Nursing care for patients with whooping cough. Whooping cough

Whooping cough – acute infectious disease with a cyclic course and characteristic bouts of convulsive cough. Etiology. Pathogen infections - bacteria in the form of short rods - was discovered by the Belgian scientist Bordet and the French scientist Zhangu in 1906. Infection occurs by airborne droplets More often, whooping cough affects children from 1 to 5 years, but sometimes children under the age of one are sick. The incubation period lasts from 2 to 15, but more often it is 5–9 days. At this time, the symptoms of the disease do not appear. Then, during the course of the disease, three periods are distinguished: catarrhal, convulsive and resolution. catarrhal period lasts up to 2 weeks. The onset of the disease is atypical. A general malaise develops, a runny nose, a cough that worsens every day, the temperature rises to subfebrile (37-38 ° C), and then drops to normal. convulsive period lasts from 1 to 5 weeks. The number of convulsive coughing attacks increases from 10 to 50 per day. Disease resolution period lasts 1-3 weeks. Gradually, the cough becomes weaker, convulsive attacks are less frequent and less prolonged, recovery begins. Total duration whooping cough can be from 5 to 12 weeks. The patient is considered contagious for 30 days from the onset of the disease. Complications: pneumonia, bronchitis (especially in children from 1 to 3 years old), respiratory arrest, nosebleeds. Care of sick children. An important place in the treatment is properly organized patient care. It should be in a separate room, in which wet cleaning and thorough ventilation are carried out 2 times a day. Bed rest is prescribed only at elevated temperature and the occurrence of complications. A sick child with a normal temperature should spend more time in the open air, but separately from healthy children. Fresh cold air has a very good effect on children with whooping cough, which improves ventilation of the lungs and increases the flow of oxygen into the body: coughing fits become less frequent and weaker. Feeding children should be frequent (up to 10 times a day), but in small portions and better after a coughing fit. Regardless of the severity of the disease, the main place in the treatment is given to antibiotics prescribed by a doctor. Prevention whooping cough in the children's team provides for isolation of the patient, which is usually organized at home. Isolation continues until the 30th day from the onset of the disease. Children under 7 years of age who have not had whooping cough and have not received vaccinations, after contact with the patient, are separated from children's groups for 14 days. Children over 7 years old, as well as adults working in childcare facilities and in contact with the patient, are subject to medical supervision for 14 days.

Introduction

1. Etiology of whooping cough in children

2. Epidemiology of whooping cough

4. Whooping cough clinic in children

7. Prognosis of whooping cough in children

8. Treatment of whooping cough in children

Conclusion

References

Introduction

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

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

1. Etiology of whooping cough in children

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

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

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

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

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

2.toxin;

.hemagglutinin;

.a protective antigen that confers immunity to infection.

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

2. Epidemiology of whooping cough

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

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

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

whooping cough is an acute infectious disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

One of the characteristics of the epidemic process of whooping cough is seasonality. 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 the territories where it is better detected and recorded.

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

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

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

Epidemiology of whooping cough in children.

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

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

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

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

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

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

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

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

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

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

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

3. Pathogenesis and pathological anatomy of whooping cough in children

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

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

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

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

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

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

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

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

Functional and morphological changes in the respiratory system:

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

2.Spasmodic condition of the bronchi.

.Atelectasis.

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

.Emphysema of the lung tissue.

.Interstitial tissue changes:

A)increased permeability of the vascular walls,

b)hemostasis, hemorrhage,

V)lymphostasis,

G)lymphocytic, histiocytic, eosinophilic peribronchial infiltration.

7.Hypertrophy of the hilar lymph nodes.

8.Changes in terminal nerve fibers:

A)a state of increased excitability;

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

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

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

.Violation of the respiratory rhythm, inspiratory convulsions.

2.Increased permeability of the walls of blood vessels.

.Venous congestion, aggravated by coughing.

.Changes in the lungs.

.Increased blood pressure due to vasospasm.

4. Whooping cough clinic in children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5. Complications of whooping cough in children

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

Whooping cough complications

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

6. Diagnosis, differential diagnosis of whooping cough in children

Timely recognition of whooping cough allows:

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

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

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

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

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

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

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

Laboratory diagnosis can be confirmed by three methods.

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

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

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

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

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

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

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

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

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

7. Prognosis of whooping cough in children

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

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

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

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

8. Treatment of whooping cough in children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

9. Prevention of whooping cough in children

Preventive actions.

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

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

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

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

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

Anti-epidemic measures

Activities aimed at early detection of patients

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

Activities aimed at interrupting transmission routes

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

Activities aimed at a susceptible organism

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

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

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

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

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

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

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

10. Nursing process for whooping cough

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

Actions of the hospital nurse:

Creation of a protective regime in the ward, department;

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

organization of walks in the fresh air;

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

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

providing emergency care for fainting, apnea, convulsions.

Actions of the site nurse:

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

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

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

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

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

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

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

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

Nurse actions:

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

counting the number of breaths, pulse per minute;

body temperature control;

strict adherence to medical prescriptions.

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

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

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

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

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

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

Timing of vaccination and revaccination:

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

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

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

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

Severely ill infants are advised to 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 disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevention in contact with the sick.

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

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

11. Activities in the focus of whooping cough

The room where the patient is located is thoroughly ventilated.

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

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

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

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

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

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

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

Conclusion

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

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

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

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

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

References

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

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

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

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

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

Similar works to Whooping cough - an acute infectious disease

Scarlet fever
Pathogen -
hemolytic
streptococcus
group A
Resistant during
external environment
Highlights
exotoxin,
defiant
allergic
mood
organism
Scarlet fever is an acute infectious
a disease characterized
symptoms of intoxication, tonsillitis and
skin rashes

Scarlet fever

Epidemiology:
Source of infection - patient or carrier
The transmission mechanism is airborne and
contact-household (toys, through "third parties"),
food
Entry gate - tonsils (97%), damaged skin
(1.5%) - extrabuccal form (more often with burns)
Most often sick children 2-7 years old
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 maw" with 1
day of illness
"Crimson Tongue"
Rash on the skin

Clinical signs of scarlet fever

Angina (follicular,
lacunar)
Purulent plaque in lacunae
tonsils
"Flaming pharynx" - 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
Cleaned from edges and tip
and for 2-3 days it becomes
"crimson"
"Raspberry tongue" - bright
pink s
hypertrophied
papillae

Clinical signs of scarlet fever

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

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

Characterized by white dermographism in the first week of the disease

Features of the rash with scarlet fever
Characterized by white dermographism in
first week of illness

Features of the rash with scarlet fever

Missing on
face in the area
nasolabial
triangle
(pale
nasolabial
triangle
Filatov)

Features of the rash with scarlet fever

The rash disappears
after 3-7 days
Appears
pityriasis
peeling on
torso
lamellar
peeling
palms and soles

Pitted rash on the palms and lamellar peeling of the skin of the palms - a specific symptom of scarlet fever

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

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

Complications of scarlet fever

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

Care and treatment of scarlet fever

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

Wet cleaning, airing 2 times a day
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, supraks, cephalexin)
Antihistamines (suprastin, etc.)
Antipyretics (paracetomol)
Irrigate the throat with dioxidine, hexoral
Control of diuresis, pulse, blood pressure
Give information to parents and referrals
on KLA, OAM (10 and 20 days of illness), ECG
Bacteriological examination - take a smear
from tonsils to streptococcus

Work in the hearth of scarlet fever

Activities with the patient
1. Hospitalization is not required
2. Submit to IES (notify the Central State Sanitary and Epidemiological Service about
disease)
3. Isolate the patient for 10 days
(children up to 8 years old + 12 days
"home quarantine"
4. Current disinfection is carried out
systematically (dishes, toys,
personal hygiene items),
organize mask, chlorine
patient care routine,
quartz
5. Final disinfection in
foci is not carried out
(Sanitary and epidemiological
rules SP 3.1.2.1203-03
"Prevention
streptococcal infection)
With contact
1. Reveal all contacts
2. Quarantine for 7 days
(only in DDU) from the moment
isolation of the last patient
3. Set surveillance
(thermometry, throat examination,
skin). Children with ARI
inspected up to 15 days from
the onset of the disease for the presence
skin lamellar
peeling of the palms
4. Contacts in the family who were not ill
scarlet fever are not allowed in
Kindergarten and 1-2 grade school for 7
days (when hospitalized
patient) or 17 days (if
patient is treated at home

Whooping cough
Pathogen -
wand bordezhangu
Unstable during
external environment
Highlights
exotoxin,
defiant
irritation
receptors
respiratory
ways
Whooping cough is an acute infectious
cyclic disease,
characterized by a long
persistent paroxysmal cough.

Whooping cough

Epidemiology:
Whooping cough
The source of infection is the patient up to 25-30 days from the onset
disease
The transmission mechanism is airborne. Contact
should be tight and long
Entrance gate - upper respiratory tract
Children from 1 month to 6 years of age get sick more often, get sick and
newborns
Typical autumn-winter seasonality (peak December)
Contagiousness index - up to 70%
Immunity is stable, lifelong
Lethality - 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
subfebrile
Behavior,
health, appetite
not violated
Cough is unrelenting
therapy and enhanced

Clinical signs of whooping cough

Convulsive period - 2-8
weeks or more:
The cough becomes
paroxysmal
Reprises are noted -
wheezing convulsive
breaths
The attack ends
viscous discharge
sputum, mucus or
vomiting
In children under one year old - often
apnea

View of a patient with whooping cough during a coughing fit

Clinical signs of whooping cough

Characteristic external
view during attack
- face turns red
then turns blue, veins
swell out of the eyes
tears flow
tongue sticking out of mouth
to the limit
sore
on the bridle
language

The real problems with whooping cough:

Respiratory failure -
paroxysmal cough due to
irritation of the cough center
Vomiting - due to severe coughing
Ineffective discharge
sputum
Stopping breathing due to apnea
Potential Issues
for whooping cough:
Risk of complications

Whooping cough complications

Group 1 - associated with
the action of a toxin or
the whooping cough
Emphysema
Atelectasis
Encephalopathy
The appearance of the umbilical
inguinal hernia
Hemorrhages in
conjunctiva, brain
rectal prolapse
2 group - accession
secondary infection
Bronchitis
Pneumonia

Treatment and care for whooping cough

General mode, outdoor walks, headboard
sublime
Nutrition by age, exclude foods (seeds,
nuts), because may be aspirated when coughing
Supplement after vomiting
Organize leisure and protective regime, not
leaving the child alone (possibly apnea)
During an attack, sit or pick up, after
remove mucus from the mouth with a tissue
Wearing a mask when in contact with a sick person
Wet cleaning, airing 2 times a day,
humidify the air, temperature up to +22
Antibiotics (rulid, ampioks, etc.), expectorants
drugs and antitussives (libexin, tusuprex)
Give humidified oxygen

Work in the focus of whooping cough

Activities with the patient
1. Hospitalizations are subject
children with severe forms,
children under 2 years of age, not vaccinated
from whooping cough, from closed
foci
2. Submit IES (report to
TsGSEN about the disease)
3. Isolate the patient for 30
days from onset of illness
4. Organize a mask
routine, regular
ventilation, damp
cleaning, quartzing
5. Final disinfection
not carried out
With contact
1. Identify all coughing
contact up to 14 years old,
remove from visit
children's team to
getting 2 negative
results
whooping cough test tank
2. Set watch to 14
days (only in kindergartens, boarding schools, orphanages)
3. Find out vaccination
history: unvaccinated up to 1
years and older, weakened
children - appropriate
administer pertussis
immunoglobulin

Specific prophylaxis for whooping cough

Vaccination is 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!!!

Introduction………………………………………………………………………….3
1. Etiology and pathogenesis……………………………………………………….4
2. Symptoms and course……………………………………………………....6
3. Nursing process for whooping cough……………………………………...8
Conclusion………………………………………………………………………11
Literature……………………………………………………………………….12

Introduction
Whooping cough is an acute infectious disease characterized by gradually increasing bouts of spasmodic cough. The causative agent is a stick with rounded ends. In the external environment, the microbe is not stable and quickly dies under the influence of disinfecting factors, such as sunlight, and at a temperature of 56 degrees it dies after 10-15 minutes.
The source of the disease is a sick person. The infection is transmitted by airborne droplets during coughing, talking, sneezing. The patient ceases to be contagious after 6 weeks. Most often, children from 5-8 years old get sick.
With whooping cough, the mucous membrane of the upper respiratory tract is affected, where catarrhal inflammation is noted, causing specific irritation of the nerve endings. Frequent bouts of coughing disrupt cerebral and pulmonary circulation, which leads to insufficient oxygen saturation of the blood, a shift in oxygen-base balance towards acidosis. The increased excitability of the respiratory center persists for a long time after recovery.
The incubation period lasts from 2-15 days, more often 5-9 days. During whooping cough, the following periods are distinguished, catarrhal (3-14 days), spasmodic, or convulsive (2-3 weeks), and a convalescent period.

1. Etiology and pathogenesis
The causative agent of whooping cough is a short rod with rounded ends (0.2-1.2 microns), gram-negative, immobile, well stained with aniline dyes. Antigenically heterogeneous. The antigen that causes the formation of agglutinins (agglutinogen) consists of several components. They are called factors and are designated by numbers from 1 to 14. Factor 7 is generic, factor 1 contains B. pertussis, 14 - B. parapertussis, the rest are found in various combinations; for the whooping cough pathogen, these are factors 2, 3, 4, 5, 6, for parapertussis - 8, 9, 10. The agglutination reaction with adsorbed factor sera makes it possible to differentiate bordetella species and determine their antigenic variants. The causative agents of whooping cough and parapertussis are very unstable in the external environment, so sowing should be done immediately after taking the material. Bacteria quickly die when dried, ultraviolet irradiation, under the influence of disinfectants. Sensitive to erythromycin, chloramphenicol, antibiotics of the tetracycline group, streptomycin.
The gateway of infection is the mucous membrane of the respiratory tract. Pertussis microbes attach to the cells of the ciliated epithelium, where they multiply on the surface of the mucous membrane without penetrating into the bloodstream. At the site of the introduction of the pathogen, an inflammatory process develops, the activity of the ciliary apparatus of epithelial cells is inhibited and the secretion of mucus increases. In the future, ulceration of the epithelium of the respiratory tract and focal necrosis occurs. The pathological process is most pronounced in the bronchi and bronchioles, less pronounced changes develop in the trachea, larynx and nasopharynx. Mucopurulent plugs clog the lumen of the small bronchi, developing focal atelectasis, emphysema. There is peribronchial infiltration. In the genesis of convulsive attacks, the sensitization of the body to the toxins of the whooping cough is important. Constant irritation of the respiratory tract receptors causes coughing and leads to the formation of a focus of excitation of the dominant type in the respiratory center. As a result, typical attacks of spasmodic cough can also be caused by non-specific stimuli. From the dominant focus, excitation can also radiate to other parts of the nervous system, for example, to the vasomotor (increased blood pressure, vasospasm). Irradiation of excitation also explains the appearance of convulsive contractions of the muscles of the face and trunk, vomiting and other symptoms of whooping cough. Past whooping cough (as well as pertussis vaccinations) does not provide lifelong immunity, so recurrence of whooping cough is possible (about 5% of whooping cough cases occur in adults.
The source of infection is only a person (patients with typical and atypical forms of whooping cough, as well as healthy bacteria carriers). Patients in the initial stage of the disease (catarrhal period) are especially dangerous. The infection is transmitted by airborne droplets. Upon contact with patients in susceptible people, the disease develops with a frequency of up to 90%. More often children of preschool age get sick. More than 50% of whooping cough cases in young children are associated with a lack of maternal immunity and possibly the absence of transplacental transmission of protective specific antibodies. In countries where the number of vaccinated children is reduced to 30% or less, the level and dynamics of the incidence of pertussis becomes the same as it was in the pre-vaccination period. Seasonality is not very pronounced, there is a slight increase in the incidence in autumn and winter.

2. Symptoms and course
The disease lasts approximately 6 weeks and is divided into 3 stages: prodromal (catarrhal), paroxysmal and convalescent.
The incubation period lasts from 2 to 14 days (usually 5-7 days). The catarrhal period is characterized by general malaise, slight cough, runny nose, subfebrile temperature. Gradually, the cough intensifies, the children become irritable, capricious.
At the end of the 2nd week of illness, a period of spasmodic cough begins. there is a runny nose, sneezing, occasionally a moderate fever (38-38.5) and a cough that does not decrease from antitussives. Gradually, the cough intensifies, becomes paroxysmal, especially at night. Bouts of convulsive coughing are manifested by a series of coughing shocks, followed by a deep whistling breath (reprise), followed by a series of short convulsive shocks. The number of such cycles during an attack ranges from 2 to 15. The attack ends with the release of viscous vitreous sputum, sometimes vomiting is noted at the end of the attack. During an attack, the child is excited, the face is cyanotic, the veins of the neck are dilated, the tongue protrudes from the mouth, the frenulum of the tongue is often injured, respiratory arrest may occur, followed by asphyxia. In young children, reprises are not expressed. Depending on the severity of the disease, the number of attacks can vary from 5 to 50 per day. The number of seizures increases over the course of the illness. After the attack, the child is tired. In severe cases, the general deterioration of the condition worsens.
Infants do not have the typical whooping cough attacks. Instead, after a few coughing shocks, they may experience short-term respiratory arrest, which can be life-threatening.
Mild and erased forms of the disease occur in previously vaccinated children and adults who fall ill again.
Starting from the third week, a paroxysmal period begins, during which a typical spasmodic cough is observed: a series of 5-15 quick cough shocks, accompanied by a short wheezing breath. After a few normal breaths, a new paroxysm may begin. During paroxysms, a copious amount of viscous mucous vitreous sputum is secreted (usually infants and young children swallow it, but sometimes its separation in the form of large blisters through the nostrils is noted). Characterized by vomiting that occurs at the end of an attack or with vomiting caused by the discharge of thick sputum. During a coughing fit, the patient's face turns red or even blue; the tongue protrudes to failure, trauma to its frenulum on the edge of the lower incisors is possible; sometimes there are hemorrhages under the mucous membrane of the conjunctiva of the eye.
The recovery stage starts from the fourth week; The period of convulsive cough lasts 3-4 weeks, then the attacks become less frequent and finally disappear, although the "normal" cough continues for another 2-3 weeks (resolution period). In adults, the disease proceeds without bouts of convulsive coughing, manifested by prolonged bronchitis with a persistent cough. Body temperature remains normal, paroxysms become less frequent and severe, rarely end in vomiting, the patient feels better and looks better. The average duration of the disease is about 7 weeks (from 3 weeks to 3 months). Paroxysmal cough may reappear within a few months; as a rule, it provokes SARS.

3. Nursing process for 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 are used (diphenhydramine, suprastin, tavegil), vitamins, inhalation aerosols of proteolytic enzymes (chymopsin, chymotrypsin), which facilitate the discharge of viscous sputum, mukaltin.
Mostly children of the first half of the year with a pronounced severity of the disease are subject to hospitalization due to the risk of developing apnea and serious complications. Hospitalization of older children is carried out in accordance with the severity of the disease and for epidemic reasons. In the presence of complications, indications for hospitalization are determined by their severity, regardless of age. It is necessary to protect patients from infection.
Severely ill infants are advised to 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 disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.
Erased forms of whooping cough do not require treatment. It is enough to eliminate external stimuli to ensure peace and longer sleep for patients with whooping cough. In mild forms, prolonged exposure to fresh air and a small number of symptomatic measures at home can be limited. Walks should be daily and long. The room in which the patient is located should be systematically ventilated and its temperature should not exceed 20 degrees. During an attack of coughing, you should take the child in your arms, slightly lowering his head.
With the accumulation of mucus in the oral cavity, it is necessary to free the child's mouth with a finger wrapped in clean gauze ...
Diet. Serious attention should be paid to nutrition, since pre-existing or developed nutritional deficiencies can significantly increase the likelihood of an adverse outcome. Food is recommended to give fractional portions.
It is recommended to feed the patient little and often. Food should be complete and sufficiently high-calorie and fortified. With frequent vomiting, the child should be supplemented 20-30 minutes after vomiting.
The appointment of antibiotics is indicated in young children, with severe and complicated forms of whooping cough, in the presence of concomitant diseases in therapeutic doses for 7-10 days. Ampicillin, gentamicin, erythromycin have the best effect. Antibacterial therapy is effective only in the early stages of uncomplicated whooping cough, in catarrhal and no later than 2-3 days of the convulsive period of the disease.
The appointment of antibiotics in the spasmodic period of whooping cough is indicated for the combination of whooping cough with acute respiratory viral diseases, bronchitis, bronchiolitis, in the presence of chronic pneumonia. One of the main tasks is the fight against respiratory failure.
The most responsible therapy for severe whooping cough in children of the first year of life. Oxygen therapy is necessary with the help of a systematic supply of oxygen, cleaning the airways from mucus and saliva. When breathing stops - suction of mucus from the respiratory tract, artificial ventilation of the lungs. With signs of brain disorders (tremor, short-term convulsions, increasing anxiety), seduxen is prescribed and, for the purpose of dehydration, lasix or magnesium sulfate. From 10 to 40 ml of a 20% glucose solution with 1-4 ml of a 10% calcium gluconate solution is injected intravenously, to reduce pressure in the pulmonary circulation and to improve bronchial patency - eufillin, for children with neurotic disorders - bromine preparations, luminal, valerian. With frequent severe vomiting, parenteral fluid administration is necessary.
It is recommended that the patient stay in the fresh air (children practically do not cough outdoors).
Antitussives and sedatives. The efficacy of expectorant mixtures, cough suppressants, and mild sedatives is questionable; they should be used sparingly or not at all. Cough-provoking influences (mustard plasters, jars) should be avoided.
For the treatment of patients with severe forms of the disease - glucocorticosteroids and / or theophylline, salbutamol. With apnea attacks - chest massage, artificial respiration, oxygen.
Prevention in contact with the sick
In unvaccinated children, human normal immunoglobulin is used. The drug is administered twice with an interval of 24 hours as soon as possible after contact.
Chemoprophylaxis with erythromycin at an age dosage for 2 weeks can also be carried out.

Conclusion
Whooping cough is widespread throughout the world. Every year, about 60 million people fall ill, of which about 600,000 die. Whooping cough also occurs in countries where pertussis vaccinations have been widely practiced for many years. Probably, among adults, whooping cough is more common, but not detected, as it occurs without characteristic convulsive seizures. When examining individuals with a persistent persistent cough, 20-26% are serologically diagnosed with pertussis infection. Mortality from whooping cough and its complications reaches 0.04%.
The most common complication of whooping cough, especially in children under 1 year of age, is pneumonia. Often develop atelectasis, acute pulmonary edema. Most often, patients are treated at home. Patients with a severe form of whooping cough and children under 2 years of age are hospitalized.
With the use of modern methods of treatment, mortality in whooping cough has decreased and occurs mainly among children 1 year old. Death can occur from asphyxia with complete closure of the glottis due to spasm of the muscles of the larynx during a coughing fit, as well as from respiratory arrest and convulsions.
Prevention consists in carrying out vaccination of children with pertussis-diphtheria-tetanus vaccine. The effectiveness of pertussis vaccine is 70-90%.
Vaccination is particularly good at protecting against severe forms of whooping cough. Studies have shown that the vaccine is 64% effective against mild whooping cough, 81% against paroxysmal and 95% against severe.

Literature

1. Veltishchev Yu.E. and Kobrinskaya B.A. Pediatric emergency care. Medicine, 2006 - 138s.
2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic
practice. - M.: - Perm, 2001 - 211s.
3. Sergeeva K.M., Moskvicheva O.K., Pediatrics: a guide for doctors and students K.M. - St. Petersburg: Peter, 2004 - 218s.
4. Tulchinskaya V.D., Sokolova N.G., Shekhovtseva N.M. Nursing in pediatrics. Rostov n / a: Phoenix, 2004 -143s.

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

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

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

Anti-epidemic measures

Activities aimed at early detection of patients

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

Activities aimed at interrupting transmission routes

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

Activities aimed at a susceptible organism

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

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

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

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

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

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

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

10. Nursing process for whooping cough

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

Actions nurses hospital:

- creation of a protective regime in the ward, department;

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

- organization of walks in the fresh air;

- control over the mode of feeding (frequent, small portions);

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

- Providing emergency care for fainting, apnea, convulsions.

Actions nurses site:

- monitor compliance by the parents of the child with the isolation regime within 30 days from the moment of illness;

- inform the parents of other children about the case of whooping cough;

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

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

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

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

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

Target nurses (plot, hospital): prevent or reduce the risk of pneumonia.

Actions nurses:

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

- counting the number of breaths, pulse per minute;

- control of body temperature;

- Strict compliance with medical prescriptions.

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

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

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

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

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

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

TimingholdingvaccinationAndrevaccination:

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

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

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

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

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

Severely ill infants are advised to 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 disorders and encephalic syndrome) require resuscitation, as they can be life-threatening.

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

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

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

It is recommended to feed the patient little and often. Food should be complete and sufficiently high-calorie and fortified. With frequent vomiting, the child should be supplemented 20-30 minutes after vomiting.

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

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

Peculiaritieswhooping coughatchildrenfirstof the yearlife.

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

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

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

If any problems arise in a sick child goal nurses is their elimination (reduction).

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

It is recommended that the patient stay in the fresh air (children practically do not cough outdoors).

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

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

Prevention in contact with the sick.

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

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

11. Activities in the focus of whooping cough

The room where the patient is located is thoroughly ventilated.

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

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

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

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

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

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

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

Conclusion

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

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

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

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

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

References

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

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

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

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

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

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