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Pertussis, commonly known as whooping cough, is a highly contagious acute respiratory infection caused by the bacterium Bordetella pertussis. While often perceived as a historical disease, it remains a significant public health concern globally, particularly for infants who are too young to be fully vaccinated. The disease is characterized by severe paroxysms of coughing that can last for weeks or even months, earning it the nickname the “100-day cough.” Unlike common viral upper respiratory infections, pertussis is bacterial and produces specific toxins that paralyze the respiratory tract’s cilia, leading to inflammation and an inability to clear secretions.
At Liv Hospital, the definition of pertussis encompasses not only the acute clinical presentation but also the prolonged recovery phase and the critical need for community-level prevention strategies to protect vulnerable neonates.
The causative agent, Bordetella pertussis, is a small, aerobic, gram-negative coccobacillus that strictly infects humans. It possesses a unique affinity for the ciliated epithelium of the respiratory tract. Upon inhalation via respiratory droplets, the bacteria adhere to the cilia of the nasopharynx and trachea using specialized proteins. Once attached, the bacteria do not invade the bloodstream directly; instead, they colonize the surface and release a potent cocktail of toxins.
These toxins are responsible for the clinical manifestations of the disease. The definition of the disease is therefore rooted in this toxin-mediated pathology, which disrupts local immune defenses and causes systemic effects, such as lymphocytosis (an increase in white blood cells). Understanding this biological mechanism is essential for recognizing why the cough persists even after antibiotics have eliminated the bacteria.
Pertussis is one of the most contagious diseases known to humans. The basic reproduction number, or R0, is estimated to be between 12 and 17, meaning a single infected individual can transmit the disease to up to 17 unprotected people. Transmission occurs primarily through aerosolized respiratory droplets expelled during coughing, sneezing, or even talking.
The disease is most contagious during the early catarrhal stage, which unfortunately mimics a common cold. This creates a dangerous epidemiological window in which infected individuals unknowingly spread the bacteria before the characteristic “whoop” appears. Household transmission is the most common route, often with an older sibling or parent serving as the source for an infant.
Despite widespread vaccination programs, pertussis has resurged in many developed countries. This phenomenon is multifactorial, involving the waning immunity provided by acellular vaccines, pathogen adaptation, and increased awareness leading to better reporting.
The definition of the disease burden has shifted from being primarily a childhood illness to one that affects all age groups, including adolescents and adults who act as reservoirs for the bacteria. The World Health Organization monitors these trends to adjust vaccination schedules. In low-income settings, pertussis remains a leading cause of vaccine-preventable death in infants, highlighting the global disparity in healthcare access.
The classic definition of pertussis involves a progression through three distinct clinical stages: catarrhal, paroxysmal, and convalescence.
The primary damage in pertussis occurs in the airways. The tracheal cytotoxin released by the bacteria paralyzes and eventually kills the ciliated epithelial cells. These cells act as a “mucociliary escalator,” constantly sweeping mucus and trapped debris out of the lungs. When these cells are destroyed, mucus accumulates in the lower airways, leading to obstruction and atelectasis (collapse of lung tissue).
The violent coughing fits are the body’s desperate mechanical attempt to clear this obstruction in the absence of functioning cilia. This pathological definition explains why the cough persists long after the bacteria are gone; the respiratory lining needs time to regenerate.
The definition of pertussis has evolved with the introduction of vaccines. While the classic “whooping” presentation is common in unvaccinated children, vaccinated individuals or those with prior immunity often present with “atypical pertussis.” In these cases, the illness may manifest simply as a prolonged cough without the whoop or post-tussive vomiting.
This atypical presentation complicates the clinical definition and diagnosis, as it is easily mistaken for bronchitis, asthma, or allergies. Recognizing atypical pertussis is crucial for preventing transmission to high-risk infants who may not yet be immunized.
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Pertussis is caused by a bacterium called Bordetella pertussis, which infects the respiratory tract and releases toxins that damage the airways.
It is called the 100-day cough because the symptoms, particularly coughing fits, can persist for many weeks or even months as the lungs heal.
Pertussis is a bacterial infection, not a viral one. This means it can be treated with antibiotics, although they are most effective when given early.
Yes, adults can get pertussis, especially if their immunity from childhood vaccines has worn off. Their symptoms are often milder, but they can still spread the disease.
Yes, it is highly contagious. It spreads easily through the air when an infected person coughs or sneezes, making it very dangerous in close environments like households.
This is a worrying trend of deaths that could have been prevented by vaccines. The effect of vaccine-preventable diseases on health worldwide is huge. Knowing
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