developing apnea and serious complications. Hospitalization of older children is carried out in accordance with the severity of the disease and for epidemic reasons. In the presence of complications, indications for hospitalization are determined by their severity, regardless of age. It is necessary to protect patients from infection.

Severely ill infants should be placed in a darkened, quiet room and disturbed as little as possible, since exposure to external stimuli can cause severe paroxysms with anoxia. For older children with mild forms of the disease, bed rest is not required.

Severe manifestations of pertussis infection (profound respiratory rhythm disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.

Erased forms of whooping cough do not require treatment. It is enough to eliminate external stimuli to ensure peace and longer sleep for whooping cough patients. In mild forms, prolonged exposure to fresh air and a small number of symptomatic measures at home can be limited. Walks should be daily and long. The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees. During an attack of coughing, you need to take the child in your arms, slightly lowering his head.

With the accumulation of mucus in the oral cavity, it is necessary to free the child's mouth with a finger wrapped in clean gauze.

Diet. Serious attention should be paid to nutrition, since pre-existing or developed nutritional deficiencies can significantly increase the likelihood of an adverse outcome. Food is recommended to give fractional portions.

The appointment of antibiotics is indicated in young children, with severe and complicated forms of whooping cough, in the presence of concomitant diseases in therapeutic doses for 7-10 days. The best effect is provided by ampicillin, gentamicin, erythromycin. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal and no later than 2-3 days of the convulsive period of the disease.

The appointment of antibiotics in the spasmodic period of whooping cough is indicated for the combination of whooping cough with acute respiratory viral diseases, bronchitis, bronchiolitis, in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.

Features of whooping cough in children of the first year of life.

1. Shortening of the catarrhal period and even its absence.

2. The absence of reprises and the appearance of their analogues - temporary stops in breathing (apnea) with the development of cyanosis, the possible development of seizures and death.

3. Longer period of spasmodic cough (sometimes up to 3 months).

If any problems arise in a sick child purpose of the nurse is their elimination (reduction).

The most responsible therapy for severe whooping cough in children of the first year of life. Oxygen therapy is necessary with the help of a systematic supply of oxygen, cleaning the airways from mucus and saliva. When breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. With signs of brain disorders (tremor, short-term convulsions, increasing anxiety), seduxen is prescribed and, for the purpose of dehydration, lasix or magnesium sulfate. From 10 to 40 ml of a 20% glucose solution with 1-4 ml of a 10% calcium gluconate solution is injected intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - aminofillin, for children with neurotic disorders - bromine preparations, luminal, valerian. With frequent severe vomiting, parenteral fluid administration is necessary.

Antitussives and sedatives. The efficacy of expectorant mixtures, cough suppressants, and mild sedatives is questionable; they should be used sparingly or not at all. Cough-provoking influences (mustard plasters, jars) should be avoided.

For the treatment of patients with severe forms of the disease - glucocorticosteroids and / or theophylline, salbutamol. With apnea attacks, chest massage, artificial respiration, oxygen.

Prevention in contact with the sick.

In unvaccinated children, human normal immunoglobulin is used. The drug is administered twice with an interval of 24 hours as soon as possible after contact.

Chemoprophylaxis with erythromycin at an age dosage for 2 weeks can also be carried out.

Whooping cough can affect both adults and children. Immunity from this respiratory infection is developed only after a person has been ill once. In children, the manifestations are more severe, and complications can be very serious, even fatal. Vaccination is done in the first months of life. It does not guarantee complete protection against infection, but in vaccinated children, the disease occurs in a much milder form. Doctors recommend that parents, when caring for children with whooping cough, protect them as much as possible from any factors that provoke the appearance of a suffocating cough.

The causative agent of this disease is whooping cough (a bacterium called Bordetella). The infection affects the trachea and bronchi.

The respiratory tract is covered with the so-called ciliated epithelium, the cells of which have "cilia" that ensure the movement of sputum and its removal to the outside. When irritated by their toxic substances secreted by whooping cough pathogens, the nerve endings transmit a signal from the epithelium to the brain (to the area responsible for coughing). The response is a reflex cough, which should push out the source of irritation. Bacteria are firmly held on the epithelium due to the fact that they have special villi.

Characteristically, the cough reflex is so fixed in the brain that even after the death of all bacteria, strong urges to cough continue to persist for several more weeks. Waste products of pertussis bacteria cause general intoxication of the body.

Warning: Humans have no innate immunity to this disease. Even a baby can get sick. Therefore, it is so important to protect him from contact with adults who have a strong persistent cough. It may well be a sign of whooping cough, which in an adult, as a rule, does not have other characteristic manifestations.

The susceptibility of a person is so great that if a baby gets sick, then the rest of the family will definitely get infected from it. Whooping cough lasts 3 months as long as the cough reflex exists. In this case, for about 2 weeks, the disease has practically no symptoms. If somehow it is possible to establish in the very first days that pertussis bacteria are present in the body, then the disease can be quickly suppressed, since the dangerous cough reflex has not yet had time to gain a foothold. Usually, the symptoms of whooping cough in children are detected already at a severe stage. Then the disease continues until the cough gradually disappears on its own.

Video: How to prevent coughing fits

How infection occurs

Most often, whooping cough infects children under the age of 6-7 years. Moreover, in babies younger than 2 years, the probability of infection is 2 times higher than in older children.

The incubation period for whooping cough is 1-2 weeks. Within 30 days, the child should not attend a childcare facility, contact with other children, since whooping cough is very contagious. Infection is possible only by airborne droplets in close contact with a sick person or a carrier when he sneezes or coughs.

Outbreaks of the disease occur more often in the autumn-winter period. This is due to the fact that whooping cough bacteria quickly die under the rays of the sun, and the duration of daylight hours in winter and autumn is minimal.

Whooping cough forms

When infected with whooping cough, the course of the disease is possible in one of the following forms:

1. Typical - the disease consistently develops with all its inherent signs.
2. Atypical (erased) - the patient only coughs slightly, but there are no strong attacks. For some time, the cough may disappear altogether.
3. In the form of a bacteriocarrier, when there are no signs of the disease, but the child is a carrier of bacteria.

This form is dangerous because other people can be infected, while the parents are sure that the baby is healthy. Most often, this form of whooping cough occurs in older children (after 7 years), if they have been vaccinated. The baby remains a carrier also after recovery from a typical whooping cough up to 30 days from the moment the infection enters his body. Often in such a latent form, whooping cough manifests itself in adults (for example, workers in child care facilities).

The first signs of whooping cough

At the initial stage, the disease does not cause much concern for parents, since the first signs of whooping cough resemble the common cold. The baby has severe chills due to rising temperature, headache, weakness. Snot appears, and then an intensifying dry cough. And the usual cough medicines do not help. And only after a few days, symptoms of a typical whooping cough may appear, which gradually increase.

Video: Whooping cough infection, symptoms, the importance of vaccination

Periods of illness and characteristic symptoms of whooping cough

There are the following periods of development in a child of whooping cough symptoms:

1. Incubation. The infection has already occurred, but there are no first signs of the disease. They appear only on the 6-14th day from the moment the bacteria enters the body.
2. Premonitory. This is a period associated with the appearance of whooping cough harbingers: a dry, gradually increasing (especially at night) cough, a slight increase in temperature. At the same time, the child feels well. But this state lasts 1-2 weeks without change.
3. Spasmodic. There are bouts of convulsive coughing associated with an attempt to push out something that irritates the respiratory tract, it is difficult to inhale air. After several coughing exhalations, a deep breath follows with a characteristic whistling sound (reprise) arising from a spasm of the larynx in the vocal cords. After that, the baby convulsively shudders several times. The attack ends with the release of mucus or vomiting. Coughing fits with whooping cough can be repeated from 5 to 40 times a day. The frequency of their occurrence is a characteristic of the severity of the disease. During an attack, the child's tongue sticks out, the face has a red-blue color. The eyes turn red, as blood vessels burst due to tension. It is possible to stop breathing for 30-60 seconds. This period of illness lasts approximately 2 weeks.
4. Reverse development (resolution). The cough gradually weakens, attacks appear for another 10 days, the pauses between them increase. Then severe symptoms disappear. The child coughs a little for another 2-3 weeks, but the cough is normal.

Note: In infants, the excruciating attacks do not last so long, but after a few coughing movements, respiratory arrest may occur. Oxygen starvation of the brain causes diseases of the nervous system, developmental delays. Even death is possible.

Video: How to recognize whooping cough

Possible Complications

Complications of whooping cough can be inflammation of the respiratory system: lungs (pneumonia), bronchi (bronchitis), larynx (laryngitis), trachea (tracheitis). As a result of the narrowing of the lumen of the respiratory passages, as well as spasms and swelling of the tissues, death can occur. Especially quickly bronchopneumonia develops in children under the age of 1 year.

Complications such as emphysema (bloating), pneumothorax (damage to the lung wall and air leakage into the surrounding cavity) are possible. Strong tension during an attack can cause an umbilical and inguinal hernia, nosebleeds.

After whooping cough, due to cerebral hypoxia, tissue damage to individual centers sometimes occurs, as a result of which the child's hearing is impaired or epileptic seizures occur. Seizures are very dangerous, which also occur due to disruption of the brain and can lead to death.

Due to tension when coughing, damage to the eardrums, hemorrhage in the brain occurs.

Diagnosis of whooping cough in children

If whooping cough in a child occurs in a mild and atypical form, the diagnosis is very difficult. The doctor may assume that the malaise is caused by this particular disease, in the following cases:

• the child does not cough for a long time, the symptom only intensifies, while the runny nose and fever stopped after 3 days;
• expectorants do not have any effect, on the contrary, the state of health worsens after taking them;
• Between coughing fits, the baby seems healthy and has a normal appetite.

In this case, to make sure that the patient has whooping cough, a bacteriological culture of a throat swab is done. The difficulty lies in the fact that the bacterium is sufficiently firmly held by the ciliated epithelium and is not brought out. The likelihood that even in the presence of pertussis pathogens they can be detected in this way is reduced to zero if the child has eaten or brushed his teeth before the procedure. They will be completely absent in the sample if the baby was given even an insignificant dose of antibiotic.

A general blood test is also done, which allows you to detect a characteristic increase in the content of leukocytes and lymphocytes.

Methods for diagnosing whooping cough are used by a blood test for antibodies (ELISA, PCR, RA).

There is a method of express diagnostics. The smear is processed with a special composition and studied under a microscope, which uses the effect of the glow of antibodies when illuminated.

Warning: If there are characteristic symptoms of whooping cough, the child must be isolated to avoid infecting other people. In addition, his situation may worsen after communicating with patients with a cold or flu. Even after recovery, the body is weakened, the slightest hypothermia or infection causes severe complications of whooping cough.

Signs of pneumonia

Inflammation of the lungs is one of the most common complications. Since parents know that whooping cough does not go away quickly, they do not always go to the doctor if the baby's condition changes. However, in some cases, delay is dangerous, so it is imperative to show the child to a specialist. Warning signs that require urgent treatment include:

Temperature rise. If this happens 2-3 weeks after the onset of whooping cough attacks, the baby does not have a runny nose.

Increased cough after the condition of the child has already begun to improve. Sudden increase in the duration and frequency of seizures.

Rapid breathing between attacks. General weakness.

Treatment of whooping cough in children

Whooping cough is mostly treated at home, unless it occurs in babies under the age of 1 year. Their complications develop rapidly, the baby can simply not have time to save. A child of any age is hospitalized if complications arise or respiratory arrest occurs during attacks.

First aid at home for whooping cough

During a coughing fit, the baby should not lie down. He must be planted immediately. The temperature in the room should be no more than 16 degrees. Turn off the heating completely and use a sprinkler to humidify the air.

It is important to calm and distract the baby with the help of toys, cartoons. Since the cause of coughing is the excitation of the nerve center of the brain, fear and excitement provoke increased coughing and spasm in the respiratory tract. At the slightest deterioration in the condition, it is urgent to call an ambulance.

Note: As doctors emphasize, any means are good to stop and prevent an attack, as long as they evoke positive emotions in the baby. Watching children's TV shows, buying a dog or new toys, going to the zoo force the brain to switch to the perception of new experiences, reduce sensitivity to irritation of the cough center.

How to alleviate the condition and speed up recovery

A sick baby needs to walk every day to prevent brain hypoxia and improve breathing. At the same time, one must remember that it can infect other children. Especially useful are walks along the banks of a river or lake, where the air is cooler and more humid. It is not recommended to walk a lot, it is better to sit on a bench.

The patient should not be nervous.

An attack can provoke improperly organized nutrition. It is necessary to feed the baby often and little by little, mainly liquid food, since the chewing movement also causes coughing and vomiting. As Dr. E. Komarovsky explains, in a baby frightened by a previous attack while eating, even an invitation to the table often reflexively causes a whooping cough.

Warning: In no case is it recommended to self-medicate, use "grandmother's remedies" to get rid of a cough. The nature of the cough in this case is such that heating and infusions do not get rid of it, and an allergic reaction to plants can lead to a state of shock.

In some cases, after consulting with your doctor first, you can use folk tips to alleviate the condition when you cough. For example, traditional healers recommend for children over 13 years of age to prepare a compress from a mixture of equal amounts of camphor and eucalyptus oils, as well as vinegar. He is advised to lay on the chest of the patient for the whole night. This helps make breathing easier.

Antibiotic treatment

Whooping cough is usually detected at a stage when the cough reflex, which is the main danger, has already developed. In this case, antibiotics do not help.

At the stage of the appearance of harbingers of the disease, the baby is given only antipyretic medicine if there is a slight rise in temperature. It is impossible to give him expectorants when a dry paroxysmal cough appears on his own, since the movement of sputum will cause increased irritation of the respiratory tract.

Antibiotics (namely erythromycin, which has no harmful effect on the liver, intestines and kidneys) are used to treat children for whooping cough at a very early stage, while severe coughing fits have not yet appeared.

They are taken more often for preventive purposes. If someone in the family has whooping cough, then taking an antibiotic will protect children from the action of the bacterium. It kills the microbe before a cough develops. The antibiotic will also help not to get sick to adult family members caring for a sick baby.

Treatment in the hospital

In conditions of increased severity, the patient with whooping cough is hospitalized. The hospital uses funds to eliminate respiratory failure and oxygen starvation of the brain.

If a child is admitted to the hospital at the first stage of the disease, then the task is to destroy microbes, stop apnea attacks (stop breathing), relieve convulsions, and eliminate spasms in the bronchi and lungs.

To enhance the body's resistance to whooping cough infection, gamma globulin is introduced at an early stage. Vitamins C, A, group B are prescribed. Calming agents are used (infusions of valerian, motherwort). To relieve spasms and convulsions, treatment with antispasmodics is used: calcium gluconate, belladonna extract.

Antitussive drugs do not have a sufficient effect on whooping cough, however, with excruciating attacks, under the supervision of a doctor, they are given to children to facilitate sputum discharge. Among the drugs used are ambroxol, ambrobene, lazolvan (to thin sputum), bromhexine (mucus excretion stimulant), eufillin (relieves spasms in the respiratory organs).

In the treatment of children for whooping cough, antiallergic drugs are also used, and in severe cases, tranquilizers (seduxen, relanium).

To reduce the frequency of seizures and reduce the likelihood of apnea, psychotropic drugs (chlorpromazine), which also have an antiemetic effect, are used. Respiratory arrest is prevented by the administration of hormonal drugs. At the end of the spasmodic period, massage and breathing exercises are prescribed.

In order to prevent complications, oxygen therapy is used, and sometimes artificial ventilation of the lungs.

Video: The use of erythromycin for whooping cough, the importance of vaccination, cough prevention

Prevention

Since whooping cough is highly contagious, when cases of the disease are detected in a children's institution, all children and adults who have been in contact with the patient are examined and prophylactically treated. Erythromycin, which kills pertussis bacteria, is used, as well as injections of gamma globulin, which stimulates the production of antibodies.

Especially dangerous is infection with whooping cough in infants. Therefore, it is necessary to limit the child's stay in crowded places and communication with unfamiliar children and adults. If a child is brought from the hospital, while one of the family members is sick, it is necessary to completely exclude his contact with the baby.

Vaccination is the main preventive measure. It reduces the risk of infection. In the case of whooping cough, the course is much easier.

Forecast.

The prognosis of pertussis largely depends on the age of the child, the severity of the course and the presence of complications. Whooping cough is not very dangerous for older children.

The prognosis remains serious in young children with the addition of complications (pneumonia, asphyxia, encephalopathy).

Mortality among children under one year old reaches 0.1-0.9%.

Basic principles of treatment.

Children of early age with a severe form of whooping cough, with complications or with concomitant diseases are subject to hospitalization.

It is necessary to create a protective regime, to exclude as much as possible all irritants (mental, physical, painful, etc.).

The main task of pathogenetic therapy in severe forms is to combat hypoxia, oxygen therapy is carried out in oxygen tents, while the oxygen concentration should not exceed 40%, in mild and moderate forms, aerotherapy is indicated (prolonged exposure to fresh air), when breathing stops - mechanical ventilation.

To improve bronchial patency, eufillin is prescribed orally or parenterally (especially in case of signs of cerebrovascular accident, with obstructive syndrome, pulmonary edema).

To thin viscous sputum: mukaltin, mucopront, potassium iodide solution; antitussive drugs for children after 2 years - glaucine hydrochloride, glauvent, etc.

Inhalations with a solution of sodium bicarbonate, aminophylline, novocaine, ascorbic acid.

Carrying out postural drainages, suction of mucus.

Diet food.

Sedatives: seduxen, phenobarbital (reduce the frequency of seizures).

Immunomodulators.

Antibacterial therapy: erythromycin, rulid, vilprafen, sumamed (prevent the colonization of pertussis bacteria, but their effectiveness is limited by the early stages of the disease, in addition, they are indicated when a secondary bacterial infection is attached), the course of treatment is 8-10 days.

Pertussis immunoglobulin (children under 2 years).

Vitamin therapy.

Preventive and anti-epidemic measures for whooping cough:

In conditions of incomplete and late diagnosis, the patient is isolated for 30 days from the onset of the disease at home, and in severe forms and according to epidemic indications, hospitalization is carried out.

The focus is quarantined for 14 days from the moment of separation from the sick person, contacts are identified, they are registered and monitored daily (coughing detection) with a 2-fold bacteriological examination, with an interval of 7-17 days (until 2- x negative tests).

Only children of 7 years old are subject to separation.

Carrying out current disinfection during quarantine.

Specific prophylaxis: routine active immunization of children under one year of age with DTP (associated pertussis-diphtheria-tetanus vaccine).

DTP vaccination: from 3 months three times with an interval of 30 days.

I revaccination of DTP - 1.5-2 years after vaccination.

Vaccinations against whooping cough are not available for children older than 3 years.

Children under one year of age who have not been vaccinated against whooping cough are given immunoglobulin according to indications.

Nursing process in whooping cough.

Timely identify real and potential problems, violated needs of the patient and his family members.

Possible patient problems:

sleep disturbance;

loss of appetite;

persistent, obsessive cough;

respiratory failure;

• violation of physiological functions (loose stools);

  violation of motor activity;

  change in appearance;

  the inability of the child to independently cope with the difficulties that arose as a result of the disease;

  psycho-emotional stress;

  complication of the disease.

Possible problems for parents:

maladaptation of the family due to the illness of the child;

fear for the child;

uncertainty about the successful outcome of the disease;

lack of knowledge about illness and care;

inadequate assessment of the child's condition;

chronic fatigue syndrome.

Nursing intervention.

Inform parents about the causes of development, the course of whooping cough, the principles of treatment and care, preventive measures, and prognosis.

Limit the contact of a sick child with other children as much as possible.

Provide isolation of the patient at home until 2 negative results of bacteriological examination are obtained, and in severe cases, provide assistance in organizing hospitalization.

Ensure adequate aeration of the room where the sick child is located. Optimally, if the windows are constantly open, this is necessary for the child, especially at night, when the most severe coughing attacks occur (in the fresh air they settle down, are less pronounced and complications occur much less frequently).

Teach parents to provide first aid in case of vomiting and convulsions. Follow all doctor's orders in a timely manner.

Create a calm, comfortable environment around the child, protect him from unnecessary unrest and painful manipulations. Involve parents in the process of caring for a child, teach them how to properly sanitize the airways, carry out inhalations with a 2% solution of sodium bicarbonate, vibration massage.

Provide the child with nutrition adequate to his condition and age, it should be complete, enriched with vitamins (especially vitamin C, which contributes to better absorption of oxygen). Easily digestible liquid and semi-liquid foods are recommended: dairy cereal or vegetable mashed vegetarian soups, rice, semolina porridge, mashed potatoes, fat-free cottage cheese, you should limit the consumption of bread, animal fats, cabbage, extractive and spicy foods. In severe forms of the disease, give liquid and semi-liquid food (not containing crumbs, lumps), often and in small portions. With frequent vomiting, it is necessary to supplement the child after an attack and vomiting.

The amount of liquid consumed should be increased to 1.5-2 liters, a rosehip broth, tea with lemon, fruit drinks, warm degassed alkaline mineral waters (Borjomi, Narzan, Smirnovskaya) or a 2% solution of soda mixed in half with warm milk should be introduced.

Advise parents to organize an interesting leisure time for the child: diversify it with new toys, books, decals and other calm games according to age (since whooping cough attacks increase with excitement and increased physical activity).

Protect the patient from communicating with patients with acute respiratory viral infections, since the addition of secondary viral and bacterial infections creates a threat of developing pneumonia and an increase in the severity of whooping cough.

Organize current disinfection at home (disinfect dishes, toys, care items, furnishings, carry out wet cleaning twice a day with a soap and soda solution).

In the period of convalescence, it is recommended that the child be given non-specific disease prevention (complete nutrition enriched with vitamins, sleeping in the fresh air, hardening, dosed physical activity, exercise therapy, physiotherapy, massage).

Map the Nursing Process

whooping cough

Questions for self-study:

Define whooping cough.

What are the properties of the whooping cough pathogen?

What are the sources of infection?

What is the mechanism and ways of transmission of infection?

What is the development mechanism of whooping cough?

What are the main clinical manifestations of whooping cough in the catarrhal period?

What are the main clinical manifestations of whooping cough in the spasmodic period?

What are the features of the course of whooping cough in children under one year old?

What are the basic principles of whooping cough treatment?

What preventive and anti-epidemic measures are taken for whooping cough?

What complications can develop with whooping cough?

NURSING PROCESS MAP

NURSING PROCESS MAP

(the result of the dynamics of the disease)

the date	Stage 1 Collection of information	Stage 2 Patient problems	Stage 3 care plan	Stage 4 Implementation of the care plan	Stage 5 Evaluation of the effectiveness of care
	Used but not reflected in daily monitoring The examination is subjective (questioning) Objective (examination, anthropometry, percussion, auscultation, etc.) Study of medical records (history of development, survey data)	Real Primary (priority) and secondary Priority Potential	Short term goals (less than a week) Long term goals (more than a week) Independent interventions (do not require doctor's orders) Dependent interventions (based on doctor's orders or instructions) Mutually dependent interventions (carried out together with another health worker)		Effect achieved: fully not completely partially not achieved

NURSING PROCESS IN TUBERCULOSIS

Introduction

1. Etiology of whooping cough in children

2. Epidemiology of whooping cough

4. Whooping cough clinic in children

7. Prognosis of whooping cough in children

8. Treatment of whooping cough in children

Conclusion

References

Introduction

Whooping cough (Pertussis) is an acute infectious disease caused by pertussis bacillus, transmitted by airborne droplets, characterized by paroxysmal convulsive cough. Pertussis is first mentioned in the literature of the 15th century, but at that time febrile catarrhal diseases were described under this name, with which it was apparently confused. In the 16th century whooping cough is mentioned in connection with an epidemic in Paris, in the 17th century it was described by Sidenham. in the XVIII century - N.M. Maksimovich-Ambodik. A detailed description of whooping cough and its separation into an independent nosological unit date back to the 19th century (Trousseau). In Russia, the clinical picture of this disease is described by S.F. Khotovitsky in the book "Pediatrics" (1847). then N.F. Filatov. Whooping cough was studied in detail with the disclosure of pathogenesis in the 20th century, mainly in the 30s - 40s (A.I. Dobrokhotova. M.G. Danilevich. V.D. Soboleva and others).

Historical data Whooping cough was first described in the 16th century, in the 17th century. Sidenham suggested the real name of the disease. In our country, a great contribution to the study of whooping cough was made by N. Maksimovich-Ambodik, S.V. Khotovitsky, M.G. Da-nilevich, A.D. Shvalko. The causative agent of the disease Etiology. The causative agent of whooping cough is a gram-negative, hemolytic bacillus, immobile, not forming capsules and spores, unstable in the external environment. Pertussis bacillus forms exotoxin (pertussis toxin, lymphocytosis-stimulating factor), which is of major importance in pathogenesis. The causative agent has 8 agglutinogens, the leading ones are 1, 2.3. Agglutinogens are complete antigens against which antibodies (agglutanins, complement-fixing) are formed during the disease. Depending on the presence of leading agglutinogens, four serotypes of whooping cough are distinguished (1, 2, 0; 1, 0, 3; 1, 2, 3 and 1.0.0). Serotypes 1, 2.0 and 1.0.3 are more often isolated from vaccinated, patients with mild and atypical forms of the disease, serotype 1, 2, 3 - from unvaccinated, patients with severe and moderate forms. The antigenic structure of whooping cough also includes: filamentous hemagglutinin and protective agglutinogens (promote bacterial adhesion); adenylate cyclase toxin (determines virulence); tracheal cytotoxin (damages the epithelium of the cells of the respiratory tract); dermonecrotoxin and hemolysin (participate in the implementation of local damaging reactions); lipopolysaccharide (has the properties of endotoxin); histamine sensitizing factor. Source of infection Epidemiology. The source of infection are patients (children, adults) with both typical and atypical forms. Patients with atypical forms of whooping cough pose a particular epidemiological danger in family foci with close and prolonged contact (mother and child). The source can also be bacteria carriers of whooping cough. A patient with whooping cough is a source of infection from the 1st to the 25th day of the disease (subject to rational antibacterial therapy). Transmission mechanism: drip. The route of transmission is airborne. Infection occurs with close and sufficiently long contact with the patient (whooping cough spreads to 2-2.5 meters). Contagiousness index - 70-100%. Morbidity, age structure. Whooping cough affects children of all ages, including newborns, and adults. The maximum incidence of whooping cough is observed in the age group of 3-6 years. Seasonality: whooping cough is characterized by an autumn-winter rise with a maximum incidence in November-December and a spring-summer decline with a minimum incidence in May-June. Periodicity: an increase in the incidence of whooping cough is recorded after 2-3 years. Immunity after whooping cough is persistent; repeated diseases are noted against the background of an immunodeficiency state and require laboratory confirmation. Mortality is currently low.

1. Etiology of whooping cough in children

The etiology of whooping cough was elucidated by Bordet and Gengou in 1906-1908. It is caused by the gram-negative hemoglobinophilic bacillus Bordetella pertussis.

This is a fixed, small, short stick with rounded ends, 0.5 - 2 microns long. The classic medium for its growth is potato-glycerol agar with 20-25% human or animal blood (Borde-Jangu medium). Currently, casein charcoal agar is used. The stick on the media grows slowly (3-4 days), they usually add 20-60 IU of penicillin to inhibit other flora, which easily drowns out the growth of whooping cough; she is not sensitive to penicillin. Small shiny colonies resembling droplets of mercury are formed on the media.

The pertussis bacillus quickly dies in the external environment, it is very sensitive to the effects of elevated temperature, sunlight, drying, and disinfectants.

Individual fractions with immunogenic properties have been isolated from pertussis bacilli:

1.agglutinogen, which causes the formation of agglutinins and a positive skin test in recovered and vaccinated children;

2.toxin;

.hemagglutinin;

.a protective antigen that confers immunity to infection.

Under experimental conditions in animals, the clinical picture of whooping cough cannot be caused, although the pathogenic effect of the pertussis bacillus on monkeys, kittens, and white mice is noted. This is of great help in his study.

2. Epidemiology of whooping cough

Until now, whooping cough remains a serious problem not only for Russia, but for the whole world. According to the World Health Organization, about 60 million people fall ill with whooping cough every year, and about 1 million children die, mostly under the age of one year. As domestic and foreign practice shows, the main deterrent to the development of the whooping cough epidemic is vaccination.

Before the introduction of active immunization, whooping cough was a widespread disease throughout the world and ranked among the first places among airborne infections in terms of incidence.

On the territory of the Russian Federation, the incidence of whooping cough is unevenly distributed. The highest incidence is recorded in St. Petersburg (22.6 per 100 thousand population), Novosibirsk region (16.3 per 100 thousand population), Oryol region (16.1 per 100 thousand population), Moscow (15.7 per 100 thousand population), the Tyumen region (15.5 per 100 thousand population) and the Republic of Karelia (13.7 per 100 thousand population). This can be explained by the presence of large cities in these regions, where crowding of the population facilitates the spread of infections transmitted by airborne droplets, as well as low vaccination coverage in some regions (coverage in Karelia is 80-90%).

whooping cough is an acute infectious disease

In the long-term dynamics in all regions, there is a downward trend in the incidence, as well as synchronism of fluctuations in the incidence in the years of upsurge and years of decline. However, the rate of decline is more pronounced in regions with high incidence and less pronounced in regions with low incidence.

As in other regions of the world, in the pre-vaccination period (before 1959), the incidence of whooping cough in the Russian Federation was recorded at the level of 360-390 per 100 thousand of the population, reaching higher figures in the years of periodic rises (475.0 cases per 100 thousand population per year in 1958). The highest incidence rates occurred in large cities (in 1958 in Moscow - 461 per 100 thousand population, in Leningrad - 710 per 100 thousand population, and in some areas more than 1000 per 100 thousand population).

If we consider the incidence of whooping cough in Russia from 1937 to 1959, then we can identify a significant trend towards a decrease in the incidence from 1937 to 1946. During this period, the incidence has decreased by more than 2 times. In subsequent years (1947-1958) there was a significant trend towards an increase in the incidence rate with a growth rate of 23.8 (per 100,000 population per year). This led to an increase in the incidence by more than 3 times by 1958 and amounted to 475.0 per 100 thousand of the population.

After the start of mass immunization of the children's population of Russia in 1959, the incidence of whooping cough dropped sharply. So, over 10 years, there was a decrease in the incidence of almost 20 times to 21.0 (per 100 thousand population per year) in 1969. In subsequent years, the rate of decline in incidence somewhat slowed down - from 30.0 (per 100 thousand population per year) (1959-1969) to 2.0 (per 100 thousand population per year) (1969-1979).

A similar situation after the start of active immunization against whooping cough was noted in other countries: in Hungary, the incidence rate decreased to 18.7 (per 100,000 population); Czechoslovakia - up to 58.0 (per 100 thousand population). In the USA, the incidence has decreased by 70%, in England - by 8-12 times.

In 1980, an increase in unjustified medical exemptions from vaccination of children led to a decrease in vaccination coverage of the population to 60% and, as a result, to an increase in the incidence of whooping cough from 1979 to 1993. . During this period, the incidence increased annually by 1.0 (per 100 thousand population per year) and amounted to 26.6 cases (per 100 thousand population per year) in 1993. An increase in immunization coverage of the child population over 95% by 2000 led to to a decrease in morbidity by 1.6 cases (per 100,000 population per year), and in 2006 the incidence was 5.7 cases per 100,000 population. However, in recent years, there has been a slight slowdown in the rate of decline in the incidence - up to 0.5 cases per 100 thousand people per year.

Similar manifestations of the epidemic process were observed with a decrease in vaccination coverage in other countries of the world (England, Germany, Japan, USA, Canada). For example, in England, the incidence increased by more than 2 times and amounted to 125 cases per 100 thousand of the population during the years of the rise in the incidence (1978, 1982), the subsequent increase in vaccination coverage of the child population contributed to a decrease in the incidence to 1.7 per 100 thousand population by 2000

Thanks to the success of vaccination, the incidence of whooping cough in the Russian Federation by 2007 approached the incidence rate in the European Region (in 2007, the incidence was 5.7 per 100 thousand population in Russia and 5.5 in the European Region), although it still remains slightly higher .

In the long-term dynamics of whooping cough incidence, pronounced cyclic fluctuations are observed with a period of 3-4 years. This is due to a change in the virulence of circulating pathogens, an increase in which is inevitable with an increase in the frequency of passages among people with increased susceptibility.

In the pre-vaccination period in Russia, pronounced cyclical fluctuations were observed - in the years of the rise, the incidence increases by an average of 130 cases per 100 thousand of the population, or by 45-120% compared with the years of decline in the incidence.

After the introduction of vaccinations from 1958 to 1973. Against the background of a decrease in the incidence of epidemiologically significant fluctuations, no epidemiologically significant fluctuations were observed, but since 1973, cyclical fluctuations with a period of 3-4 years began to be noted again. In the years of rise, the incidence increases by 1.9-3 times compared with the years of decline in the incidence.

Synchronous cyclic fluctuations in incidence were observed in all age groups. During the years of rise, the incidence in the groups "children 1-2 years old" increased by 49%, in the remaining groups by 2-2.4 times and more than three times among adults.

When analyzing the dynamics of the incidence of whooping cough in various contingents of the Russian population over the past 10 years, it should be noted that a downward trend is observed only among the child population. Moreover, the rate of decrease in the incidence is most pronounced in the groups "children 1-2 years old" and "children 3-6 years old" (8.2 and 13.5, respectively). In these groups, the incidence decreased by 4 and 4.5 times and amounted to 30.4 per 100 thousand of the population in the group "children 1-2 years old", 36.6 per 100 thousand population in the group "children 3-6 years old". The rate of decrease in the incidence rate is less pronounced in the groups of "children under one year old" and "children 7-14 years old" (6.5 and 1.0, respectively) - the incidence rate decreased by 2.4 and 2 times and amounted to 79.8 per 100 thousand population in the group of "children under one year", 27.7 per 100 thousand of the population in the group of "children 7-14 years old". The incidence of whooping cough in adults over the past 10 years has almost doubled and currently stands at 0.4 per 100,000 population.

The total rank of different age groups at the beginning and at the end of the observation period differs significantly. In 1992, the most epidemiologically significant group was "children 3-6 years old", since it was among this contingent that a high incidence was recorded, and the proportion of this group in the structure of pertussis incidence was the largest. The groups "children under one year old" and "children 1-2 years old" were in second place in terms of the total rank. The least epidemiologically significant groups were "children aged 7-14" and "adults". At the end of the observation period, the most epidemiologically significant groups are "children under one year old" and "children 7-14 years old", since among them the highest incidence rate is recorded and the total proportion of these groups is 73.7%. Due to the effectiveness of the ongoing vaccination, the groups "children 3-6 years old" and "children 1-2 years old" are in second and third place, respectively, in terms of total rank. Adults remain the least epidemiologically significant group due to the low incidence of a small proportion (1.9%) in the incidence structure.

Thus, despite the successful vaccination, among the age groups "children under one year" and "schoolchildren" the highest incidence rate is recorded and their proportion increases among all registered cases of whooping cough. In addition, these groups are characterized by pronounced cyclical upswings. An increase in the incidence of adults and a mild decrease in the incidence of schoolchildren contributes to the spread of infection and supports the circulation of the pathogen.

One of the characteristics of the epidemic process of whooping cough is seasonality. The modern epidemiological feature of whooping cough infection can be considered autumn-winter seasonality, which is one of the indicators of the development of its epidemic process and is closely related to the social factors of public life. The manifestation of this symptom characteristic of the epidemic process of whooping cough can be traced in the territories where it is better detected and recorded.

On average, the rise in incidence began in September, lasted about 8 months, and ended in April. The month of maximum incidence was December.

However, there is a significant variation in the start, end, and duration of the seasonal upturn, depending on whether it was a recession year or a boom year. So, in the years of rising incidence, the seasonal increase in incidence began earlier (in August), lasted longer - the duration of the seasonal rise was from 7 to 11 months, while in the years of recession, the seasonal rise begins later (in September-October), lasts less (about 4 months). -8 months) and ended in February-April. The off-season period averages 4 months (from 1-2 months in the years of rising incidence to 6 months in the years of recession).

Seasonal rises in the incidence of whooping cough are typical for all age groups, but have different severity. The most pronounced seasonal rise in the groups "children 3-6 years old organized" and "children 7-14 years old" - it lasted from September to June and amounted to 10 months. The month of maximum incidence was December. "Disorganized children aged 3-6" are the first to be involved in the epidemic process - the seasonal rise in this group begins in June and ends in February. Then unorganized children 1-2 years old are involved (seasonal rise from August to February). Children aged 3-6 years attending preschool educational institutions and schoolchildren are involved in the epidemic process in September, which is associated with the formation of organized teams. In the groups "children under one year old" and "children 1-2 years old organized" the seasonal rise begins in October, ends in January-February. In the adult group, the seasonal rise is least pronounced - from November to September.

Epidemiology of whooping cough in children.

Patients are the source of infection. Contagiousness is greatest at the very beginning of the disease, in the future it gradually decreases in parallel with a decrease in the frequency of isolation of the pathogen. The sowing of pertussis sticks in the catarrhal period and in the 1st week of convulsive cough reaches 90-100%, in the 2nd week - 60-70%, in the 3rd week it decreases to 30-35%, in the 4th - up to 10% and from the 5th week it stops. Antibiotic therapy shortens the time of isolation of whooping cough, - it ends by the 25th day and even earlier. It is believed that contagiousness ends by the 30th day from the onset of the disease.

susceptibility and immunity.Susceptibility to infection is high - the contagiousness index ranges from 0.7 to 1.0. The difference in the susceptibility of the population is due to the genetic characteristics of people, the nature of the immunity formed as a result of vaccinations, as well as the peculiarities in the virulence of the pathogen and the magnitude of the infecting doses. After the transfer of whooping cough in a clinically expressed form, a sufficiently intense immunity develops if all the constituent parts of the pertussis pathogen, especially typical antigens, took part in its formation. But repeated cases were observed even in pre-vaccination time. Maternal immunity lasts no more than 4-6 weeks.

In all forms of whooping cough, patients pose a great danger as sources of infection. With typical forms, this danger is great, because the diagnosis, with few exceptions, is made only in the convulsive period and in the preceding catarrhal period, with high contagion, patients remain in children's groups. Patients with erased forms of whooping cough often cannot be diagnosed at all, and they spread the infection throughout the course of the disease. The frequency of erased forms is significant - from 10 to 50% of the number of cases. In recent years, cases of pertussis infection from adults have become noticeably more frequent - from mothers, fathers; cases of infection from nurses are known.

The carriage of whooping cough in the spread of infection is not significant. It is observed rarely, for a short time. In the absence of a cough, the release of the microbe into the external environment is limited.

Transmission of infection occurs by airborne droplets. The patient has contagious discharge from the upper respiratory tract, sputum, mucus; the pertussis contained in them is scattered in the environment during coughing, the dispersion radius is not more than 3 m. Transmission of infection through a third party, through things is unlikely due to the rapid death of the pathogen in the external environment.

Immunity is also developed after vaccination, but it is less resistant, and revaccination is carried out to maintain it. In addition, post-vaccination immunity in some cases does not protect children from the disease, but whooping cough in vaccinated children usually occurs in a mild or erased form.

Pertussis incidencein the past it was almost universal and second only to measles. Infants fell ill relatively rarely and accounted for about 10% of all cases, which depended on the characteristics of their regimen (limited communication with a wide range of children and thus less possibility of infection). The greatest number of diseases fell on the age from 1 to 5 years, then it fell after 10 years, and even more so in adults it became rare. It was noted that the groups of nurseries and kindergartens were often affected, and large foci appeared in them.

The situation changed after the introduction in the USSR in 1959 of compulsory vaccination, which led to a reduction in the incidence of more than 7 times. At the same time, children under the age of 1 year were in the most unfavorable position. They are still susceptible to whooping cough, since immunization begins to be carried out mainly from the second half of the year of life, and the sources of infection are vaccinated older children who fall ill with erased forms of whooping cough. Therefore, the incidence of whooping cough in infants is reduced less than in older children, and the proportion of infants among all cases even increased. More often than in the past, adults began to get sick.

Seasonality for whooping cough is uncharacteristic, it can occur at any time of the year. The frequency of incidence is expressed in its increase for several months or a year and then in the onset of a lull for 3-4 years. After the introduction of active immunization, this periodicity smoothed out.

Mortalitywith whooping cough in the past was high. Back in 1940, in Leningrad, it was 3.2%, and hospital mortality reached significantly higher figures, since the most seriously ill patients were hospitalized. Before the introduction of chemotherapy, it was estimated at 8-10%, and in the first half of the 20th century it was even 60% (Iochman). Among children suffering from rickets II-III degree, malnutrition, mortality increased by 3-4 times.

Currently, the lethality of whooping cough has been reduced to hundredths of a percent. In the structure of mortality of the population, whooping cough has practically lost its significance.

3. Pathogenesis and pathological anatomy of whooping cough in children

Long-term studies of a team of employees working under the guidance of A.I. Dobrokhotova, with the participation of I.A. Arshavsky and others.

The active principle of change is whooping cough.It is located on the mucous membrane of the respiratory tract - the larynx, trachea, in the bronchi, bronchioles and even in the alveoli.

Pertussis endotoxin causes irritation of the mucous membrane, resulting in a cough. Morphologically, catarrhal changes in the mucous membranes are revealed.

A widespread catarrhal process in the respiratory tract, prolonged irritation with a toxin leads to an increase in cough; it takes on a spasmodic character and behind it arises the goal of interconnected changes. With a spasmodic cough, the rhythm of breathing is disturbed, inspiratory pauses occur, which leads to congestion in the brain, to impaired gas exchange, to incomplete ventilation of the lungs and thus to hypoxemia and hypoxia, and contributes to the development of emphysema. Violation of the rhythm of breathing, delay in inspiration contributes to the disorder of hemodynamics; puffiness of the face, expansion of the right ventricle of the heart; arterial hypertension may develop. A circulatory disorder can also occur in the brain, which, together with hypoxemia, hypoxia, can lead to focal changes, convulsions.

There are indications that pertussis toxin, being absorbed into the blood, can have a direct effect on the nervous, cardiovascular systems, promote bronchospasm, etc. However, there is no convincing data in favor of this. A peculiar feature of whooping cough is the absence of intoxication (neurotoxicosis).

Specific morphological changes in whooping cough have not been identified. In the lungs, emphysema, hemo - and lymphostasis, blood overflow of the pulmonary - capillaries, peribroichnal edema are usually found. perivascular and interstitial tissue, sometimes spastic condition of the bronchial tree, atelectasis: circulatory disorders with degenerative changes are also determined in the myocardium. A sharp expansion of blood vessels, especially capillaries, was found in the brain tissue: degenerative structural changes also occur as a result of a special sensitivity to hypoxemia (B.N. Klosovsky). In the experiment, a similar picture occurs with prolonged increasing asphyxia.

Against the background of changes caused by whooping cough, inflammatory processes occur extremely often, especially pneumonia, caused by pneumococcus, streptococcus, and in recent years mainly by staphylococcus: they proceed severely, for a long time and serve as the main cause of death. Whooping cough often co-occurs with other infections, especially intestinal infections with SARS, which drastically worsen the severity of the disease. The addition of OVRI, infectious processes, as a rule, leads to an increase in coughing attacks. They are also usually the cause of the so-called relapses of whooping cough.

The basics of whooping cough pathogenesis can be represented as follows.

Functional and morphological changes in the respiratory system:

.Changes in the epithelium of the larynx, trachea, bronchi (degeneration, metaplasia without pronounced exudation due to the viscosity of thick sputum).

2.Spasmodic condition of the bronchi.

.Atelectasis.

.Inspiratory contraction of the respiratory muscles due to tonic convulsions.

.Emphysema of the lung tissue.

.Interstitial tissue changes:

a)increased permeability of the vascular walls,

b)hemostasis, hemorrhage,

in)lymphostasis,

G)lymphocytic, histiocytic, eosinophilic peribronchial infiltration.

7.Hypertrophy of the hilar lymph nodes.

8.Changes in terminal nerve fibers:

a)a state of increased excitability;

b)morphological changes in receptors located in the epithelium of the mucous membranes.

9.With complicated whooping cough, the changes are supplemented, respectively, by a frequently associated viral microbial infection.

The main causes of hemodynamic disturbances in the central nervous system, leading to increasing oxygen deficiency, acidosis, cerebral edema, and in some cases to hemorrhages:

.Violation of the respiratory rhythm, inspiratory convulsions.

2.Increased permeability of the walls of blood vessels.

.Venous congestion, aggravated by coughing.

.Changes in the lungs.

.Increased blood pressure due to vasospasm.

4. Whooping cough clinic in children

The incubation period ranges from 3 to 15 days(on average 5-8 days). Three periods are distinguished during the course of the disease: catarrhal, spasmodic cough and resolution.

catarrhal periodcharacterized by the appearance of a dry cough, in some cases there is a runny nose. The patient feels well, appetite is usually not disturbed, the temperature may be subfebrile, but more often it is normal. A feature of this period is the persistence of coughing; despite treatment, it gradually intensifies and acquires the character of limited attacks, which means a transition to the next period. The duration of the catarrhal period is from 3 to 14 days, this period is the shortest in severe forms and in infants.

The spasmodic (convulsive) period is characterized by the presence of coughing in the form of seizures, often preceded by precursors (aura) in the form of general anxiety, sore throat, etc. The attack consists of short coughing shocks (each of them is an exhalation), following one after another, which are interrupted from time to time by reprises. A reprise is a breath, it is accompanied by a whistling sound due to spastic narrowing of the glottis.

The attack ends with the release of thick mucus, maybe vomiting. Often, after a short break, a second attack occurs, followed by a third or more .; The concentration of seizures, their occurrence in a short period of time is called paroxysm. During an attack of coughing, the appearance of the patient is very characteristic. Due to the sharp predominance of exhalations (with each cough) and difficult inhalation during reprise, congestion occurs in the veins due to spasm and narrowing of the glottis. The child's face turns red, then turns blue, the veins in the neck swell, the face becomes puffy, the eyes become bloodshot; in a severe attack, there may be an involuntary separation of urine and feces. The patient's tongue is usually protruded to the limit, it also becomes cyanotic, tears flow from the eyes. As a result of frequently repeated attacks, puffiness of the face, swelling of the eyelids become persistent, hemorrhages may appear on the skin and conjunctiva of the eyes, which gives the patient with whooping cough a characteristic appearance even outside the attack. The friction of the protruding tongue during cough shocks against the teeth leads to the formation of an ulcer on the frenulum of the tongue, covered with a dense white coating.

In short, lighter attacks, there are the same changes, but less pronounced.

Outside of an attack, the general condition of patients with mild and moderate forms of whooping cough, occurring without complications, is almost not disturbed. In severe forms, children become irritable, lethargic, adynamic. They are afraid of seizures.

The temperature is back to normal. Dry rales are heard in the lungs; in severe forms, emphysema is determined. Radiologically, with severe forms of whooping cough, more often in older children, a basal triangle is determined (darkening with a base on the diaphragm and an apex in the hilus region).

In the study of the cardiovascular system, an increase in the pulse during an attack is found; there may be an increase in blood pressure; decrease in capillary resistance. In severe forms, there may be an expansion of the boundaries of the right ventricle of the heart.

In the spasmodic period in the first I - III: weeks, the number of attacks and their severity increase, then they stabilize for about 2 weeks, after which they gradually become rarer, shorter and lighter, and finally lose their paroxysmal character. The duration of the spasmodic period is from 2 to 8 weeks, but it can be significantly lengthened.

The resolution period is characterized by a cough without attacks, it can continue for another 2-4 weeks or more. The total duration of the disease is about 6 weeks, but may be longer.

In the period of resolution or even after the complete disappearance of the cough, "returns of seizures" sometimes occur (due to the presence of a focus of excitation in the medulla oblongata). They represent a response to some nonspecific stimulus, most often in the form of OVRI, while the patient is not contagious.

In the peripheral blood with whooping cough, lymphocytosis and leukocytosis are determined (the number of leukocytes can reach 15-109 / l - 40-109 / l or more). In severe forms, they become especially pronounced. ESR is low or normal. Leukocytosis, lymphocytosis appear even in the catarrhal period and persist until the infection is eliminated.

There are typical, erased, atypical and asymptomatic forms. Typical forms include the presence of a spasmodic cough. They can be of different severity: light, moderate and heavy.

The severity of whooping cough is determined at the height of the convulsive period, mainly by the number of seizures. This is natural, since as the frequency of attacks increases, they become longer, the number of reprises increases, and paroxysms form. The number of paroxysms also increases, changes in the body become more pronounced. This pattern can sometimes be broken.

With a mild form, the frequency of attacks is from 8 to 10 per day, they are short, the general well-being of the patient is not disturbed. With a moderate form, the number of attacks increases to 10-15, they are longer, with a large number of reprises, which entails venous congestion, sometimes vomiting and other changes: the patients feel disturbed, but very moderately. In severe form, there are up to 20-25 attacks per day, they last for several minutes, are accompanied by many reprises, paroxysms, vomiting occur; venous congestion is very pronounced even without attacks, the state of health is sharply disturbed, the patients become lethargic, irritable, lose weight, eat poorly.

The erased ones include forms with a mild spasmodic cough: coughing fits are very light, rare, they can last only a few days. Atypical forms proceed completely without convulsive cough. Their important diagnostic feature is also a tendency to divide into periods: a gradual increase in cough, its concentration, as it were, into attacks, but real attacks with reprisals do not develop; after stabilization of such changes for 6-10, sometimes for 14 days, a period of resolution occurs, the cough gradually subsides. Erased and atypical forms proceed very easily, the well-being of children is not disturbed, in accordance with this, hematological data also change less sharply. Leukocytosis, lymphocytosis can be minor, short-term, only one of these indicators can be changed. An asymptomatic form has also been described; it is diagnosed only on the basis of immunological changes; there may be mild hematological changes.

In infants, whooping cough is especially severe. They reduce the duration of the incubation and catarrhal periods, which is characteristic of severe forms. Very pronounced hypoxemia, hypoxia. Instead of a reprise, the child may cry, cry, sneeze, hold, and even stop breathing. Convulsive contractions of individual groups of facial muscles are observed, general convulsions may occur. Repeated respiratory arrests with cyanosis, loss of consciousness, convulsions indicate severe disorders of cerebral circulation and simulate a picture of encephalitis. They join early, complications of an inflammatory nature are difficult. Special examinations reveal the extremely frequent presence of sgfmlococcal infection, which can develop both in the form of local occipital lesions (pneumonia, otitis media, intestinal forms) and in the form of a generalized infection (O.N. Alekseeva).

5. Complications of whooping cough in children

In severe forms of whooping cough complications occur. nature "of its most pronounced manifestations." due to respiratory failure in the lungs, emphysema, atelectasis develop.Disturbance of gas exchange, impaired cerebral circulation, cerebral edema lead to seizures, loss of consciousness, to a picture resembling encephalitis.

Whooping cough complications

With whooping cough, complications can be caused by secondary, mainly coccal, flora (pneumococcus, streptococcus, staphylococcus aureus). Hemostasis, lymphostasis in the lung tissue, atelectasis, impaired gas exchange, catarrhal changes in the respiratory tract create exceptionally favorable conditions for the development of a secondary infection (bronchitis, bronchiolitis, pneumonia, pleurisy). Pneumonia is predominantly small-focal, difficult to treat, often occurs with subfebrile temperature and with poor physical data. Along with this, there is also rapidly flowing pneumonia with high temperature, respiratory failure, with an abundance of physical data. These complications, as a non-specific irritant, can lead to a sharp increase in the manifestations of the whooping cough process (increase, lengthening of convulsive cough attacks, increased cyanosis, brain disorders, etc.).

6. Diagnosis, differential diagnosis of whooping cough in children

Timely recognition of whooping cough allows:

.take the necessary preventive measures and thereby prevent infection of others;

2.alleviate the severity of the disease by early exposure to whooping cough.

Early diagnosis of whooping cough in the catarrhal period, as well as in erased, atypical forms is difficult. Of the clinical symptoms, obsession, persistence, a gradual increase in cough with poor physical data, and the complete absence of at least a temporary improvement from treatment are important. Cough, despite treatment, intensifies and begins to concentrate in attacks.

In the convulsive period, it is easier to diagnose the presence of coughing attacks with reprisals, viscous sputum, vomiting, etc., the characteristic appearance of the patient: pallor of the skin, puffiness of the face outside the attacks, sometimes hemorrhages in the sclera, small hemorrhages on the skin, an ulcer on the frenulum of the tongue in the presence of teeth etc. When diagnosing a disease in newborns, in children of the first months of life, the same changes matter, but taking into account the features outlined above.

In the period of resolution, the basis for diagnosis is coughing attacks, which retain their characteristic features for a long time.

With erased forms of whooping cough, the same duration of cough and the lack of effect of treatment should be taken into account; the cyclical nature of the process - a slight increase in coughing at a time corresponding to the transition of the catarrhal period to convulsive; increased cough in case of accession of another disease.

Epidemiological data help in the diagnosis, the presence of contact not only with patients with obvious whooping cough, but also with long-term coughing children and adults.

Laboratory diagnosis can be confirmed by three methods.

.Sowing. The material is taken in two ways: by the method of "cough plates" and "posterior pharyngeal swab". In the first two weeks, cultures give positive results in 70-80% of children and in 30-60% of adults. In the future, its diagnostic value decreases. 4 weeks after the onset of the disease, the pathogen, as a rule, cannot be isolated. However, in real conditions, the percentage of bacteriological confirmation in patients with whooping cough does not exceed 20-30%. Failures in the isolation of the pathogen are associated with the characteristics of the microorganism and its slow growth, the timing of bacteriological examination (the best inoculation is achieved when examining patients within the first two weeks from the onset of the disease), the rules for taking the material, the frequency of examination, the timing and conditions of delivery of the material, the quality of nutrient media and etc.

2.Polymerase chain reaction (PCR). Determination of B. pertussis DNA in the contents of the nasopharynx using PCR expands the possibilities of laboratory diagnosis of whooping cough, especially in patients receiving antibiotics, but rarely gives positive results in the later stages of the disease.

.Serology. Confirm the diagnosis of whooping cough at 2-3 weeks of illness

allow only serological methods. Using enzyme-linked immunosorbent assay (ELISA), IgG and IgA antibodies to pertussis toxin and fibrous hemagglutinin are determined. In non-immune individuals, seroconversion (increase in antibody titer by 2-4 times) has a diagnostic value. A single high antibody titer (2 or more standard deviations above the average for the corresponding population group) is a valuable diagnostic feature. The sensitivity of a single detection of antibodies is 50-80%.

Differential Diagnosiscarried out mainly with OVRI, bronchitis, tracheobronchitis, parapertussis. The main difference between whooping cough is the persistence of cough, the absence or low severity of catarrhal changes, poor physical data.

Of the laboratory methods, hematological examination is of the greatest value. If there are no changes, the study is repeated. Along with complex hematological changes (leukocytosis and lymphocytosis), the patient may have only leukocytosis or only lymphocytosis. The changes are also subtle.

bacteriological method.The study is carried out by sowing sputum on a Petri dish with the appropriate medium. It is better to take sputum with a cotton swab from the posterior pharyngeal space; sowing on the environment is done immediately. The method of "cough plates" is proposed: an open Petri dish with a nutrient medium is kept at a distance of 5-8 cm in front of the patient's mouth during coughing; mucus flying out of the mouth settles on the medium. Bacteriological examination has relatively little diagnostic value, since positive results can be obtained mainly in the early stages of the disease; etiotropic treatment reduces the survival rate. The basis of diagnosis is clinical changes. In recent years, the possibility of accelerated diagnosis by detecting whooping cough directly in smears from the nasopharyngeal mucus in the immunofluorescence reaction has been studied.

Immunological (serological) method.Agglutination reactions (RA) and complement fixation reactions (RSC) are used. Reactions come to light since the 2nd week of the convulsive period; the most evident increase in the titer of dilutions in immunological reactions in the dynamics of the disease. RSK gives positive results a little earlier and more often. The value of immunological reactions is reduced due to the late appearance. In addition, they may be negative, especially in infants and with early use of a number of antibiotics.

An intradermal allergic test with pertussis agglutinogen or an allergen is proposed. With a positive reaction after the introduction of 0.1 ml of the drug, an infiltrate with a diameter of at least 1 cm is formed at the injection site. The reaction is taken into account in a day; later it weakens. Its disadvantage is in the late terms of appearance (in the convulsive period).

7. Prognosis of whooping cough in children

Mortalitywith whooping cough at the present time, with well-placed work, it is practically not observed. Sometimes there are deaths among infants. The cause of death, as a rule, is severe manifestations of whooping cough with impaired cerebral circulation, complicated by pneumonia. Extremely unfavorable layering OVRI, staphylococcal infection. They increase whooping cough changes, which in turn leads to a more severe course of inflammatory processes - a vicious circle is created.

Severe forms of whooping cough, occurring with impaired cerebral circulation, with severe hypoxemia, respiratory arrest, convulsions, are unfavorable in relation to the long-term prognosis, especially in infants. After them, various disorders of the nervous system are often observed: neurosis, absent-mindedness, mental retardation up to oligophrenia; epilepsy is sometimes associated with whooping cough. The consequences of whooping cough can be bronchiectasis, chronic pneumonia.

Since 1959, after the introduction of active immunization against whooping cough, there have been changes in epidemic and logical indicators. The clinic noted an increase in the frequency of mild and erased forms of whooping cough, causing difficulties in diagnosis due to diseases of vaccinated children.

Clinical manifestations of whooping cough in unvaccinated children (this applies mainly to infants) have fully retained their classic features. Their whooping cough is severe, with a large number of complications, however, with proper treatment, lethality can be practically eliminated by using a complex of pathogenetic and etiotropic agents that affect both whooping cough and secondary microbial infection. The possibility of long-term consequences in these cases retains its significance. In vaccinated children, whooping cough usually occurs in the form of mild forms, moderate forms are rare, complications of the first group practically do not occur, and complications of the second group are rare and mild.

8. Treatment of whooping cough in children

Treatment of patients with whooping cough is based on an accurate account of its pathogenesis. The primary task is to eliminate whooping cough as early as possible, which can prevent the formation of changes in the central nervous system. This problem is solved by etiotropic treatment - the use of antibiotics.

The use of levomycetin in the catarrhal period or at the beginning of the spasmodic period has a beneficial effect on the manifestations of whooping cough, the number and severity of attacks are reduced, and the duration of the disease is shortened. From the 2nd week of spasmodic cough and later, when changes in the central nervous system become the basis of the disease, antibiotics do not have a stopping effect.

Levomycetin is given orally at 0.05 mg / kg 4 times a day for 8-10 days. In severe forms, children over the age of 1 are prescribed chloramphenicol sodium succinate. With the formed process from the 2-3rd week of the spasmodic period, ampicillin, erythromycin are used. Ampicillin is prescribed orally or intramuscularly at the rate of 25-50 mg/kg per day in 4 doses for 10 days, the dose of erythromycin is 5-10 mg/kg per dose, 3-4 grooves per day. In severe forms, a combination of two, and sometimes three antibiotics is indicated.

Specific anti-pertussis y-globulincomplements successful treatment at an early stage of the disease. It is administered intramuscularly in doses of 3 ml for 3 consecutive days, then several times every other day.

With clinically pronounced symptoms of hypoxemia and hypoxia, gene therapy is indicated - keeping in an oxygen tent for 30-60 minutes several times a day. In the absence of a tent, the patient is allowed to breathe humidified oxygen. A good effect has a long lasting effect. exposure to fresh air (at a temperature not lower than 10 ° C). It normalizes the rhythm of heart contractions, deepens breathing, enriches the blood with oxygen. Intravenous administration of 15-20 ml of a 25% glucose solution is shown, preferably together with calcium gluconate (3-4 ml of a 10% solution).

Neuroplegics(chlorpromazine, propazine), due to the direct effect on the central nervous system, have a positive effect both in the early and late periods of the disease. They help to calm patients, reduce the frequency and severity of spasmodic cough, prevent or reduce the number of delays that occur during coughing, respiratory arrest, and vomiting. Do injections of 2.5% solution of chlorpromazine at the rate of 1-3 mg / kg of the drug per day with the addition of 3-5 ml of 0.25-0.5% solution of novocaine; propazine is given orally at a dose of 2-4 mg/kg.

The daily dose is administered in 3 doses, the course of treatment is 7-10 days.

Antispastic agents (atropine, belladonna, papaverine) are used to relieve seizures, but they are ineffective. Narcotic drugs (luminal, lidol, chloral hydrate, codeine, etc.) are contraindicated. They depress the respiratory center, reduce the depth of breathing and increase hypoxemia.

When breathing stops, artificial respiration is used. Means that excite the respiratory center are harmful, since in these cases it is already in a state of sharp overexcitation.

Vitamin therapy is needed: vitamins A, C. K, etc.

Physiotherapy is widely used in hospital conditions: ultraviolet irradiation, calcium electrophoresis, novocaine, etc.

Complications of an inflammatory nature, especially pneumonia, require the earliest possible and sufficient use of antibiotics. Penicillin can also give an effect, but subject to sufficient dosage (at least 100,000 IU / kg per day). Since complications are often caused by staphylococci, semi-synthetic penicillin preparations (oxacillin, ampicillin, methicillin sodium salt, etc.), broad-spectrum antibiotics (oletethrin, sigmamycin, etc.) are prescribed.

In severe cases, a combination of antibiotics is needed. A similar tactic should be followed with an increase in coughing attacks, with relapses, the cause of which, as a rule, is the addition of an inflammatory process. In these cases, stimulating therapy is also important (hemotransfusion, plasma transfusion, injections of y-globulin, etc.). physiotherapy procedures.

Whooping cough regimenit is necessary to build on the wide use of fresh air (walking, airing the room), reducing external stimuli that cause negative emotions. Older children are helped by distraction from illness by reading, calm games. This explains the slowing down of coughing when climbing on airplanes, when taking children to other places (inhibition of the dominant by new, stronger stimuli).

In a hospital setting, individual isolation of children with the most severe forms of whooping cough and young children is very important as a measure to prevent cross-infection.

Whooping cough foodshould be complete, high-calorie. In organizing the nutrition of a child, a strictly individual approach is necessary. With frequent bouts of coughing, vomiting, food should be given to the child at shorter intervals, in small quantities, in a concentrated form. You can supplement your baby shortly after vomiting.

9. Prevention of whooping cough in children

Preventive actions.

In modern conditions, whooping cough prevention is provided by active immunization. In Russia, specific prophylaxis is carried out with the help of an associated drug - adsorbed pertussis-diphtheria-tetanus vaccine (DPT). Vaccinations are carried out from the age of 3 months with a three-fold administration of the drug with a 1.5-month interval. At 18 months, a single revaccination is carried out.

Within 6-12 years after the completion of the course of immunization, the level of protection is reduced by 50%. The duration of protection is determined by the vaccination schedule, the number of doses received and the level of circulation of the pathogen in the population (probability of natural boosting).

Post-vaccination immunity does not protect against disease. Whooping cough in these cases proceeds in the form of mild and erased forms of infection. Over the years of specific prevention, their number has increased to 95% of cases. The disadvantages of the whole-cell vaccine are high reactogenicity, due to the risk of complications, it is impossible to administer the second and subsequent revaccinates, which does not solve the problem of eliminating pertussis infection, post-vaccination immunity is short, the protective efficacy of various whole-cell DTP vaccines varies significantly (36-95%). The protective efficacy of whole cell vaccines depends on the level of maternal antibodies (in contrast to a cell-free vaccine).

The pertussis component of the DTP vaccine has sufficient reactogenicity; after vaccinations, both local and general reactions are observed. Registered reactions of a neurological nature, which are a direct consequence of vaccinations. These circumstances have led to the fact that pediatricians are very cautious about administering DTP vaccinations, this explains the large number of unreasonable medical exemptions.

Given the new concept, first in Japan and then in other developed countries, an acellular pertussis vaccine based on pertussis toxin and new protective factors was created and introduced. Currently, families of combined pediatric preparations based on 2-, 3- and 5-component pertussis vaccine are produced on an industrial scale. The following have been available in developed countries for several years now: four-component (AaDPT + inactivated polio vaccine (IPV) or Haemophilus influenzae vaccine (HIB)), five-component (AaDPT + IPV + Hib), six-component (AaDPT + IPV + Hib + hepatitis B) vaccines.

Anti-epidemic measures

Activities aimed at early detection of patients

Identification of patients with whooping cough is carried out according to clinical criteria in accordance with the standard case definition with further mandatory laboratory confirmation. Children under the age of 14 years who have not had whooping cough, regardless of their vaccination history, who have been in contact with whooping cough patients, if they have a cough, are allowed into the children's team after receiving two negative results of bacteriological examination. Contact persons are placed under medical supervision for 7 days and a double bacteriological examination is carried out (two days in a row or with an interval of one day).

Activities aimed at interrupting transmission routes

Children in the first months of life and children from closed children's groups (children's homes, orphanages, etc.) are subject to isolation (hospitalization). All patients with whooping cough (children and adults) identified in nurseries, nursery-kindergartens, orphanages, maternity hospitals, children's departments of hospitals and other children's organized groups are subject to isolation for a period of 14 days from the onset of the disease. Bacteriocarriers are also subject to isolation until two negative results of bacteriological examination are obtained. In the focus of pertussis infection, the final disinfection is not carried out, daily wet cleaning and frequent airing are carried out.

Activities aimed at a susceptible organism

Unvaccinated children under the age of one year, children over one year old, unvaccinated or with incomplete vaccinations, as well as weakened by chronic or infectious diseases, it is advisable to administer antitoxic anti-pertussis immunoglobulin to those who have been in contact with whooping cough patients. Immunoglobulin is administered regardless of the time that has passed since the day of communication with the patient. Emergency vaccination in the outbreak is not carried out.

Neutralization of the source of infectionincludes isolation as early as possible at the first suspicion of whooping cough, and even more so when this diagnosis is established. Isolate the child at home (in a separate room, behind a screen) or in the hospital for 30 days from the onset of the disease. After removing the patient, the room is ventilated.

Quarantine (separation) is subject to children under the age of 7 who were in contact with the patient, but did not have whooping cough. The quarantine period is 14 days in case of isolation of the patient.

All children under the age of 1 year, as well as young children who are not immunized against whooping cough for any reason, in case of contact with a patient, 7-globulin is administered (3-6 ml twice every 48 hours), it is better to use a specific anti-pertussis 7- globulin.

Hospitalization is subject to patients with severe, complicated forms of whooping cough, especially under the age of 2 years, and especially infants, patients living in adverse conditions. According to epidemiological indications (for isolation), patients are hospitalized from families in which there are infants, from hostels where there are children who did not have whooping cough.

Active immunizationis the main link in the prevention of whooping cough. The DTP vaccine is currently being used. The pertussis vaccine in it is represented by a suspension of the first phase of pertussis bacilli adsorbed by phosphate or aluminum hydroxide. Immunization starts from 3 months, is carried out three times with an interval of 1.5 months, revaccination is carried out 1 1/2-2 years after the vaccination is completed.

Full coverage of vaccination and revaccination of children leads to a significant reduction in the incidence.

10. Nursing process for whooping cough

With whooping cough, the actions of a nurse will depend on her profile (district nurse, hospital nurse, kindergarten nurse, etc.).

Actions of the hospital nurse:

Creation of a protective regime in the ward, department;

providing a child with physical assistance during a coughing fit (support the child, soothe);

organization of walks in the fresh air;

control over the feeding regimen (frequent, small portions);

prevention of nosocomial infection (control of the isolation of the child);

providing emergency care for fainting, apnea, convulsions.

Actions of the site nurse:

Monitor compliance of the child's parents with the isolation regime within 30 days from the moment of illness;

inform parents of other children about a case of whooping cough;

to identify possible contacts of the child (especially in the first days of illness) with healthy children and ensure their observation within 14 days from the moment of contact;

be able to provide emergency care for apnea, convulsions, fainting;

promptly inform the doctor about the deterioration of the child's condition.

The leading action of the kindergarten nursein case of whooping cough, quarantine measures will be carried out within 14 days from the moment of isolation of a sick child (early isolation of all children suspected of whooping cough; not to allow transfers of children to other groups, etc.).

The most common problem in all children with whooping cough is the risk of developing pneumonia.

The purpose of the nurse (district, hospital):prevent or reduce the risk of pneumonia.

Nurse actions:

Careful monitoring of the child's condition (timely notice changes in behavior, changes in skin color, the appearance of shortness of breath);

counting the number of breaths, pulse per minute;

body temperature control;

strict adherence to medical prescriptions.

The most common laboratory confirmation of whooping cough is leukocytosis up to 30x10 9/l with severe lymphocytosis and bacteriological examination of pharyngeal mucus.

Children in the first year of life and children with severe disease are usually hospitalized in DIB.

The period of isolation of patients with whooping cough is long - at least 30 days from the moment of illness.

With the advent of spasmodic cough, antibiotic therapy is indicated for 7-10 days (ampicillin, erythromycin, chloramphenicol, chloramphenicol, methicillin, gentomycin, etc.), oxygen therapy (the child's stay in an oxygen tent). Also apply hyposensitizing agents(diphenhydramine, suprastin, diazolin, etc.), mukaltin and bronchodilators (mukaltin, bromhexine, eufillin, etc.), inhalation of aerosols with sputum thinning enzymes (trypsin, chymopsin).

Since the problem of all children is the risk of whooping cough, and the main goal of the nurse is to prevent the disease, her actions should be aimed at developing specific immunity in children.

For this purpose, it can be applied DTP vaccine(adsorbed pertussis-diphtheria-tetanus vaccine).

Timing of vaccination and revaccination:

revaccination - at 18 months (0.5 ml / m, once).

At all times, when treating patients with whooping cough, doctors paid great attention to general hygiene rules - regimen, care and nutrition.

In the treatment of whooping cough, antihistamines are used (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, mukaltin.

Mostly children of the first half of the year with a pronounced severity of the disease are subject to hospitalization due to the risk of developing apnea and serious complications. Hospitalization of older children is carried out in accordance with the severity of the disease and for epidemic reasons. In the presence of complications, indications for hospitalization are determined by their severity, regardless of age. It is necessary to protect patients from infection.

Severely ill infants should be placed in a darkened, quiet room and disturbed as little as possible, since exposure to external stimuli can cause severe paroxysms with anoxia. For older children with mild forms of the disease, bed rest is not required.

Severe manifestations of pertussis infection (profound respiratory rhythm disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.

Erased forms of whooping cough do not require treatment. It is enough to eliminate external stimuli to ensure peace and longer sleep for whooping cough patients. In mild forms, prolonged exposure to fresh air and a small number of symptomatic measures at home can be limited. Walks should be daily and long. The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees. During an attack of coughing, you need to take the child in your arms, slightly lowering his head.

With the accumulation of mucus in the oral cavity, it is necessary to free the child's mouth with a finger wrapped in clean gauze.

Diet. Serious attention should be paid to nutrition, since pre-existing or developed nutritional deficiencies can significantly increase the likelihood of an adverse outcome. Food is recommended to give fractional portions.

The appointment of antibiotics is indicated in young children, with severe and complicated forms of whooping cough, in the presence of concomitant diseases in therapeutic doses for 7-10 days. The best effect is provided by ampicillin, gentamicin, erythromycin. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal and no later than 2-3 days of the convulsive period of the disease.

The appointment of antibiotics in the spasmodic period of whooping cough is indicated for the combination of whooping cough with acute respiratory viral diseases, bronchitis, bronchiolitis, in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.

Features of whooping cough in children of the first year of life.

1. Shortening of the catarrhal period and even its absence.

The absence of reprises and the appearance of their analogues - temporary stops in breathing (apnea) with the development of cyanosis, the possible development of convulsions and death.

A longer period of spasmodic cough (sometimes up to 3 months).

If any problems arise in a sick child purpose of the nurseis their elimination (reduction).

The most responsible therapy for severe whooping cough in children of the first year of life. Oxygen therapy is necessary with the help of a systematic supply of oxygen, cleaning the airways from mucus and saliva. When breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. With signs of brain disorders (tremor, short-term convulsions, increasing anxiety), seduxen is prescribed and, for the purpose of dehydration, lasix or magnesium sulfate. From 10 to 40 ml of a 20% glucose solution with 1-4 ml of a 10% calcium gluconate solution is injected intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - aminofillin, for children with neurotic disorders - bromine preparations, luminal, valerian. With frequent severe vomiting, parenteral fluid administration is necessary.

Antitussives and sedatives. The efficacy of expectorant mixtures, cough suppressants, and mild sedatives is questionable; they should be used sparingly or not at all. Cough-provoking influences (mustard plasters, jars) should be avoided.

For the treatment of patients with severe forms of the disease - glucocorticosteroids and / or theophylline, salbutamol. With apnea attacks, chest massage, artificial respiration, oxygen.

Prevention in contact with the sick.

In unvaccinated children, human normal immunoglobulin is used. The drug is administered twice with an interval of 24 hours as soon as possible after contact.

Chemoprophylaxis with erythromycin at an age dosage for 2 weeks can also be carried out.

11. Activities in the focus of whooping cough

The room where the patient is located is thoroughly ventilated.

Children who were in contact with the patient and did not have whooping cough are subject to medical supervision within 14 days from the moment of separation from the patient. The appearance of catarrhal phenomena and cough raises the suspicion of whooping cough and requires isolation of the child from healthy children until the diagnosis is clarified.

Children under 10 years of age who have been in contact with a sick person and who have not had whooping cough are quarantined for a period of 14 days from the moment of isolation of the patient, and in the absence of separation - within 40 days from the moment of illness or 30 days from the moment the patient develops convulsive cough.

Children over 10 years of age and adults working in children's institutions are allowed in children's institutions, but within 14 days from the moment of separation from the patient, they are under medical supervision. With ongoing home contact with the patient, they are under medical supervision for 40 days from the onset of the disease.

All children who have not had whooping cough and are in contact with the patient are subject to examination for bacteriocarrier. If a bacteriocarrier is detected in non-coughing children, they are admitted to children's institutions after three negative bacteriological studies conducted at intervals of 3 days and with a certificate from the clinic stating that the child is healthy.

Contact children under the age of one year, who are not vaccinated against whooping cough and who have not had whooping cough, are injected intramuscularly with gamma globulin 6 ml (3 ml every other day).

Contact children aged 1 to 6 years who have not had whooping cough and are not vaccinated against whooping cough are given accelerated immunization with pertussis monovaccine three times, 1 ml every 10 days.

In foci of whooping cough, according to epidemiological indications, children who have been in contact with a patient previously vaccinated against whooping cough, in whom more than 2 years have passed since the last vaccination, are revaccinated once at a dose of 1 ml. the room where the patient is located is thoroughly ventilated.

Conclusion

Whooping cough is widespread throughout the world. Every year, about 60 million people fall ill, of which about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely practiced for many years. Probably, among adults, whooping cough is more common, but not detected, since it occurs without characteristic convulsive seizures. When examining individuals with a persistent persistent cough, 20-26% are serologically diagnosed with pertussis infection. Mortality from whooping cough and its complications reaches 0.04%.

The most common complication of whooping cough, especially in children under 1 year of age, is pneumonia. Often develop atelectasis, acute pulmonary edema. Most often, patients are treated at home. Patients with a severe form of whooping cough and children under 2 years of age are hospitalized.

With the use of modern methods of treatment, mortality in whooping cough has decreased and occurs mainly among children 1 year old. Death can occur from asphyxia with complete closure of the glottis due to spasm of the muscles of the larynx during a coughing fit, as well as from respiratory arrest and convulsions.

Prevention consists in carrying out vaccination of children with pertussis - diphtheria-tetanus vaccine. The effectiveness of pertussis vaccine is 70-90%.

Vaccination is particularly good at protecting against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild whooping cough, 81% against paroxysmal and 95% against severe.

References

1.Veltishchev Yu.E. and Kobrinskaya B.A. Pediatric emergency care. Medicine, 2006 - 138s.

2.Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic

.practice. - M.: - Perm, 2001 - 211s.

.Sergeeva K.M., Moskvicheva O.K., Pediatrics: a guide for doctors and students K.M. - St. Petersburg: Peter, 2004 - 218s.

.Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n / a: Phoenix, 2004 - 143s.

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