Whooping cough (pertussis) is an infectious disease of the bronchial tubes and respiratory tract caused by bacteria. It is triggered by the Bordetella pertussis balterium. Although whooping cough is generally known as a childhood disease, it is also increasingly affecting adolescents and adults. There is a vaccination against pertussis.
What is whooping cough?
Whooping cough (whooping cough) or in medical terms pertussis is a highly contagious infectious disease, which is caused by bacteria that affect the nose, throat, trachea and lungs of the patient. As the name suggests, pertussis manifests itself in spasmodic coughing fits, which are followed by wheezing (shortness of breath, morbid breathing sounds)). The disease is very protracted (several weeks to months) and ends fatally in one in a thousand patients. Infants are particularly at risk during their first six months of life, as they may experience sudden respiratory arrests. Whooping cough is by no means a purely pediatric disease, however. People of all ages can be affected. Once the disease has been overcome, immunity lasts for about four to twelve years. Subsequently, a further infection is not excluded. Similarly long the immunity exists after a vaccination against whooping cough.
Causes
The bacterium Bordetella pertussis as the pathogen and causative agent of whooping cough is spread by droplet infection. When people talk, cough, or sneeze, the pathogens become airborne and are inhaled by people in the surrounding area. This is how the bacteria enter the respiratory tract, where they settle in the mucous membranes. Here they multiply and carry out their own metabolism. The bacteria produce various proteins, some of which are toxins that destroy the mucous membranes and weaken the immune system. They also damage surrounding tissue and thus cause the typical symptoms of the disease. The pathogens that cause whooping cough have a particularly high infectivity. More than three-quarters of the people who come into contact with them fall ill. In addition to Bordetella pertussis, Bordetella parapertussis can also lead to the clinical picture of whooping cough, but in most cases these infections are shorter and less severe or even silent.
Symptoms, complaints, and signs
In pertussis, symptoms and signs often persist for weeks or even months. The signs of illness occur in three stages. In the catarrhal stage, symptoms resemble a cold. Those affected suffer from sneezing, runny nose, cough and hoarseness. In addition, a slight fever sets in. Sometimes conjunctivitis is also present, which, like the other signs, persists for one to two weeks. In the second stage, the actual whooping cough develops. Sufferers suffer from severe coughing attacks with wheezing when inhaling. This stage lasts from three to six weeks, with the coughing attacks subsiding only after one month. The coughing attacks occur especially in children and adolescents. They can be recognized by the fact that the sufferer coughs several times with his tongue stretched out in front of him and then inhales with a wheezing sound. The wheezing sound, which is accompanied by a viscous, glassy sputum, is typical. Many affected persons have to vomit or suffer from fever. The symptoms occur mainly at night and in the morning hours. Depending on age, other symptoms may occur, such as respiratory failure in infants and dry cough in adults. In the last stage, the symptoms slowly subside. After six to ten weeks, whooping cough is overcome.
Disease progression
Usually, whooping cough disease progresses in three stages characterized by different symptoms:
The first, cold-like stage (stage catarrhale) lasts about one to two weeks. Symptoms similar to a cold occur, such as sneezing, runny nose, mild cough, hoarseness or mild fever. The greatest risk of infection already exists in this phase. The second stage is the convulsive stage, which lasts two to six weeks. Here, the typical symptoms of whooping cough appear: strong, spasmodic coughing attacks with the tongue sticking out are accompanied by wheezing inhalation. The coughing attacks repeat at short intervals and often end in retching and vomiting. An accumulation of the cough attacks occurs at night and after exertion such as sports or stress.Whooping cough is also threatening because of the occurrence of severe concomitant diseases such as pneumonia, otitis media or cerebral hemorrhage. The decrementi stage is the last phase of the disease, in which the symptoms slowly become weaker and weaker. If left untreated, it lasts six to ten weeks.
Complications
In the decrementi stage, symptoms gradually decrease, but it is usually too late here for causative therapy for whooping cough. Accordingly, antibiotics may still be used, which caps the course of the disease in this final stage at up to six weeks in length. If left untreated, the cough that is still present and the cramp-like cough attacks can drag on for another ten weeks. Particularly in infants, pertussis leads more quickly to dangerous swelling of the respiratory tract and associated respiratory failure. The longer the body is affected by whooping cough, the more likely it is that more severe symptoms will occur. Secondary infections of the lungs (15 to 20 percent of cases) and middle ear are common. Seizures, which lead to a temporary lack of oxygen to the brain, affect up to four percent of sufferers. Here, any consequential damage depends on the duration of the oxygen deficiency. In 0.5 percent of cases, there is brain involvement due to the toxins produced by the pathogens that cause pertussis. Such an encephalopathy always leaves tissue damage. Consequential damage ranges from motor impairment to permanent sensory difficulties and can also affect cognitive performance. Younger people are often more severely affected than older people. One in a thousand infected people die from the disease.
When should you see a doctor?
If classic whooping cough symptoms persist for more than a week, a doctor should be consulted. Treatment of whooping cough is essential to avoid serious complications. For this reason, a doctor should be consulted as soon as the first signs of illness appear, so that the symptoms can be clarified and, if necessary, treated directly on the spot. If the patient develops a high fever or shortness of breath, it is best to consult a doctor on the same day. In case of circulatory problems, a visit to the hospital is indicated. The sufferer should be examined immediately to ensure that whooping cough is not due to a serious illness. At the latest, if whooping cough significantly impairs well-being or results in other health problems, the symptoms must be taken to a doctor. Neurological deficits indicate brain involvement and must be treated immediately in a clinic. Children, the elderly, the sick, and pregnant women should always have pertussis examined by a doctor to avoid complications. In addition to the family doctor, the ENT specialist or a pulmonary specialist may be consulted.
Treatment and therapy
The course of the disease in pertussis can only be mitigated and shortened if antibiotic therapy is started in time, i.e., during the catarrhal stage or the early convulsive stage. However, the administration of antibiotics is also useful at a later stage, as this breaks the chain of infection. Infants suffering from whooping cough must be hospitalized because they are often unable to cough up the mucus on their own. In addition to drug therapy, simple measures can alleviate the symptoms: A quiet environment, plenty of fluids and many small meals are important general measures. Hanging damp cloths in the bedroom can reduce nighttime coughing fits.
Outlook and prognosis
Whooping cough usually results from a bacterial infection. For the affected person, an existing whooping cough is often a very unpleasant affair, as whooping cough is very difficult to cough up. It is also a very dry cough that should usually be treated with medication. If the affected person decides to take such treatment, antibacterial drugs can be used to bring about a rapid improvement or a complete cure. After two to three days, the cough should slowly subside and the resulting sore throat should also improve. If the affected person does not seek medical or drug treatment for an existing whooping cough, considerable complications are to be expected.The intensity of whooping cough will worsen significantly, so that medical treatment becomes inevitable. As soon as the first signs of worsening of whooping cough appear, a visit to the doctor should not be put on the back burner. By means of appropriate treatment, an existing whooping cough can be effectively combated so that a complete and prompt cure can be achieved. If whooping cough does not improve after a few days, medical treatment should be resorted to. This can prevent complications.
Follow-up care
Even after antibiotic therapy is completed, the symptoms of whooping cough persist for a long time. This is due to damaged mucous membranes and cilia in the bronchial tubes, as well as continued irritation of lung tissue by bacterial toxins that are only gradually broken down by the body. The focus of aftercare is therefore on measures to restore the mucous membranes; also to prevent secondary infections of the weakened airways with other pathogens. Regular inhalations with hot water and a few teaspoons of sea salt help the damaged bronchial tubes to regenerate and also relieve the irritating cough that is often still present. Adding dried thyme to the inhalation can additionally support the healing of inflamed tissue in the bronchial tubes and the removal of toxins. Increasing the humidity to 40 to 50 percent in the sleeping area, such as by using a humidifier or boiling water, is also helpful so that the nighttime sleep needed for healing is not interrupted by coughing fits. Even after an infection has been overcome, cured patients can become re-infected with the pathogen after some time without being noticed and thus infect other people, especially infants and young children. Therefore, as soon as one’s symptoms have completely disappeared, one should have one’s own vaccination protection checked by a doctor as a last follow-up measure and, if necessary, refresh it.
What you can do yourself
Whooping cough does not necessarily require medical treatment. Some self-help measures and remedies from household and nature are just as effective as medicines from the pharmacy. The basic rule for all sufferers is: Drink plenty of fluids. Classic herbal teas, tap water or mild fruit juices are recommended. In the first few days, the diet should consist of small, light meals such as soup or baby porridge. Accompanying bed rest is important. The sufferer should sleep a lot – preferably in a warm environment (up to 21 °C) with high humidity. In addition, various home remedies can alleviate the symptoms of pertussis. For example, inhaling hot water with sea salt or chamomile flowers has proven effective. An effective home remedy is a decoction of sour apple cider with sugar and fennel, which is best taken in sips. Homeopathy recommends, among others, the preparations Belladonna, Carbo vegetabilis and Ledum palustre. If the symptoms have not subsided after a few days, a visit to the doctor is recommended. Infants and small children should always be taken to the pediatrician in case of whooping cough. The doctor can give further tips and measures, with the help of which the pertussis is quickly cured.
