Whooping cough is an acute infectious disease. Whooping cough

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 (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, and mucaltin are used.

Mostly children in the first half of the year with severe illness 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 epidemiological 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.

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

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

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

If mucus accumulates in the oral cavity, you need to empty the child's mouth using a finger wrapped in clean gauze...

Diet. Careful attention should be paid to nutrition, as pre-existing or developing nutritional deficiencies can significantly increase the likelihood of an adverse outcome. It is recommended to give food in fractional portions.

The prescription 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. Ampicillin, gentamicin, and erythromycin have the best effect. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal whooping cough and no later than the 2-3rd day of the convulsive period of the disease.

The prescription of antibiotics during the spasmodic period of whooping cough is indicated when whooping cough is combined with acute respiratory viral diseases, with bronchitis, bronchiolitis, and in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.

The most important treatment for severe whooping cough in children of the first year of life. Oxygen therapy is necessary using systematic oxygen supply, cleaning the airways from mucus and saliva. If breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. For signs of brain disorders (tremors, short-term convulsions, increasing anxiety), seduxen is prescribed and, for dehydration purposes, 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 administered intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - aminophylline, for children with neurotic disorders - bromine preparations, luminal, valerian. With frequent severe vomiting, parenteral fluid administration is necessary.

Antitussives and sedatives. The effectiveness of expectorants, cough suppressants and mild sedatives is questionable; they should be used with caution or not at all. Exposures that provoke cough should be avoided (mustard plasters, cups)

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

Prevention upon contact with a sick person

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

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

whooping cough vaccine

Lecture No. 13

Topic: “Nursing care for tonsillitis, scarlet fever, whooping cough”

Sore throat (acute tonsillitis) -

This is an acute infectious disease primarily affecting the palatine tonsils.

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

Transmission routes:

1. Airborne

2. Nutritional.

3. Contact and household.

Source of infection :

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

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

Predisposing factors : local or general hypothermia.

Clinic:

1. General intoxication syndrome : (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 sore throat.

There are:

1. Catarrhal

2. Follicular

2. Lacunar

Catarrhal tonsillitis. The intoxication syndrome 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 tonsillitis can be the initial stage of another form of tonsillitis, and sometimes a manifestation of a particular infectious disease.

Angina follicular and lacunar. Characterized by more severe intoxication (headache, sore throat, temperature up to 39°, chills).

Examination of the pharynx for follicular sore throat: suppurating follicles in the form of white or yellowish peas are visible, visible through the mucous membrane. Sometimes the gaps contain yellow or grayish, dense plugs that have an unpleasant putrefactive odor.

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

Complications of tonsillitis:

1. Local

Quinsy,

Peritonsillar abscess,

Swelling of the larynx (laryngitis),

Cervical lymphadenitis,

Otitis etc.

2. Infectious-allergic:

Rheumatism, glomerulonephritis

Treatment

- bed rest until temperature normalizes

Drink plenty of warm drinks

Antibiotics (cefuroxime, azithromycin, josamycin) - 5 days

Antihistamines

Rinsing the throat with saline solution, herbal decoctions (chamomile, calendula, eucalyptus)

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

Site observation:

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

After recovery:

The patient is given intramuscular bicillin-3 once to prevent rheumatism and nephritis,

General blood and urine tests are done. After a month, 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, sore throat, pinpoint rash, and 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 tonsillitis.

Transmission path:

Airborne and household contact, very rarely food.

Incubation period 2-7 days.

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

1. Intoxication syndrome

2. inflammation at the entrance gate (angina)

3. pinpoint rash on the skin.

Intoxication manifested by an increase in temperature to high numbers of 38.5-39, poor health, headache, often vomiting.

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

Regional lymph nodes are enlarged.

The tongue has a characteristic appearance during scarlet fever - in the first 2-3 days it is coated in the center with a white coating and is rather dry. The tip of the tongue is crimson in color, from 2-3 days the tongue begins to clear, becomes crimson, with pronounced papillae. " Raspberry" tongue – lasts 1-2 weeks.

By the end of the first, beginning of the second day, it appears simultaneously throughout the body. pinpoint, thick rash on a hyperemic skin background. The skin feels hot, dry, rough (shagreen skin). The favorite place for localization of the rash is in the groin folds, elbow bends, lower abdomen, armpits, and popliteal fossae. The nasolabial triangle always remains free of rash.

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

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

- Infectious– otitis media, sinusitis, laryngitis, bronchitis, pneumonia, peritonsillar abscess.

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

Treatment:

At home, children from closed institutions, severe cases, are subject to hospitalization

and complicated forms, children under 3 years of age.

-mode bed rest for the entire acute period.

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

Antihistamines (tavegil, fenkarol) - according to indications

Symptomatic (antipyretics, gargling).

-specific No;

- nonspecific - consists of isolating patients for 10 days; if recovery has not occurred by the 10th day, then the period is increased.

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

Anti-epidemic measures rallies in DU(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:

the causative agent of whooping cough is a gram-negative rod ( Bordetellapertussis). There are 4 known serotypes that produce exo- and endotoxins during growth and development. The central nervous system (respiratory and vasomotor centers) is most sensitive to toxins. In the external environment, the rod is unstable and quickly dies because sensitive to high temperature, sunlight, drying, and disinfectants.

Source of infection – patients with typical and atypical forms of whooping cough.

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

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

low-grade fever. The cough is dry, obsessive, gradually increasing, and there may be a runny nose.

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

A coughing attack consists of coughing impulses following each other on exhalation, interrupted by a whistling, convulsive inhalation - reprise. The attack ends with the discharge of thick, viscous glassy sputum or vomiting. In a typical coughing attack, the patient’s appearance is characteristic: the face turns red, then turns blue, becomes purple-red, the veins of the neck, face, and head swell, and lacrimation is noted. The tongue protrudes from the mouth to the limit. As a result of friction of the frenulum of the tongue on the teeth, a tear or ulcer forms. Outside of an attack, puffiness of the face, swelling of the eyelids, and pale skin persist. Hemorrhages in the sclera and petechial rash on the face and neck are possible.

4. Permission period from 2 to 3 weeks -

The cough loses its typical character and occurs less and less frequently, but attacks can be provoked by emotional stress or physical exertion. For 2-6 months, the child’s increased excitability remains, trace reactions are possible (return of paroxysmal, convulsive cough when ARVI is added).

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

Features of whooping cough in young children:

Periods 1 and 2 were shortened, period 3 was extended to 50-60 days;

Coughing attacks may not occur repeatedly, but are often accompanied by cessation of breathing, and there may be convulsions;

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

Laboratory diagnostics:

1) “cough patch” method

2) a smear from the back of the throat - a tank inoculated on Bordet-Giangou medium (potato-glycerin agar with the addition of blood and penicillin) or KUA (casein-charcoal agar).

3) RPGA - for diagnosing 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:

Subject to hospitalization children with severe forms, with complications, with an unsmooth course, unfavorable premorbid background, with exacerbation of chronic diseases and young children. According to epidemic indications - children from closed institutions.

Mode- gentle, with mandatory individual walks.

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

after vomiting, supplement feeding.

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, broncholitin, libexin, tusuprex, sinekod);

Antihistamines (claritin, suprastin);

Vitamins with microelements;

For severe forms - prednisolone;

Oxygen therapy, for apnea - mechanical ventilation;

Eufillin (for 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.

-nonspecific

Isolate 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 when treating a patient with whooping cough at home. Contact children of the first year of life and unvaccinated children under 2 years of age are given antitoxic anti-pertussis immunoglobulin.

Introduction

1. Etiology of whooping cough in children

2. Epidemiology of whooping cough

4. Clinic of whooping cough 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 the whooping cough bacillus, transmitted by airborne droplets, characterized by paroxysmal convulsive cough. Whooping cough was first mentioned in the literature of the 15th century, but then febrile catarrhal diseases were described under this name, with which it was apparently confused. In the 16th century, whooping cough was mentioned in connection with an epidemic in Paris; in the 17th century, it was described by Sidenham. in the 18th century - N.M. Maksimovic-Ambodik. A detailed description of whooping cough and its identification as an independent nosological unit date back to the 19th century (Trousseau). In Russia, the clinical picture of this disease was described by S.F. Khotovitsky in the book "Pediatrics" (1847). then N.F. Filatov. Whooping cough was studied in detail, revealing its pathogenesis in the 20th century, mainly in the 30s and 40s (A.I. Dobrokhotova, M.G. Danilevich, V.D. Soboleva, etc.).

Historical data Whooping cough was first described in the 16th century, in the 17th century. Sidenham suggested the real name for 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. Causative agent of the disease Etiology. The causative agent of whooping cough is a gram-negative, hemolytic bacillus, immobile, does not form capsules or spores, and is unstable in the external environment. Pertussis bacillus produces an exotoxin (pertussis toxin, lymphocytosis-stimulating factor), which is of primary importance in pathogenesis. The pathogen has 8 aglutinogens, the leading ones being 1, 2,3. Agglutinogens are full antigens to which antibodies (agglutanins, complement-fixing) are formed during the disease process. Depending on the presence of leading aglutinogens, four serotypes of pertussis bacillus 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 people, patients with mild and atypical forms of the disease, serotype 1, 2, 3 - from unvaccinated people, patients with severe and moderate forms. The antigenic structure of the pertussis bacillus also includes: filamentous hemagglutinin and protective agglutinogens (promote bacterial adhesion); adenylate cyclase toxin (determines virulence); tracheal cytotoxin (damages the epithelium of respiratory tract cells); dermonecrotoxin and hemolysin (participate in the implementation of local damaging reactions); lipopolysaccharide (has endotoxin properties); histamine-sensitizing factor. Source of infection Epidemiology. The source of infection is patients (children, adults) with both typical and atypical forms. Patients with atypical forms of whooping cough pose a particular epidemiological danger in family units with close and prolonged contact (mother and child). The source may also be pertussis bacteria carriers. 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 through close and sufficiently long contact with a patient (whooping cough bacillus spreads 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. Frequency: an increase in the incidence of whooping cough is recorded after 2-3 years. Immunity after suffering from whooping cough is persistent; recurrent diseases are observed 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 clarified by Bordet and Gengou in 1906-1908. Its causative agent is the gram-negative hemoglobinophilic bacillus Bordetella pertussis.

This is a stationary, small, short rod with rounded ends, 0.5 - 2 microns long. The classic medium for its growth is potato-glycerin agar with 20-25% human or animal blood (Bordet-Giangu medium). Currently, casein charcoal agar is used. The bacterium grows slowly on media (3-4 days); 20-60 units of penicillin are usually added to them to suppress other flora, which easily suppresses the growth of the pertussis bacillus; She is insensitive to penicillin. Small shiny colonies resembling droplets of mercury form on the media.

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

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

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

2.toxin;

.hemagglutinin;

.a protective antigen that provides immunity to infection.

Under experimental conditions, the clinical picture of whooping cough cannot be caused in animals, although the pathogenic effect of the whooping cough bacillus on monkeys, kittens, and white mice is noted. This provides significant assistance in studying it.

2. Epidemiology of whooping cough

To this day, whooping cough remains a serious problem not only for Russia, but for the whole world. According to WHO, about 60 million people worldwide 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 limiting factor in the development of whooping cough epidemic is vaccine prevention.

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

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), 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 crowded populations facilitate the spread of airborne infections, as well as low vaccination coverage in some regions (80-90% coverage in Karelia).

whooping cough is an acute infectious disease

In long-term dynamics in all regions, there is a tendency towards a decrease in incidence, as well as synchronicity in incidence fluctuations in the years of growth and years of decline. However, the rate of decline is more pronounced in regions with high incidence rates and less pronounced in regions with low incidence rates.

As in other regions of the world, in the pre-vaccination period (before 1959), the incidence of whooping cough in the Russian Federation was registered at the level of 360-390 per 100 thousand population, reaching higher figures during 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, we can identify a significant downward trend in incidence from 1937 to 1946. During this period, the incidence rate decreased by more than 2 times. In subsequent years (1947-1958), there was a significant trend towards an increase in incidence with a growth rate of 23.8 (per 100 thousand population per year). This led to an increase in incidence by more than 3 times by 1958 and amounted to 475.0 per 100 thousand population.

After the start of mass immunization of the Russian child population in 1959, the incidence of whooping cough decreased sharply. Thus, over 10 years, the incidence rate decreased almost 20 times to 21.0 (per 100 thousand population per year) in 1969. In subsequent years, the rate of decline in incidence slowed down somewhat - 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 observed in other countries: in Hungary, the incidence rate decreased to 18.7 (per 100 thousand population); Czechoslovakia - up to 58.0 (per 100 thousand population). In the USA, the incidence decreased by 70%, in England - by 8-12 times.

In 1980, an increase in unjustified medical exclusions of children from vaccination led to a decrease in vaccination coverage of the population to 60% and, as a consequence, 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 a decrease in incidence by 1.6 cases (per 100 thousand population per year), and in 2006 the incidence was 5.7 cases per 100 thousand population. However, in recent years there has been a slight slowdown in the rate of decline in incidence - to 0.5 cases per 100 thousand population 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 more than 2 times and amounted to 125 cases per 100 thousand population during the years of rising 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 vaccine prevention, 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 the incidence of whooping cough, pronounced cyclical fluctuations are observed with a period of 3-4 years. This is explained by 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 - during the years of rise, the incidence increases by an average of 130 cases per 100 thousand population, or by 45-120% compared to the years of decline in incidence.

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

Synchronous cyclical fluctuations in incidence were observed in all age groups. During the years of growth, the incidence in the groups “children 1-2 years old” increased by 49%, in other groups by 2-2.4 times and more than three times among adults.

When analyzing the dynamics of whooping cough incidence in various populations of Russia over the past 10 years, it should be noted that a downward trend is observed only among the child population. Moreover, the rate of decline in 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 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 decline in incidence in the groups of “children under one year old” and “children 7-14 years old” is less pronounced (6.5 and 1.0, respectively) - the incidence decreased by 2.4 and 2 times and amounted to 79.8 per 100 thousand population in the group “children under one year old”, 27.7 per 100 thousand population in the group “children 7-14 years old”. The incidence of whooping cough in adults has almost doubled over the past 10 years and is currently 0.4 per 100 thousand population.

The overall rank of different age groups at the beginning and 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 share of this group in the structure of whooping cough incidence was the largest. The groups “children up to one year old” and “children 1-2 years old” were in second place in total rank. The least epidemiologically significant groups were “children 7-14 years old” 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 share of these groups is 73.7%. Due to the effectiveness of the vaccine prophylaxis, the groups “children 3-6 years old” and “children 1-2 years old” are in second and third place in the overall rank, respectively. Adults remain the least epidemiologically significant group due to the low incidence of a small proportion (1.9%) in the incidence structure.

Thus, despite successful vaccine prevention, the highest incidence rate is recorded among the age groups “children under one year” and “schoolchildren” and their share among all registered cases of whooping cough is increasing. In addition, these groups are characterized by pronounced cyclical rises. An increase in the incidence of adults and a slight decrease in the incidence of schoolchildren contributes to the spread of infection and maintains the circulation of the pathogen.

One of the characteristics of the epidemic process of whooping cough is seasonality. A modern epidemiological feature of pertussis 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 areas where it is better identified 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 significant variation in the start, end and duration of the seasonal upswing depending on whether it was a down year or a up year. Thus, during the years of rising incidence, the seasonal increase in incidence began earlier (in August), lasted longer - the duration of the seasonal rise ranged from 7 to 11 months, while in the years of decline, the seasonal rise begins later (in September-October), lasts less (about 4 -8 months) and ended in February-April. The off-season period averages 4 months (from 1-2 months in years of rising incidence to 6 months in years of decline).

Seasonal increases in the incidence of whooping cough are typical for all age groups, but have varying severity. The most pronounced seasonal increase was in the groups “organized children 3-6 years old” and “children 7-14 years old” - it lasted from September to June and lasted 10 months. The month of maximum incidence was December. The first to be involved in the epidemic process are “children aged 3-6 years who are unorganized” - 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 3-6 years old attending preschool educational institutions and schoolchildren are involved in the epidemic process in September, which is associated with the time of formation of organized groups. In the groups “children up to one year old” and “organized children 1-2 years old”, the seasonal rise begins in October and ends in January-February. In the group of adults, the seasonal rise is least pronounced - from November to September.

Epidemiology of whooping cough in children.

The source of infection is patients. Infectiousness is greatest at the very beginning of the disease; later it gradually decreases in parallel with a decrease in the frequency of pathogen excretion. The incidence of pertussis bacilli 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 stops from the 5th week. Antibiotic therapy shortens the period of excretion of pertussis sticks - 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 characteristics of the virulence of the pathogen and the magnitude of the infectious doses. After suffering from whooping cough in a clinically expressed form, a fairly intense immunity develops if all the components of the whooping cough pathogen, especially typical antigens, took part in its formation. But repeated cases were observed even in pre-vaccination times. Maternal immunity lasts no more than 4-6 weeks.

With all forms of whooping cough, patients pose a great danger as sources of infection. In 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 infectiousness, patients remain in children's groups. In patients with erased forms of whooping cough it is often not possible to diagnose it 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 sick. In recent years, cases of whooping cough infection from adults - from mothers, fathers - have become noticeably more frequent; There are known cases of infection from nurses.

Carriage of pertussis bacilli is not significant in the spread of infection. 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 bacillus contained in them disperses into the environment during a cough, the radius of dispersion is no more than 3 m. Transmission of infection through a third party or 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 stable; 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.

Incidence of whooping coughin the past it was almost universal and was second only to measles in first place. Infants were sick 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 occurred between the ages of 1 and 5 years, then it fell after 10 years, and even more so in adults it became rare. Frequent infestation of groups of nurseries and kindergartens, and the emergence of large outbreaks in them were noted.

The situation changed after the introduction of compulsory vaccination in the USSR in 1959, 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 situation. They are still susceptible to whooping cough, since immunization begins mainly in the second half of life, and the sources of infection are vaccinated older children who become ill with erased forms of whooping cough. Therefore, the incidence of whooping cough in infants has been reduced less than in older children, and the proportion of infants among all cases has even increased. Adults are getting sick more often than in the past.

Seasonality is not typical for whooping cough; 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 - even 60% (Jokhman). Among children suffering from rickets II - III degrees, malnutrition, mortality increased 3-4 times.

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

3. Pathogenesis and pathological anatomy of whooping cough in children

In the creation of a modern understanding of the pathogenesis of whooping cough, many years of research by a team of employees working under the leadership of A.I. played a major role. Dobrokhotova, with the participation of I.A. Arshavsky and others.

The active source of change is the pertussis bacillus.It is found on the mucous membrane of the respiratory tract - the larynx, trachea, bronchi, bronchioles and even the alveoli.

The endotoxin of the pertussis bacillus 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 the toxin leads to increased coughing; it takes on a spasmodic character and behind it a goal of interrelated changes arises. With a spasmodic cough, the breathing rhythm is disrupted, inspiratory pauses occur, which leads to congestion in the brain, impaired gas exchange, incomplete ventilation of the lungs and thereby to hypoxemia and hypoxia, which contributes to the development of emphysema. Irregular breathing rhythm and delayed inspiration contribute to hemodynamic disorder; puffiness of the face and dilatation of the right ventricle of the heart occur; Arterial hypertension may develop. Circulatory disorders can also occur in the brain, which, together with hypoxemia, can lead to focal changes and convulsions.

There are indications that pertussis toxin, when 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. Emphysema, hemo- and lymphostasis, blood overflow of the pulmonary capillaries, and peribroichnal edema are usually found in the lungs. perivascular and interstitial tissue, sometimes a spastic state of the bronchial tree, atelectasis: circulatory disorders with degenerative changes are also detected in the myocardium. A sharp expansion of blood vessels, especially capillaries, was found in brain tissue: degenerative structural changes also occur as a consequence of special sensitivity to hypoxemia (B.N. Klosovsky). In experiments, 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 staphylococcus: they are severe, long-lasting and are the main cause of death. Whooping cough is often combined with other infections, especially intestinal ones, with ARRI, which sharply worsen the severity of the disease. The addition of ARRI and infectious processes, as a rule, leads to more frequent and intensified coughing attacks. They are usually the cause of so-called relapses of whooping cough.

The basics of the pathogenesis of whooping cough can be presented 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.Spastic condition of the bronchi.

.Atelectasis.

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

.Emphysema of pulmonary tissue.

.Interstitial tissue changes:

A)increased permeability of vascular walls,

b)hemostasis, hemorrhages,

V)lymphostasis,

G)lymphocytic, histiocytic, eosinophilic peribronchial infiltration.

7.Hypertrophy of the hilar lymph nodes.

8.Changes in terminal nerve fibers:

A)state of increased excitability;

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

9.In complicated whooping cough, the changes are complemented 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 hemorrhages:

.Respiratory rhythm disturbance, inspiratory spasm.

2.Increased permeability of vessel walls.

.Venous congestion, worse with coughing.

.Changes in the lungs.

.Increased blood pressure due to vasospasm.

4. Clinic of whooping cough in children

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

Catarrhal periodcharacterized by the appearance of a dry cough, in some cases a runny nose is observed. The patient’s well-being and appetite are usually not impaired; the temperature may be low-grade, but more often it is normal. A feature of this period is the persistence of cough; 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 shortest in severe forms and in infants.

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

The attack ends with the release of thick mucus, and there may be vomiting. Often, after a short break, a second attack occurs, which may be followed by a third or more.; The concentration of attacks, their occurrence over a short period of time, is called paroxysm. During a coughing attack, the patient's appearance is very characteristic. Due to the sharp predominance of exhalations (with each cough impulse) and difficult inhalation during reprisal, due to spasm and narrowing of the glottis, congestion occurs in the veins. 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 involuntary separation of urine and feces. The patient's tongue is usually stuck out to the limit, it also becomes cyanotic, and tears flow from the eyes. As a result of frequently repeated attacks, puffiness of the face and 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 of an attack. The friction of the protruding tongue against the teeth during coughing shocks leads to the formation of an ulcer on the frenulum of the tongue, covered with a dense white coating.

With short, milder attacks, the same changes are present, 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, and adynamic. They are afraid of seizures.

The temperature is normalizing. Dry wheezing is heard in the lungs; in severe forms, emphysema is detected. Radiologically, in 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).

When examining the cardiovascular system, an increase in heart rate is detected during an attack; there may be an increase in blood pressure; decreased capillary resistance. In severe forms, expansion of the boundaries of the right ventricle of the heart may be observed.

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 more rare, shorter and milder and, finally, lose their paroxysmal character. The duration of the spasmodic period is from 2 to 8 weeks, but it can lengthen significantly.

The period of resolution 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.

During the period of resolution or even after the complete disappearance of the cough, “returns of attacks” 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 acute respiratory viral infection, while the patient is not contagious.

In the peripheral blood during 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 and lymphocytosis appear in the catarrhal period and persist until the infection is eliminated.

There are typical, erased, atypical and asymptomatic forms. Typical forms include those with a spasmodic cough. They can vary in severity: light, moderate and severe.

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

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

Erased forms include those with a weak expression of spasmodic cough: coughing attacks are very mild, rare, they can last only a few days. Atypical forms occur without any convulsive cough at all. Their important diagnostic feature is also a tendency to be divided into periods: a gradual increase in cough, its concentration as if in attacks, but real attacks with recurrences do not develop; after such changes stabilize for 6-10, sometimes 14 days, a period of resolution begins, the cough gradually subsides. Erased and atypical forms occur very easily, the well-being of children is not disturbed, and accordingly, hematological data change less dramatically. Leukocytosis, lymphocytosis can be insignificant, 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 also be mild hematological changes.

In infants, whooping cough is especially severe. They have a shorter duration of incubation and catarrhal periods, which is typical for severe forms. Hypoxemia, hypoxia is very pronounced. Instead of a reprise, the child may scream, cry, sneeze, hold or even stop breathing. Convulsive contractions of individual groups of facial muscles are observed, and general convulsions may occur. Repeated respiratory arrests with cyanosis, loss of consciousness, and convulsions indicate severe cerebrovascular accidents and simulate the picture of encephalitis. They join early, complications of an inflammatory nature occur severely. Special examinations reveal the extremely frequent presence of sagafmlococcal infection, which tends to develop both in the form of local infectious diseases (pneumonia, otitis, 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 arise. the nature of its most pronounced manifestations. As a consequence of severe congestion in combination with a decrease in capillary resistance, nosebleeds and hemorrhages in the conjunctiva can be observed. Sometimes even in the retina and, as an exceptional rarity, in the brain with corresponding central paralysis. As a consequence of a decrease in intrathoracic pressure due to respiratory failure, emphysema and atelectasis develop in the lungs.Disorders in gas exchange, impaired cerebral circulation, and cerebral edema lead to seizures, loss of consciousness, and a picture resembling encephalitis.

Complications of whooping cough

With whooping cough, complications can be caused by secondary, predominantly coccal, flora (pneumococcus, streptococcus, staphylococcus). Hemostasis, lymphostasis in the lung tissue, atelectasis, impaired gas exchange, catarrhal changes in the respiratory tract create extremely favorable conditions for the development of secondary infection (bronchitis, bronchiolitis, pneumonia, pleurisy). Pneumonia is predominantly small-focal, difficult to treat, and often occurs with low-grade fever and poor physical data. Along with this, rapid pneumonia occurs with high fever, respiratory failure, and an abundance of physical findings. These complications, as a nonspecific irritant, can lead to a sharp increase in the manifestations of the whooping cough process (increased frequency, prolongation of convulsive coughing attacks, increased cyanosis, brain disorders, etc.).

6. Diagnosis, differential diagnosis of whooping cough in children

Timely recognition of whooping cough allows you to:

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

2.alleviate the severity of the disease through 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, the most important are obsessiveness, persistence, gradual increase in cough with scanty physical data and the complete absence of at least temporary improvement from treatment. The cough, despite treatment, intensifies and begins to concentrate into attacks.

In the convulsive period, the diagnosis is facilitated by the presence of coughing attacks with reprises, viscous sputum, vomiting, etc., the characteristic appearance of the patient: pallor of the skin, puffiness of the face outside of 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 the disease in newborns and children in the first months of life, the same changes are important, but taking into account the features outlined above.

During the resolution period, the basis for diagnosis remains coughing attacks, which retain their characteristic features for a long time.

With erased forms of whooping cough, the same duration of cough and lack of effect from treatment should be taken into account; cyclicality of the process - a slight increase in cough at a time corresponding to the transition of the catarrhal period to the convulsive period; increased cough if another disease is associated.

Epidemiological data help in diagnosis: contact not only with patients with obvious whooping cough, but also with children and adults who have been coughing for a long time.

Laboratory diagnosis can be confirmed by three methods.

.Sowing. The material is collected in two ways: the “cough strip” method and the “posopharyngeal swab” method. In the first two weeks, sowing gives positive results in 70-80% of children and 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 isolating the pathogen are associated with the characteristics of the microorganism and its slow growth, the timing of bacteriological examination (the best inoculation rate is achieved when examining patients within the first two weeks from the onset of the disease), the rules for taking inoculation of the material, the frequency of examination, the timing and conditions of delivery of the material, the quality of the 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 in the later stages of the disease it rarely gives positive results.

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

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

Differential diagnosisIt is carried out mainly with acute respiratory viral infection, bronchitis, tracheobronchitis, and parawhooping cough. The main difference between whooping cough is the persistence of the cough, the absence or low severity of catarrhal changes, and poor physical data.

Of the laboratory methods, hematological testing is the most valuable. 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. Changes can also be subtle.

Bacteriological method.The study is carried out by inoculating sputum on a Petri dish with an appropriate medium. It is better to take sputum from the posterior pharyngeal space with a cotton swab; Sowing on media is done immediately. The “cough plate” method is proposed: an open Petri dish with a nutrient medium is held 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 percentage of chewing. The basis of diagnosis is clinical changes. In recent years, the possibility of accelerated diagnosis has been studied by identifying pertussis bacilli directly in smears from nasopharyngeal mucus in an immunofluorescence reaction.

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

An intradermal allergy test with pertussis agglutinogen or allergen has been proposed. If the reaction is positive, after administration 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 after 24 hours; later it weakens. Its disadvantage is in the late stages of its appearance (during the convulsive period).

7. Prognosis of whooping cough in children

MortalityWith whooping cough, nowadays, with well-done work, it is practically not observed. There are occasional deaths among infants. The cause of death, as a rule, is severe manifestations of whooping cough with impaired cerebral circulation, complicated by pneumonia. The accumulation of acute respiratory viral infection and staphylococcal infection is extremely unfavorable. They intensify 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, and convulsions, are unfavorable in terms of long-term prognosis, especially in infants. After them, various disorders of the nervous system are often observed: neuroses, absent-mindedness, mental retardation, even mental retardation; Sometimes the development of epilepsy is associated with whooping cough. Consequences of whooping cough can include bronchiectasis and chronic pneumonia.

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

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

8. Treatment of whooping cough in children

Treatment of patients with whooping cough is based on an accurate assessment of its pathogenesis. The primary goal is to eliminate the whooping cough bacillus 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 chloramphenicol 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 relief effect.

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

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

For clinically pronounced symptoms of hypoxemia and hypoxia, gene therapy is indicated - keeping in an oxygen tent for 30-60 minutes several times a day. If there is no tent, the patient is allowed to breathe humidified oxygen. It has a long lasting effect. stay in the fresh air (at a temperature not lower than 10° C). It normalizes the heart rate, deepens breathing, and enriches the blood with oxygen. Intravenous administration of 15-20 ml of a 25% glucose solution is indicated, preferably together with calcium gluconate (3-4 ml of a 10% solution).

Neuroplegics(aminazine, propazine), due to their direct effect on the central nervous system, have a positive effect both in the early and late stages of the disease. They help calm patients, reduce the frequency and severity of spasmodic coughs, prevent or reduce the number of delays, respiratory arrests, and vomiting that occur during coughing. Injections are made with a 2.5% solution of aminazine at the rate of 1-3 mg/kg of the drug per day with the addition of 3-5 ml of a 0.25-0.5% solution of novocaine; propazine is given orally at 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 attacks, but they are ineffective. Narcotics (luminal, lidol, chloral hydrate, codeine, etc.) are contraindicated. They depress the respiratory center, reduce the depth of breathing and increase hypoxemia.

If breathing stops, artificial respiration is used. Drugs that stimulate the respiratory center are harmful, since in these cases it is already in a state of severe overexcitation.

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

Physiotherapy is widely used in hospital settings: 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 have an effect, but only if the dosage is sufficient (at least 100,000 units/kg per day). Since complications are often caused by staphylococci, semisynthetic penicillin preparations (oxacillin, ampicillin, methicillin sodium salt, etc.) and broad-spectrum antibiotics (oletethrin, sigmamycin, etc.) are prescribed.

In severe cases, a combination of antibiotics is necessary. Similar tactics should be followed in case of frequent, intensifying coughing attacks, or relapses, the cause of which, as a rule, is the addition of some kind of inflammatory process. In these cases, stimulating therapy (blood transfusion, plasma transfusion, γ-globulin injections, etc.) is also important. physiotherapeutic procedures.

Mode of a patient with whooping coughit is necessary to build on the widespread use of fresh air (walking, room ventilation), reducing external stimuli that cause negative emotions. Older children can be distracted from illness by reading and quiet games. This explains the decrease in cough when taking off 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.

Food for a person with whooping coughmust be complete and high in calories. A strictly individual approach is required in organizing a child’s nutrition. If there are frequent attacks of coughing or vomiting, food should be given to the child at shorter intervals, in small quantities, in concentrated form. You can supplement your baby's feeding shortly after vomiting.

9. Prevention of whooping cough in children

Preventive actions.

In modern conditions, prevention of whooping cough is ensured by active immunization. In Russia, specific prevention is carried out using an associated drug - adsorbed pertussis-diphtheria-tetanus vaccine (DTP). Vaccinations are carried out from 3 months of age with three injections of the drug at 1.5-month intervals. At 18 months, a single revaccination is carried out.

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

Post-vaccination immunity does not protect against the disease. Whooping cough in these cases occurs 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 its high reactogenicity; due to the risk of complications, the second and subsequent booster vaccinations cannot be administered, which does not solve the issue of eliminating pertussis infection; post-vaccination immunity is short-lived; the protective effectiveness of various whole-cell DPT vaccines varies significantly (36-95%). The protective effectiveness of whole cell vaccines depends on the level of maternal antibodies (unlike acellular vaccines).

The pertussis component of the DTP vaccine is sufficiently reactogenic; After vaccinations, both local and general reactions are observed. Neurological reactions have been recorded that are a direct consequence of vaccinations. These circumstances have led to the fact that pediatricians approach vaccinations with the DPT vaccine with great caution, which explains the large number of unfounded medical exemptions.

Taking into account the new concept, first in Japan and then in other developed countries, an acellular pertussis vaccine was created and introduced, based on pertussis toxin and new protective factors. Currently, families of combined pediatric drugs based on 2-, 3- and 5-component pertussis vaccines are produced on an industrial scale. In developed countries, the following have been available for several years: four-component (DaDT + inactivated polio vaccine (IPV) or Haemophilus influenzae vaccine (HIB)), five-component (DaDPT + IPV + Hib), six-component (DaDTP + 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 vaccination history, who have communicated with someone who has whooping cough, if they have a cough, are allowed into the children's group after receiving two negative results of a bacteriological examination. Contact persons are placed under medical observation for 7 days and undergo a double bacteriological examination (two days in a row or with an interval of one day).

Measures aimed at interrupting transmission routes

Children in the first months of life and children from closed children's groups (orphanages, orphanages, etc.) are subject to isolation (hospitalization). All patients with whooping cough (children and adults) identified in nurseries, kindergartens, children's homes, 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. Bacteria carriers are also subject to isolation until two negative bacteriological test results are obtained. In the source of pertussis infection, final disinfection is not carried out; daily wet cleaning and frequent ventilation are carried out.

Measures aimed at susceptible organisms

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

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

Children under 7 years of age who have been in contact with a sick person but have not had whooping cough are subject to quarantine (separation). The quarantine period is 14 days when the patient is isolated.

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

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

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

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

10. Nursing process for whooping cough

In case of whooping cough, the nurse’s actions 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 attack (supporting the child, calming him down);

organization of walks in the fresh air;

control over feeding regimen (frequent, small portions);

prevention of nosocomial infection (control of child isolation);

providing emergency care for fainting, apnea, convulsions.

Actions of the site nurse:

Monitor the child’s parents’ compliance with the isolation regime for 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 monitoring of them for 14 days from the moment of contact;

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

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

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

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

The purpose of the nurse (site, 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 respirations and 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 of the first year of life and children with severe disease are usually hospitalized in the DIB.

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

With the appearance of a spasmodic cough, antibiotic therapy is indicated for 7-10 days (ampicillin, erythromycin, chloramphenicol, chloramphenicol, methicillin, gentomycin, etc.), oxygen therapy (the child stays in an oxygen tent). Also used hyposensitizing agents(diphenhydramine, suprastin, diazolin, etc.), mucaltin and bronchodilators (mucaltin, bromhexine, aminophylline, etc.), inhalation of aerosols with enzymes that dilute sputum (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 used DTP vaccine(adsorbed pertussis-diphtheria-tetanus vaccine).

Timing for vaccination and revaccination:

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

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

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

If mucus accumulates in the oral cavity, you need to empty the child's mouth with a finger wrapped in clean gauze.

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 cessation of 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 nurse's goalis their elimination (reduction).

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

Prevention upon contact with a sick person.

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

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

11. Measures in the outbreak of whooping cough

The room where the patient is located is thoroughly ventilated.

Children who have been in contact with the patient and have not had whooping cough are subject to medical supervision for 14 days from the moment of separation from the patient. The appearance of catarrhal symptoms and cough raises 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 patient and have not had whooping cough are subject to quarantine for a period of 14 days from the moment the patient is isolated, and in the absence of separation - for 40 days from the moment of illness or 30 days from the moment the patient develops a convulsive disorder. cough.

Children over 10 years of age and adults working in child care institutions are allowed into child care institutions, but are under medical supervision for 14 days from the moment of separation from the patient. If contact with the patient continues at home, they are under medical supervision for 40 days from the onset of the disease.

All children who have not had whooping cough and who are in contact with the patient are subject to examination for bacterial carriage. If bacterial carriage is detected in children who do not cough, they are allowed into children's institutions after three times negative bacteriological tests, carried out at intervals of 3 days and upon presentation of a certificate from the clinic stating that the child is healthy.

Contact children under one year of age who have not been vaccinated against whooping cough and who have not had whooping cough are given intramuscular injections of 6 ml of gamma globulin (3 ml every other day).

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

In areas of whooping cough, according to epidemiological indications, children who have come into contact with a patient who has been previously vaccinated against whooping cough, and for 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 is thoroughly ventilated.

Conclusion

Whooping cough is widespread throughout the world. Every year, about 60 million people get sick, of whom about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely administered for many years. It is likely that whooping cough is more common among adults, but is not detected, since it occurs without characteristic convulsive attacks. When examining people with persistent, prolonged cough, pertussis infection is serologically detected in 20-26%. The mortality rate 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. Atelectasis and acute pulmonary edema often develop. Most often, patients are treated at home. Patients with severe whooping cough and children under 2 years of age are hospitalized.

With the use of modern treatment methods, mortality from whooping cough has decreased and occurs mainly among children 1 year of age. Death can occur from asphyxia when the glottis is completely closed due to spasm of the laryngeal muscles during a coughing attack, as well as from respiratory arrest and convulsions.

Prevention consists of vaccinating children with pertussis-diphtheria-tetanus vaccine. The effectiveness of the whooping cough vaccine is 70-90%.

The vaccine protects particularly well against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild forms of whooping cough, 81% against paroxysmal and 95% effective against severe.

References

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

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

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

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

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

Similar works to - Whooping cough - an acute infectious disease

Scarlet fever
Pathogen –
hemolytic
streptococcus
group A
Stable during
external environment
Highlights
exotoxin,
defiant
allergic
mood
body
Scarlet fever - acute infectious
a disease characterized
symptoms of intoxication, sore throat and
skin rashes

Scarlet fever

Epidemiology:
Source of infection – patient or bacteria carrier
The transmission mechanism is airborne and
contact and household (toys, through “third parties”),
food
Entry gate – tonsils (97%), damaged skin
(1.5%) - extrabucal form (more often with burns)
Children aged 2-7 years are most often affected
Typical autumn-winter seasonality
Contagiousness index – 40%
Immunity is stable, but repeated cases are possible
Incubation period 2-7 days

Sudden onset
Expressed
intoxication
(temperature 3840°C, vomiting, headache
pain, general
weakness
Sore throat, sore throat,
"flaming throat" from 1
day of illness
"Raspberry Tongue"
Skin rash

Clinical signs of scarlet fever

Sore throat (follicular,
lacunar)
Purulent plaque in lacunae
tonsils
“Burning throat” - bright
limited hyperemia
tonsils, uvula, arches.
There is no plaque on the tonsils

Clinical signs of scarlet fever

Specific changes
tongue - white coating on the tongue
Cleans from edges and tip
and in 2-3 days it becomes
"raspberry"
"Crimson tongue" - bright
pink with
hypertrophied
papillae

Clinical signs of scarlet fever

Pinpoint rash on
hyperemic background
skin (from the end of 1 day of illness)

More saturated
on the side
surfaces
torso, below
belly, on
flexion
surfaces, in
places
natural
folds

White dermographism is characteristic in the first week of the disease.

Features of the rash with scarlet fever
White dermographism is characteristic
first week of illness

Features of the rash with scarlet fever

Not available on
face in the area
nasolabial
triangle
(pale
nasolabial
triangle
Filatova)

Features of the rash with scarlet fever

The rash disappears
in 3-7 days
Appears
pityriasis
peeling on
torso
Lamellar
peeling
palms and soles

A pinpoint rash on the palms and lamellar peeling of the skin of the palms is a specific symptom of scarlet fever

Real problems with scarlet fever: 1. Hyperthermia, headache, vomiting - due to intoxication; 2. Sore throat - due to sore throat; 3.Skin defect – me

The real problems with
scarlet fever:
1.Hyperthermia, headache,
vomiting - due to intoxication;
2. Sore throat - due to sore throat;
3.Skin defect –
pinpoint rash;
4.Discomfort due to dryness,
peeling of the skin.
Potential problems
for scarlet fever:
Risk of complications

Complications of scarlet fever

Early (at 1 week) for
bacterial count
factor a
Otitis
Sinusitis
Purulent lymphadenitis
Late (2-3 weeks) for
allergic account
factor a
Myocarditis
Nephritis
Rheumatism

Care and treatment of scarlet fever

Bed rest until normalization
temperature, then until 10 days
semi-bed
Diet (follow for 3 weeks):
mechanically, thermally gentle, rich
potassium, with salt restriction, with exception
obligate allergens

Wet cleaning, ventilation 2 times per
day
Organize a chlorine regime

Care and treatment of scarlet fever

Maintain oral hygiene: rinse
soda solution, chamomile infusion,
calendula
Antibiotics for 7 days (penicillin series
or sumamed, suprax, cephalexin)
Antihistamines (suprastin, etc.)
Antipyretics (paracetomol)
Irrigate the throat with dioxidin, hexoral
Monitoring diuresis, pulse, blood pressure
Provide information and directions to parents
on OBC, OAM (10 and 20 days of illness), ECG
Bacteriological examination - take a smear
from tonsils to streptococcus

Working in a scarlet fever outbreak

Activities with the patient
1. Hospitalization is not necessary
2. Submit the IES (notify the Center for State Sanitary and Epidemiological Surveys about
disease)
3. Isolate the patient for 10 days
(children under 8 years + 12 days
"home quarantine")
4. Current disinfection is carried out
systematically (dishes, toys,
personal hygiene items),
organize mask, chlorine
patient care regimen,
quartz
5. Final disinfection in
not carried out in outbreaks
(Sanitary and epidemiological
rules SP 3.1.2.1203-03
"Prevention
streptococcal infection")
With contact
1. Identify all contacts
2. Quarantine for 7 days
(only in DDU) from the moment
isolation of the last patient
3. Establish surveillance
(thermometry, examination of the pharynx,
skin). Children who have had acute respiratory infections
are inspected until the 15th day from
onset of illness for the presence
cutaneous lamellar
peeling palms
4. Family contacts who have not been ill
scarlet fever are not allowed in
Preschool and 1st-2nd grade school for 7
days (during hospitalization
patient) or 17 days (if
the patient is being treated at home)

Whooping cough
Pathogen –
BordeJangu stick
Unstable during
external environment
Highlights
exotoxin,
defiant
irritation
receptors
respiratory
ways
Whooping cough is an acute infectious disease
a disease with a cyclical course,
characterized by long-term
persistent paroxysmal cough.

Whooping cough

Epidemiology:
Whooping cough
Source of infection - patient up to 25-30 days from onset
illnesses
The transmission mechanism is airborne. Contact
must be tight and long
Entry gate – upper respiratory tract
Children from 1 month to 6 years get sick more often; they also get sick
newborns
Typical autumn-winter seasonality (peak December)
Contagiousness index – up to 70%
Immunity is strong and lifelong
Mortality – 0.1-0.9%
Incubation period 3 - 15 days

Clinical signs of whooping cough

Catarrhal period - 1-2
weeks:
Dry cough at night
before bedtime
Temperature
normal or
low-grade fever
Behavior,
well-being, appetite
not violated
Cough does not respond
therapy and intensifies

Clinical signs of whooping cough

Convulsive period - 2-8
weeks or more:
The cough becomes
paroxysmal
Reprises are noted -
whistling convulsions
breaths
The attack ends
viscous discharge
phlegm, mucus or
vomiting
In children under one year of age - often
apnea cessation of breathing

View of a patient with whooping cough during a coughing attack

Clinical signs of whooping cough

Characteristic external
appearance during an attack
– the face turns red,
then the veins turn blue
swell from the eyes
tears are flowing
Tongue sticking out of mouth
to the limit
Ulcer
on the bridle
language

The real problems with whooping cough are:

Breathing disorders –
paroxysmal cough due to
irritation of the cough center
Vomiting – due to severe cough
Ineffective outlet
sputum
Stopping breathing due to apnea
Potential problems
for whooping cough:
Risk of complications

Complications of whooping cough

Group 1 – associated with
by the action of a toxin or
the whooping cough stick itself
Emphysema
Atelectasis
Encephalopathy
The appearance of the umbilical and
inguinal hernia
Hemorrhages in
conjunctiva, into the brain
Rectal prolapse
Group 2 – joining
secondary infection
Bronchitis
Pneumonia

Treatment and care for whooping cough

General mode, walks in the fresh air, headboard
sublime
Nutrition according to age, exclude foods (seeds,
nuts), because aspiration may occur when coughing
Supplement after vomiting
Organize leisure and security regime, not
leaving the child alone (possibly apnea)
During an attack, sit or pick up, after
remove sticky mucus from the mouth with a tissue
Mask mode when in contact with a patient
Wet cleaning, airing 2 times a day,
humidify the air, temperature up to +22
Antibiotics (rulid, ampiox, etc.), expectorants
drugs and antitussives (libexin, tusuprex)
Give humidified oxygen

Working in a whooping cough outbreak

Activities with the patient
1. Hospitalization is subject to
children with severe forms,
children under 2 years old, not vaccinated
from whooping cough, from closed
outbreaks
2. Submit IES (report to
TsGSEN about the disease)
3. Isolate the patient for 30
days from the onset of the disease
4. Organize a mask
mode, regular
ventilation, damp
cleaning, quartzing
5. Final disinfection
not carried out
With contact
1. Identify everyone who is coughing
contact up to 14 years old,
suspend from visiting
children's group up to
receiving 2 negative
results
tank examination for whooping cough
2. Set observation to 14
days (only in kindergartens, boarding schools, orphanages)
3. Find out the vaccination
medical history: unvaccinated up to 1
years and older, weakened
children - appropriate
administer antipertussis
immunoglobulin

Specific prevention of whooping cough

Vaccination is being carried out
three times at intervals
45 days DPT vaccine
V₁ - 3 months,
V₂ - 4.5 months,
V₃ - 6 months,
Revaccination
R – 18 months.
DTP vaccine, Infanrix
enter only
intramuscularly!!!

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;
breathing problems;
apnea;
disturbance of physiological functions (loose stools);
impairment of motor activity;
change in appearance;
the child’s inability to independently cope with difficulties arising as a result of the disease;
psycho-emotional stress;
complication of the disease.

Possible problems for parents:

family maladaptation due to the child’s illness;
fear for the child;
uncertainty about the successful outcome of the disease;
lack of knowledge about the disease and care;
inadequate assessment of the child’s condition;
chronic fatigue syndrome.

Nursing intervention.

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

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

Ensure that the patient is isolated at home until 2 negative bacteriological examination results are obtained, and in severe forms, assist in arranging hospitalization.

Ensure sufficient aeration of the room where the sick child is located. It is optimal if the windows are constantly open; the child needs this, especially at night, when the most severe coughing attacks occur (in the fresh air they settle down, are less pronounced and complications arise 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 worries and painful manipulations. Involve parents in the process of caring for the child, teach them how to properly sanitize the respiratory tract, carry out inhalations with a 2% sodium bicarbonate solution, and vibration massage.

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

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

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

Protect the patient from communicating with patients with ARVI, since the addition of secondary viral-bacterial infections creates a threat of developing pneumonia and increasing the severity of whooping cough.

Organize routine disinfection at home (disinfect dishes, toys, care items, furnishings, carry out wet cleaning with soap and soda solution 2 times a day).

During the period of convalescence, it is recommended that the child undergo nonspecific disease prevention (nutritious nutrition enriched with vitamins, sleep in the fresh air, hardening, dosed physical activity, exercise therapy, physiotherapy, massage).