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    Case Files in Pedia

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    vimal raj
    Case 1 describes a 60 day old infant presenting with cough and cold for 10 days, breathing difficulty for 2 days, and bluish discoloration of the skin during coughing. A positive PCR test confirmed pertussis. Case 2 describes a 4 month old twin with a cough for over 3 weeks. Both cases were treated with oxygen, IV antibiotics, and azithromycin, and are now recovering in the ward. Pertussis should be considered as a diagnosis when infants present with coughing fits, whooping sounds, or apnea. Proper vaccination of parents/caregivers and revaccination during pregnancy is important to prevent transmission.

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    Case Files in Pedia

    Uploaded by

    vimal raj
    55 views16 pages
    Case 1 describes a 60 day old infant presenting with cough and cold for 10 days, breathing difficulty for 2 days, and bluish discoloration of the skin during coughing. A positive PCR test confirmed pertussis. Case 2 describes a 4 month old twin with a cough for over 3 weeks. Both cases were treated with oxygen, IV antibiotics, and azithromycin, and are now recovering in the ward. Pertussis should be considered as a diagnosis when infants present with coughing fits, whooping sounds, or apnea. Proper vaccination of parents/caregivers and revaccination during pregnancy is important to prevent transmission.

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    Case 1 describes a 60 day old infant presenting with cough and cold for 10 days, breathing difficulty for 2 days, and bluish discoloration of the skin during coughing. A positive PCR test confirmed pertussis. Case 2 describes a 4 month old twin with a cough for over 3 weeks. Both cases were treated with oxygen, IV antibiotics, and azithromycin, and are now recovering in the ward. Pertussis should be considered as a diagnosis when infants present with coughing fits, whooping sounds, or apnea. Proper vaccination of parents/caregivers and revaccination during pregnancy is important to prevent transmission.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    55 views16 pages

    Case Files in Pedia

    Uploaded by

    vimal raj
    Case 1 describes a 60 day old infant presenting with cough and cold for 10 days, breathing difficulty for 2 days, and bluish discoloration of the skin during coughing. A positive PCR test confirmed pertussis. Case 2 describes a 4 month old twin with a cough for over 3 weeks. Both cases were treated with oxygen, IV antibiotics, and azithromycin, and are now recovering in the ward. Pertussis should be considered as a diagnosis when infants present with coughing fits, whooping sounds, or apnea. Proper vaccination of parents/caregivers and revaccination during pregnancy is important to prevent transmission.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    CASE SCENARIO 1

    • 60 days infant presented with the following


    complaints:
    • Cough and cold for 10days
    • Breathing difficulty for 2 days
    • Bluish discoloration of skin during cough
    since one day
    • H/o apnea following each episode of cough
    was present.
    • H/o refusal of feeds for one day
    • Immunisation history: Unimmunized
    (first dose of DPT not given)
    CASE SCENARIO 2
    • 4 month baby one among the twin came to
    OPD with c/o cough >3 weeks
    • Cough: Spasmodic with inspiratory whoop
    • Other twin also have the similar complaint
    • Immunisation history: Received 2 doses of
    pentavalent vaccine
    Diagnosis???
    • Bronchiolitis with apnea ??
    • Sepsis with acute CNS infection??
    • GER ?Sandifer syndrome ??
    • Seizures ??
    • Cyanotic spells ??
    • Pertussis ??
    Investigations done
    CASE 1:
    • CBC: Leukocytosis
    with lymphocytic
    preponderance
    • ESR:15 mm/hr
    • CXR
    • Echo: ACHD(ASD)
    • Positive PCR for
    pertussis
    Treated with

    •Oxygen

    •iv Antibiotics

    •Azithromycin

    •PPI, Domperidone (for GER)

    Now babies are in ward taking


    orally well.
    Why Pertussis ??

    • CLINICAL CRITERIA (CDC Guideliness):


    • a cough illness lasting ≥2 weeks, with at
    least one of the following signs or symptoms:
    • Paroxysms of coughing; OR
    • Inspiratory whoop; OR
    • Post-tussive vomiting; OR
    • Apnea (with or without cyanosis) (FOR
    INFANTS AGED <1 YEAR ONLY)
    • Laboratory Criteria for
    Diagnosis
    • Isolation of B.
    pertussis from a clinical
    specimen
    • Positive PCR for pertussis
    Both for culturing and
    for PCR, samples taken
    from the nasopharynx
    Bordet-Gengou and
    Regan-Lowe agars are the
    media of choice for culture
    TREATMENT
    • The recommended antimicrobial agents
    for treatment or chemoprophylaxis of
    pertussis are
    • Azithromycin,
    • Erythromycin
    • Clarithromycin,
    • Trimethoprim-sulfamethoxasole.
    AGE GROUP AZITHROMYCIN ERYTHROMYCIN

    <1 MONTH 10MG/KG/DAY SINGLE NOT PREFERRED


    DOSE X 5DAYS

    1-5 MONTHS 10MG/KG/DAY SINGLE 40-50MG/KG/DAY IN 4


    DOSE X 5DAYS DIVIDED DOSE X 14
    DAYS

    ≥6 MONTHS AND 10MG/KG/DAY SINGLE 40-50MG/KG/DAY IN 4


    CHILDREN DOSE ON DAY 1 THEN DIVIDED DOSE X 14
    5 MG/KG/DAY ON DAY DAYS
    2-5 (MAXIMUM 2G/ DAY)

    ADULTS 500 MG IN SINGLE 2G/DAY IN 4 DIVIDED


    DOSE ON DAY 1 THEN DOSE FOR 14 DAYS
    250 MG/KG/DAY ON
    DAYS 2-5
    PROPHYLAXIS
    • 1 or 2 primary DPT vaccines are not sufficient
    to protect them from getting infection.

    • So, vaccination of the parent, grandparent


    and other care takers with Tdap is essential.

    • Also, all pregnant women should be


    vaccinated with Tdap vaccine instead of TT
    vaccine during third trimester (preferably
    between 27 weeks and 36 weeks)
    Post exposure prophylaxis
    • Providing PEP to high risk people within
    21 days of exposure.
    • High risk people: Infants and women in
    their third trimester of pregnancy, people
    with pre-existing health conditions that
    may be exacerbated by a pertussis
    infection.
    • Same drugs and age related doses are
    used for treatment are used for PEP.
    Take home messages
    • Always consider pertussis ddx apart from
    common respiratory viral infection
    • Newborns and infants can catch infection
    from unimmunised parents & grand parents
    who nurse them
    • Parents & grand parents or other care takers
    should be immunised with tdap
    • 1 or 2 primary DPT vaccines are not sufficient
    to protect them from getting infection.
    Thank you

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