Whooping cough (pertussis) is an acute respiratory infectious disease in children caused by the Haemophilus pertussis bacterium, transmitted through respiratory droplets. Clinically, it is characterized by paroxysmal spasmodic coughing followed by a prolonged "rooster crow-like" echo, often accompanied by vomiting. Infants do not exhibit the echo and frequently experience apnea and complications such as pneumonia. Children under 6 years old are susceptible to infection, with infants under 6 months having no immunity. Following immunization programs, the incidence of whooping cough has decreased by 97%. This disease has nearly been eradicated in China.

bubble_chart Epidemiology

There is a history of whooping cough contact 1 to 3 weeks before the onset of illness.

bubble_chart Clinical Manifestations

Divided into 3 stages:

1. Initial cough stage: 7–10 days. The onset resembles an upper respiratory tract infection, with low-grade fever, cough, runny nose, etc.
2. Paroxysmal stage: The cough progresses from mild to severe or presents as typical paroxysmal spasmodic cough with a whooping sound resembling a rooster’s crow. Each episode involves coughing dozens of times before pausing, followed by a deep inhalation. Due to spasmodic narrowing of the glottis, a special high-pitched whoop is produced. Repeated episodes often lead to vomiting, accompanied by facial flushing, tearing, and runny nose. During this stage, facial and subconjunctival hemorrhages may occur, along with tongue frenulum ulcers. Pressing the tongue or stimulating the throat can trigger a paroxysmal cough. This stage is the longest, lasting about 9 weeks.
3. Stage of convalescence: 2–3 weeks. The paroxysmal cough subsides until it disappears completely, but stimuli may still trigger coughing episodes.

bubble_chart Auxiliary Examination

1. Blood Picture: A significant increase in the total white blood cell count and lymphocyte proportion is observed.
2. Bacterial Culture: Evidence of whooping cough bacteria can be obtained from nasopharyngeal cultures during the first to second week of illness and from droplet cultures during the second to third week. The cough plate method can be used, where droplets are directly coughed onto a culture plate.
3. Immunofluorescence Method: Nasopharyngeal swabs are smeared and treated with specific antibodies adsorbed with fluorescence. The pathogen can be observed under a fluorescence microscope.
4. Serological Tests: Agglutination tests and complement fixation tests can be performed, which may turn positive starting from the second to third week of illness.
5. Immunological Examination: Enzyme-linked assays are used to measure IgM, IgG, and IgA antibodies against whooping cough bacilli. Some patients with negative bacterial cultures may still test positive, while infants under 3 months old may not show detectable levels of these antibodies.

bubble_chart Diagnosis

Hilar lymph nodes. When subcutaneous nodes cause compression symptoms, they can lead to paroxysmal spasmodic cough and may also produce echoes. Subcutaneous node tuberculin tests and chest X-rays aid in diagnosis.

bubble_chart Treatment Measures

1. General Treatment Adequate rest and sufficient sleep, keeping the living space air fresh, and avoiding all stimuli that may induce spasmodic cough in the child. Sedatives should be given to those whose sleep is affected by spasmodic cough. The diet should consist of small, frequent meals with nutritious and easily digestible foods. Refeed after vomiting, and pay attention to supplementing various vitamins and calcium to prevent malnutrition due to the prolonged course of the disease.
2. Antibiotics The first choice is erythromycin, with a dosage of 30–50 mg/(kg·d), taken orally in 4 divided doses for 7–10 days. The whooping cough bacillus is most sensitive to erythromycin. Chloramphenicol can also be used at 30–50 mg/(kg·d) with the same course of treatment, but blood counts should be monitored, and the drug should be discontinued immediately if bone marrow suppression occurs. Ampicillin at 100–50 mg/(kg·d), administered intramuscularly or intravenously in 2 divided doses, kanamycin, and compound formula SMZ-TMP are also effective, with a treatment course of 7–10 days. Care should be taken to monitor for toxic side effects. Antibiotic treatment during the catarrhal stage can shorten the course of the disease or even prevent the onset of spasmodic cough. If antibiotics are used during the spasmodic cough stage, they may not shorten the course of the disease but can reduce the period of bacterial shedding and prevent secondary infections. If the condition worsens after one week of treatment, the antibiotic should be changed, and consideration should be given to whether the infection is caused by other pathogens.
3. Symptomatic Treatment Antitussives, expectorants, and aerosol inhalation of a mixture of α-chymotrypsin and 5% sodium bicarbonate, administered multiple times daily.
4. Garlic Syrup Used for mild cases and older children, 1% garlic syrup at 2–8 ml, taken 3–5 times daily, with an additional 1 ml per year of age for children under 8 years old.
5. Other Therapies:
   1. For severe spasmodic cough and critically ill infants, prednisone at 1–2 mg/(kg·d) can be given for 3–5 consecutive days. High-titer whooping cough immunoglobulin can also be used at a dose of 1.25 ml/d.
   2. Vitamin K1 may be tried, with a general dosage of <1歲20mg/d肌肉注射;>50 mg/d intramuscularly for children aged 1 year. This product has a smooth muscle relaxant effect, which helps alleviate spasmodic cough.

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bubble_chart Prevention

1. Isolate infected children for 40 days, quarantine contacts for 21 days, and administer erythromycin for 3 to 5 days.
2. Administer the DPT (diphtheria, pertussis, tetanus) vaccine on schedule. Immunity develops within weeks after injection and lasts for 2 to 5 years.