|Whooping cough printout for doctors||You are at
If your patient gives you this, it is as a result of my advice to do so, so please indulge me and your patient by giving it some consideration. www.whoopingcough.net exists to help patients with it to get diagnosed by their own doctor.
Whooping cough AS
IT REALLY IS in the developed world today.
This page is to help inform doctors about whooping cough so they can diagnose and support their patients. Some of them may have been referred to this site by patients who have visited here, found it informative and wish to share the information with their physician.
Who am I?
Why most cases are missed
There are four difficulties and misconceptions
1. Most doctors are not familiar with the unique character of the sound of a whooping cough paroxysm because they have never heard one or had the opportunity to hear one.
2. Doctors falsely believe that whooping cough is a severe and serious illness causing frequent coughing and that they could not possibly miss such a diagnosis if their patient had it. This only true in infants.In fact, most patients feel and look perfectly well with whooping cough and usually go for many hours at a time between paroxysms. So you are most unlikely to hear a patient with whooping cough who coughs at all. And we are all so used to patients exaggerating the severity of their symptoms, that a patient with whooping cough describing their cough accurately sounds just like a patient with an ordinary cough using a bit of poetic license!
3. Doctors think it is rare. Wrong. It is far more common than we think. Because it is unrecognized, few cases are officially notified. This reinforces the idea of rarity. Research from several different sources confirms that may be roughly 30 to 100 times more common than is recognized.
4. Doctors think it has been immunized out of existence. Wrong. The effect of immunization only lasts a few years. Adolescents and adults become vulnerable once again. Adults can now get it and pass it to their children.
How do you recognise it?You need to know that when it occurs it often is in small outbreaks in a school or church community, but also frequently affects individuals or within a single family without an obvious source of infection. You should find several cases. Such clusters are strongly in favour of pertussis as the cause.
Outbreaks tend to occur every 4 to 5 years.
History of infrequent choking cough. Only half whoop. is without doubt the most important factor in diagnosis. Most patients, or parents of children with whooping cough do not give a history spontaneously that allows the diagnosis to be made. That is why a high index of suspicion is the first requirement. However, when it occurs in clusters, some will give a classical history if you can recognize it. So when you have found your first case you can assume there are others about and start asking the right questions. T he symptoms you are looking for that make it whooping cough are as follows.
It can start in one of two ways generally. The most common is a very
sore throat, slight malaise and sometimes a mild feverishness, that after 3 or 4
days turns into an unremarkable dry cough and after 10 days from the very start
of symptoms starts to become paroxysmal (uncontrollable and violent). In the third week and for the next 4 to
24 (roughly) weeks the cough generally is almost exclusively paroxysmal.
Thus after 2 weeks from the start of the illness the diagnosis is made from the
existence of paroxysms of coughing that continue for at least 2 weeks. A typical
paroxysm comes unexpectedly (but may be precipitated by a change in temperature,
or peculiar things such as a particular food). It is a succession of dryish
coughs that follow each other without any inspiration so that the lungs become
empty of air and the patient obviously develops severe facial congestion. There
sometimes follows a brief period of a feeling of suffocation, and cyanosis may
occur. Then sometimes (about 50% of patients) will occasionally, when inspiration
suddenly comes back with a rush, make an inspiratory stridulous 'whoop'. The
paroxysm may be repeated several times leaving the patient exhausted. There then
follows a long period before the next paroxysm. Children tend to have about 10 paroxysmal
a day at their worst, but adults will commonly only have 2 or 3 a day. It
usually causes onlookers as much distress as the patient! (another useful
history point). Paroxysms are commonly associated with coughing up sticky mucus
and reflex copious salivation. Most patients will retch after a paroxysm as a
matter of course. About 50% vomit at some time.
There are usually no abnormal physical signs. Sometimes there are added sounds in the chest. Sometimes a few wheezes (particularly if the patient has asthma, but usually asthmatics have a reduction in their level of wheeze when they get whooping cough). Sometimes there are a few crackles. None of these adventitious sounds or their absence are a help in diagnosing whooping cough but they obviously raise differential diagnoses that will inevitably be difficult to verify if it is actually whooping cough (back to getting a good history). Sometimes there is secondary bacterial infection which might give some signs. There may concomitant respiratory infections to confuse the picture in whooping cough ( the history will stand a chance of sorting it).
If you diagnose all the cases of whooping cough that occur the average duration from start to finish is about six weeks in children. It is usually longer in adults. If you only diagnose the more severe cases the duration is more likely to be 3 months. With all grades in between of course.
What about treatment? There isn't any really. Sick infants need hospitalization for assessment quite often, and if severe may benefit from antibiotics, steroids and oxygen. Others generally just need erythromycin or azithromycin to kill Bordetella organisms to stop infectivity. If the same is given during incubation the disease may be aborted. Management involves checking for complications such as pneumonia and supporting the parents of children in their coping with what is an exhausting experience for all the family. Pernasal swabs or blood specimens may be tested according to the advice of your laboratory. Negative tests do not exclude whooping cough as a diagnosis. The key is the sound of whooping cough, which you can hear from recordings on this site.
Thank you for reading this. www.whoopingcough.net
If a doctor in the United Kingdom wishes to phone me for advice or more information I can be reached on 0115 9830235.
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