Parapertussis (Parapertussis) is an acute infectious disease, the causative agent of which is related to the pertussis bacillus, and the clinical picture of the disease itself is similar to whooping cough, which occurs in a mild form.

Parawhooping cough, unlike whooping cough, does not leave behind immunity, while whooping cough leaves lasting immunity. The disease is registered mainly in children 3 - 6 years old. This age accounts for up to 80% of all cases of the disease. Due to the fact that most cases of the disease are mild, treatment of parawhooping cough is symptomatic.

Rice. 1. The clinical picture of parawhooping cough occurs under the guise of acute respiratory infections or tracheobronchitis.

Whooping cough and parawhooping cough. What's the difference?

The causative agent of parawhooping cough

The causative agent of parawhooping cough Bordetella parapertussis(pertussis bacillus) was first described in 1937 by Eldering and Kondrick. Bacteria belong to the genus Bordetella.

• Pertussis bacilli are gram-negative. The Gram stain is pink or red unevenly - more intense coloring is observed at the poles of the bacteria.
• Bacteria produce the enzyme tyrosinase and urease.
• Bordetella parapertussis produce hyaluronidase, lecithinase and plasmacoagulase, which are factors in the pathogenicity of bacteria.
• The parapertussis stick is motionless, its size resembles a short coco-shaped stick, the ends are rounded, the length is 0.3 - 0.5 microns. The bacteria are immobile, do not form spores, are located separately in smears, less often in pairs, form a capsule, and have flagella.

Rice. 2. Parapertussis sticks in appearance resemble short coco-shaped sticks with rounded ends, the length is 0.3 - 0.5 microns.

Cultivation of parapertussis pathogens

Bordetella parapertussis grows on plain agar. When grown on casein-charcoal agar, its color changes to brownish-brown. This is due to the production of tyrosine by bacteria, which is a differential diagnostic feature. When grown on blood agar, it causes it to darken.

Colonies Bordetella parapertussis appear after sowing 24 - 48 hours later. They are round, small, moist, with a pearlescent sheen (reminiscent of droplets of mercury). After removing the colonies from the nutrient medium, a creamy trace remains.

The growth of Bordetella is suppressed by other microflora, so an antibiotic is currently added to the nutrient medium.

Rice. 3. The causative agents of parapertussis, when growing on casein-charcoal agar, change its color to brownish-brown. This is due to the production of tyrosine by bacteria, which is a differential diagnostic feature. When grown on blood agar, it causes it to darken.

Toxin formation

The bacterial cell of parapertussis pathogens contains components that, when interacting with the human body, can lead to the development of pathological processes. These include heat-stable endotoxin and heat-labile toxin (dermonecrotic).

Antigenic structure

Parapertussis pathogens contain substances (antigens) that can trigger an immune response in the body of an infected person (formation of antibodies). The antigenic structure of parapertussis bacteria is complex and has not yet been sufficiently studied. There are generic antigens and specific antigens. Antigen 14 agglutinogen is specific for Bordetella parapertussis.

Resistance of bacteria in the external environment

Bordetella parapertussis is very sensitive to environmental factors. At a temperature of 56°C for 15 minutes, exposure to direct sunlight for an hour and ultraviolet radiation, the bacteria are killed. Bordetella parapertussis is sensitive to disinfectants. In dry sputum, parapertussis pathogens persist for several hours.

Epidemiology

Parawhooping cough is recorded mainly in children 3 to 6 years old. This age group accounts for up to 80% of all cases of parawhooping cough. Children under one year of age rarely get parawhooping cough. The disease is mainly recorded in the form of outbreaks in children's groups.

Parapertussis is a typical airborne infection. The source of infection is the patient. The maximum infectiousness of patients occurs during the catarrhal period. Susceptibility to the disease is low and amounts to 0.35. This means that whooping cough affects 35 people out of a hundred who have not previously been ill and were not vaccinated against the disease and were in close contact with patients.

The epidemiology of the disease is influenced by the high sensitivity of bacteria to environmental factors, the low susceptibility of humans to the disease, the mild course of parawhooping cough, the difficulties of diagnosis in the initial period and the lack of immunity after the disease.

In children from parapertussis foci, carriage of parapertussis infection is rare.

Rice. 4. Parawhooping cough is recorded mainly in children 3 - 6 years old. This age group accounts for up to 80% of all cases of parawhooping cough.

How the disease develops

Parapertussis pathogens spread through the respiratory tract. Thanks to adhesion(adhesion, attachment) to ciliated epithelial cells, macrophages and neutrophils, parapertussis bacilli are able to survive in the human respiratory tract. This is facilitated by fimbriae (pili, microvilli), which cover bacteria, as well as a component of bacteria such as fibrous hemagglutinin.

Due to damage to the cilia, a lot of thick mucus accumulates in the respiratory tract. By irritating the cough centers, mucus causes coughing.

Parapertussis toxin determines the clinical picture of the disease - bronchospasm. The toxin has a neurotoxic effect, affecting the afferent fibers of the vagus nerve, the impulses through which go to the respiratory center of the central nervous system. In response, a cough arises, at first normal, and then convulsive, paroxysmal.

Dermatonecrotoxin and cytotoxin damage tissue. A hemorrhage forms in the damaged area. Increasing blood flow promotes the influx of nutrients necessary for pathogens and facilitates the absorption of pertussis toxin.

Thanks to the presence of the enzyme hyaluronidase, bacteria are able to penetrate into the deep layers of respiratory tissue. Hyaluronidase loosens intercellular connections, lecithinase breaks down the phospholipid layer of the cell membrane, plasmacoagulase promotes plasma coagulation.

Rice. 5. Type of pathogens of parapertussis (computer visualization).

Symptoms of parawhooping cough in children and adults

The incubation period for parapertussis ranges from 4 to 15 days. The disease begins with mild catarrhal symptoms of the upper respiratory tract. Rhinitis, hyperemia of the pharynx, and rarely conjunctivitis are observed. The child's general condition remains satisfactory. Body temperature is often normal. Sometimes it increases by 1 - 3 days to 37.5 - 38.0 o C. In 65% of cases, parawhooping cough occurs as tracheobronchitis and acute respiratory infections.

Cough is the main one. Depending on its nature, there are three clinical forms of parawhooping cough: asymptomatic, erased and whooping cough.

Erased current

The erased course of the disease occurs in 60 - 70% of cases and is characterized by tracheobronchial cough. The diagnosis of parapertussis is established only with the help of bacteriological confirmation.

Whooping cough-like course

A whooping cough-like course of parapertussis is observed in 12 - 15% of cases. The disease is characterized by the appearance of a cough, which sometimes becomes paroxysmal. Initially, short coughing impulses appear, which follow each other throughout one exhalation. Next, the child takes a deep breath. The resulting sudden exhalation is accompanied by a whistling sound (reprise). During an attack, the child takes a forced position, his face turns red, the vessels in the eyes sharply dilate (“filled” with blood), the tongue is pushed far forward when coughing, its tip bends upward, the veins on the neck, face and head swell. A cough often ends in vomiting. Such coughing attacks are rare in a child with parawhooping cough. And the attack itself is short-lived. The duration of the convulsive cough period is 2 - 3 days.

Bacterial carriage

Bacteria carriage is observed in children from parapertussis foci in 10 - 15% of cases. When carrying the bacteria, there are no clinical signs of the disease.

Complications from parawhooping cough are extremely rare. Deaths are not recorded. Immunity does not develop after an illness.

Rice. 6. Cough is the main symptom of parawhooping cough.

Laboratory diagnosis of parapertussis

Bacteriological and serological methods are the main ones in the diagnosis of parapertussis.

Bacteriological diagnostics

Isolation of whooping cough pathogens from nasopharyngeal mucus is a classic method for laboratory confirmation of the disease.

The following are subject to bacteriological diagnostics:

• children who are suspected of having parawhooping cough and whooping cough;
• adults and children whose cough lasts 5-7 days, but not more than 1 month;
• adults who are suspected of having whooping cough and parawhooping cough, working in preschool and school institutions, maternity hospitals and children's hospitals.

Parapertussis test

The material for bacteriological examination is a smear from the nasal passages (both) and the posterior wall of the nasopharynx (not from the larynx!).

To take a smear, a Dacron swab is used or the cough patch method is used. The examination is carried out 2 times daily or 2 times every other day in the first 3 weeks of the disease.

On nutrient media, the formation of colonies occurs 3–5 days after sowing. The final result is obtained on days 5–7 of pathogen growth. For cultivation, Bordet-Gengou blood medium or casein-charcoal agar is used.

Rice. 7. The material for bacteriological examination is a smear from the nasal passages (both) and the posterior wall of the nasopharynx (not from the larynx!).

Parapertussis test using PCR

Diagnosis of parapertussis using PCR (polymerase chain reaction) is the most promising technique in modern conditions. The test is highly sensitive. It allows you to detect the DNA of bacteria, even if the content of pathogens in the material under study is no more than several dozen. The examination is carried out at 1-2 weeks of the disease.

Testing for parapertussis using serological tests

Serological diagnostics makes it possible to detect specific antibodies and their titers in the serum of a sick person.

Parapertussis pathogens contain substances (antigens) that can trigger an immune response in the body of an infected person (formation of antibodies). Serological diagnostics makes it possible to detect specific antibodies and their titers in the serum of a sick person. The results of a serological study are assessed taking into account the clinical picture of the disease.

Enzyme-linked immunosorbent assay (ELISA)

Enzyme immunoassay is a sensitive, specific and relatively inexpensive test. It can be used to measure serum immunoglobulins of classes G, M and A. Serum immunoglobulins A and M increase in the early stages of the disease, serum immunoglobulins G - in later stages. This type of study is carried out at 2-3 weeks of illness.

Agglutination reactions

Diagnosis of parawhooping cough in the later stages of the disease is carried out using agglutination reactions: RPGA, RNGA And RA. These reactions are based on the ability of corpuscular antigens to stick together with the help of antibodies. Using agglutination reactions, agglutinating antibodies to the causative agents of parapertussis are determined in the blood.

Differential diagnosis of parapertussis

More than half of all cases of parawhooping cough occur under the guise of tracheobronchitis or acute respiratory diseases. It is extremely difficult to differentiate between these diseases and parawhooping cough. Bacteriological research is of decisive importance here.

With parapertussis, the hemogram often remains normal. In some cases, moderate leukocytosis and lymphocytosis are recorded.

Rice. 8. In the photo on the left are leukocytes, on the right are lymphocytes. With parapertussis, in some cases moderate leukocytosis and lymphocytosis are recorded.

Treatment of parawhooping cough in children

Due to the fact that most cases of the disease are mild, treatment of parawhooping cough is symptomatic.

Hospitalizations Children with complicated course of the disease are subject to treatment.

Properly organized treatment regimen child helps alleviate the symptoms of the disease. For parawhooping cough, it is gentle, limiting negative psycho-emotional and physical stress. Walking in the fresh air is a mandatory therapeutic procedure.

Antibiotics for parawhooping cough are prescribed only when secondary microflora is attached and there is a threat of developing pneumonia.

For mild forms of the disease sedatives are prescribed (tincture of valerian, motherwort, peony). Antispasmodics include a mixture with belladonna extract and calcium gluconate. Vitamins C, A and P. For allergies, the use of desensitizing agents is indicated.

Rice. 9. In mild cases, treatment of parawhooping cough is symptomatic.

Antitussives for whooping cough and parawhooping cough are ineffective. However, they are sometimes used for painful coughs.

• Expectorants (mucolytics) Bronchicum, Ambroxol,Ambrobene, Stoptussin and Lazolvan.
• Drugs with an expectorant effect and stimulants of motor (motor) function of the respiratory tract - Sinetos, Tussin, Coldrex broncho and Bromhexine.
• Centrally acting antitussive drug Sinekod.
• Bronchodilators Berodual and Eufillin.

Bronchomucolytics should preferably be administered using a nebulizer. Hardware administration of drugs from this group guarantees their deep penetration into the bronchopulmonary system.

For severe paroxysmal cough, an antiallergic drug is prescribed Pipolfen and tranquilizer Seduxen.

Eufillin has antispasmodic and bronchodilator effects. The medicine of aminophylline in combination with iodine has a pronounced mucolytic effect. If you are allergic to the components of the mixture, you can use Ambroxol, Lazolvan, Ambrobene.

Rice. 10. When treating parapertussis in children, it is advisable to administer bronchomucolytics using a nebulizer.

Whooping cough is a common infection that affects not only children but also adults. However, there is another pathology with a similar clinical picture - parawhooping cough. How these diseases differ and how to determine the true cause of the symptoms can only be answered by a doctor.

Whooping cough and parapertussis are caused by different bacteria. The cause of the infectious process is Bordetella (pertussis and parapertussis, respectively). These are gram-negative, non-motile rods with poor stability in the external environment. They are similar in external structure and antigenic properties. However, the pertussis bacterium, unlike parapertussis, produces an exotoxin, which causes a more severe course of the infection.

The source of infection becomes a sick person or a carrier of pathogenic microbes (less often). The pathogen enters the body through airborne droplets, requiring close and fairly long contact. It should be remembered that whooping cough is twice as contagious as parawhooping cough, which means that the former is more dangerous epidemiologically.

The causative agents of whooping cough and parawhooping cough, once in the respiratory tract, reach the bronchioles and alveoli. There they multiply, showing their pathogenicity. In whooping cough, the main factor becomes an exotoxin that affects many body systems: respiratory, vascular, nervous, and immune. It initiates a spasm of the respiratory tract and an increase in vascular tone, provokes metabolic disorders and a decrease in T-cell immunity.

The mechanism of development of parapertussis infection is similar to whooping cough, with the exception of the influence of exotoxin. Bacteria and their metabolic products irritate the receptors of the respiratory tract. As a result, a cough develops. Constant pathogenic impulses form a focus of excitation in the respiratory center, which takes on a dominant character.

The cause of the infectious process is bacteria, the main target of which is the respiratory tract. But the pertussis bacillus has the ability to produce exotoxin, which is the main factor in its pathogenicity.

Classification

To make a diagnosis, the classification adopted in clinical practice plays an important role. The course of whooping cough and parawhooping cough has certain similarities. It could be:

• Typical and atypical (erased, asymptomatic, as a carrier).
• Mild to moderate severity.
• Smooth and non-smooth (with the addition of secondary flora, exacerbation of chronic pathology).

However, there are also significant differences. Whooping cough, unlike parawhooping cough, can occur in a severe form, with complications or abortively (with an atypical development).

Symptoms

Both infections are accompanied by similar clinical signs. For typical character forms, cyclicality. From the moment of infection until the first signs appear, it takes from 3 days to 2 weeks (incubation period). Then a dry cough gradually appears, which intensifies over time. At the same time, the child’s general condition is satisfactory, the temperature remains normal.

After 1–2 weeks, the cough becomes paroxysmal (spasmodic). Several respiratory impulses follow each other, after which the discharge of viscous sputum or vomiting is observed. At this time, the child’s face turns red and blue, swells, veins swell on the neck and head, lacrimation increases, and the tongue protrudes from the mouth. Parapertussis in children often occurs in a mild form, when the number of attacks per day is no more than 10, they are short-lived. The period of spasmodic cough itself lasts up to 3 weeks, while with whooping cough its duration is twice as long.

Severe coughing attacks follow each other with a frequency of up to 30 per day, they always end in vomiting. The general condition suffers: symptoms of respiratory failure are observed (acrocyanosis, pallor), children are lethargic and capricious, they sleep and eat poorly. Cough attacks can cause bleeding in the eyes and skin hemorrhages. A frenulum tear (or erosion) is detected on the tongue due to friction against the teeth.

The recovery period proceeds with a decrease in cough, attacks of which are observed less and less often. General well-being improves, sleep and appetite normalize. With whooping cough, a sharp return of cough is possible against the background of concomitant pathology, which is due to persistent increased excitability. But in the case of parawhooping cough, the period of convalescence proceeds favorably.

The clinical picture of both diseases has both similarities and differences. However, it is sometimes difficult to make an accurate diagnosis based on symptoms alone.

Complications

With parawhooping cough and whooping cough, the differences also relate to specific complications. In the latter case, they may be the following states:

• Emphysema.
• Atelectasis.
• Pneumonia.
• Apnea.
• Hemorrhages.
• Hernias.
• Rupture of the eardrum.

These phenomena are caused by the severe course of the disease and the effects of exotoxin, so parawhooping cough is not accompanied by them.

Additional diagnostics

Additional research methods occupy the most important place in the diagnosis of whooping cough and parawhooping cough. Laboratory tests are of particular importance:

• General blood test.
• Analysis of pharyngeal mucus (culture on a nutrient medium, PCR).
• Serological methods (ELISA, RA, RPGA).

Parapertussis differs from whooping cough in that it does not produce hematological changes (increased leukocytes and lymphocytes). When analyzing mucus from the throat (using the “cough patch” method), a specific pathogen is identified, and serological tests will make it possible to determine antibodies to it.

Treatment

Patients with whooping cough are often subject to hospitalization (in severe forms, with complications and concomitant diseases, young children, according to epidemiological indications), while parawhooping cough is treated on an outpatient basis. Specific therapy consists of taking antibiotics:

• Azithromycin.
• Amoxicillin.
• Erythromycin.
• Roxithromycin.

Increased excitability of the nervous system is relieved with sedatives, tranquilizers and antipsychotics. Severe cases require the administration of glucocorticoids and drugs that improve cerebral blood flow. However, with parawhooping cough, all these drugs are not needed - only symptomatic correction with antitussive and expectorant medications is sufficient.

Treatment of patients with parapertussis is mainly aimed at eliminating and relieving symptoms.

Prevention

If whooping cough is detected, all patients are isolated for 25 days, and those who were in contact with them do not attend educational institutions (kindergartens) for 2 weeks. However, in a situation with parawhooping cough, this only applies to children under 1 year of age. In addition, contact persons do not need to take an antibiotic for prophylactic purposes, as they do with a more dangerous infection.

Parawhooping cough is very similar to whooping cough, hence the name of the disease. However, it is characterized by less contagiousness, a milder course, and the absence of complications and changes in blood tests. Accordingly, treatment and preventive measures have certain differences.

If a child begins to cough heavily and is diagnosed with parawhooping cough, parents immediately have doubts. Where does this disease come from, because you have been vaccinated against whooping cough! To deal with this problem, let's talk about what parawhooping cough is in children, what are the symptoms, treatment, possible complications and prognosis.

Vaccination does not save: parawhooping cough - who is sick and what is its danger?

Parawhooping cough is an infectious disease, which in its manifestations is practically no different from whooping cough. The main symptom of the disease is coughing attacks. Children from 3 to 6 years old (including those vaccinated against whooping cough) are at risk of catching it; Such cases are rarely recorded in infants and adolescents.

Parawhooping cough is caused by one of the varieties of whooping cough bacillus. Infection occurs through airborne droplets upon contact with a patient. The incidence is up to 15% of the number of registered cases of whooping cough. In comparison, the disease is not so severe: coughing attacks are less frequent, and they are not so strong. It poses a particular danger to children under one year of age. Possible complications are bronchitis, pneumonia, pleurisy.

Parawhooping cough can be confused with ARVI or ARI only in the first stages of the disease. Because attacks of whooping cough are very specific and are not at all similar to those with a cold or bronchitis.

What symptoms will the child have?

The disease goes through three stages. From the moment of infection to the initial signs, no more than 15 days pass (on average, the latent period lasts from 5 to 8 days). Then parawhooping cough makes itself felt with such manifestations.

Read also:

Catarrhal period (lasts 3-14 days). It looks like this: a dry persistent cough occurs, in rare cases it is accompanied by a runny nose, and general health worsens. The temperature may remain within normal limits or rise slightly (up to 37.5˚).
Parents usually regard all this as ARVI and begin to treat the child according to the standard regimen. But no cough suppressants help reduce cough. It becomes stronger and takes on the character of attacks.

Convulsive (may last 8 weeks or longer). Symptoms become more pronounced. These include:

• paroxysmal cough, which is preceded by precursors: the throat begins to sore, the child feels anxious. The cough looks like jerky cough impulses (on exhalation), which follow one after another. It is interspersed with reprises. These are inhalations during which a whistling sound is heard, which is associated with a spasm of the glottis. Attacks are repeated up to 7 times a day;
• at the end of the attack, mucus is released or vomiting occurs;
• during the coughing process, the child’s face becomes red, gradually turns blue and becomes puffy,
• the veins in the neck swell, the eyes turn red;
• if the attack is very severe, spontaneous urination or fecal discharge may occur (less commonly, rectal prolapse);
• the patient sticks out his tongue strongly (it also acquires a bluish tint);
• tears flow from the eyes;
• eyelids become swollen;
• ulcers and white plaque can be found on the frenulum of the tongue;
• the baby becomes irritable or lethargic.

Resolution stage (2-4 weeks). There is a cough without attacks, which appears less and less often. The child's condition is gradually stabilizing.

It is impossible to distinguish whooping cough from parawhooping cough based solely on symptoms.

What is needed to make a diagnosis?

To make an accurate diagnosis, a chest X-ray, a smear culture (taken from the back of the throat), and a blood test for the presence of antibodies to parawhooping cough (they appear from 2-3 weeks from the onset of the disease and are detected within 3 months) are prescribed. It also takes into account whether there was vaccination, whether the child communicated with patients with pertussis infection.

If there are symptoms indicating paratussis in children, treatment should be carried out by one of the following specialists: infectious diseases specialist, pediatrician, ENT specialist, pulmonologist.

What treatment does the child need?

Typically, parawhooping cough can be treated at home. The patient is prohibited from visiting the kindergarten for 25 days while he is a carrier of infection. A two-week quarantine is imposed on the preschool institution. If a child under 3 years of age falls ill or the illness is severe, he may be admitted to a hospital.

There is no specific treatment; symptomatic therapy is used. To reduce the frequency and intensity of attacks, parents are recommended to carry out the following activities:

• inhalation with moist air using a nebulizer or oxygen barotherapy;
• maintaining optimal humidity and temperature (should not be dry and hot) in the room where the small patient is located;
• daily walks in the fresh air.

As for medications, the doctor may prescribe the following:

• Tussin, Bronholitin (at the stage of catarrhal phenomena);
• antibiotics from the macrolide group (they are prescribed only for complicated parawhooping cough in children under one year old);
• sedatives.

Physiotherapy and acupuncture have a good effect.

• so that the patient is not so tormented by a cough, wet towels or sheets should be hung in the room;
• before sunrise, take the child to flowing water (rivers);
• give a decoction of marshmallow roots. It is prepared like this: 4 tsp. pour 2 tbsp of this raw material. boiled water (chilled), leave for 8 hours, strain. The child should drink this entire portion per day in small sips;
• honey treatment Mix 1 teaspoon of freshly squeezed radish juice with 2 parts of honey. Take 3-4 r. per day 1 tbsp. l.;
• healing composition of 100 g of viburnum berries and 200 g of honey. The ingredients are mixed, the composition is boiled in a water bath for 10 minutes, and 1 tbsp is consumed. l. three times a day after meals.

How to protect your children from parawhooping cough?

The vaccine only provides protection against whooping cough. There are no special measures to prevent parapertussis. To reduce the likelihood of your child encountering harmful microorganisms, you should limit his contact with other children (especially stay away from coughing children).

Parawhooping cough is rare in children, but in the understanding of many parents it belongs to the category of the most dangerous diseases, the likelihood of which is extremely high. As a result, a child with the first signs of a cold, often vague and unclear, is immediately given an appropriate diagnosis, and the patient himself is sent to the infectious diseases department of the hospital. Strictly speaking, it is difficult to blame the concern of parents and their attentive attitude to the health of their children, but parapertussis infection (Bordetella parapertussis) rarely requires such decisive action, and the disease itself is quite mild. Therefore, we recommend not to panic and try to understand what happened to your baby.

Not every disease conventionally classified as a cold is critically dangerous to health and life. Parapertussis, caused by the bacterium Bordetella parapertussis (discovered in 1937), is indeed similar to its famous “brother,” but there is not much in common between them.

Differences between whooping cough and parawhooping cough (indicators of ordinary whooping cough in parentheses):

• bacterial size: 0.3-0.5 microns (0.5-2), has flagella, produces tyrosine;
• risk factors: 3 (10);
• risk group: children from 3 to 6 years old (1-3);
• susceptibility to infection (or infectivity index): 0.35 (0.7-1);
• course of the disease: mild (moderate or severe);
• symptoms: vague and unclear symptoms of tracheobronchitis, acute respiratory infections (spasmodic, exhausting cough);
• duration of the acute phase: 2-3 days (from 2 to 8 weeks);
• risk of complications: extremely low (occur frequently and have much more pronounced manifestations);
• possibility of re-infection: yes (extremely low);
• changes in blood composition: sometimes laboratory tests show moderate lymphocytosis and leukocytosis (more pronounced, and return to normal values ​​more slowly).

Features of infection

The bacterium Bordetella parapertussis is practically unviable outside the host body. When exposed to direct sunlight, it dies within an hour, and high temperatures (50-55 degrees) reduce this period to 15 minutes. In dry sputum, in the absence of proper sanitary treatment, the causative agent of parawhooping cough remains viable for up to several hours. Consequently, a considerable proportion of infection cases is explained by the negligence of medical personnel in preschool institutions, and not by the high pathogenicity of Bordetella parapertussis.

The main route of transmission is airborne, about 80% of cases are children from 3 to 6 years old. The probability of infection is far from 100%. Thus, out of 100 children who are in close contact with a carrier, no more than 35 will get sick. In infants and children aged 1-2 years, the risk is practically absent. Most often, the disease is registered in preschool institutions (nurseries, kindergartens).

What happens after infection?

The parapertussis bacillus, having entered the body, begins to spread through the respiratory tract, where without adequate treatment it can exist for quite a long time. Having penetrated the lungs, the infection affects the so-called cilia, which causes mucus to accumulate in the respiratory tract, which provokes coughing attacks.

Attention! Children whose disease is very severe are subject to unconditional hospitalization. In all other cases, parawhooping cough can be treated at home.

Toxins that are produced during the acute phase of the disease:

• Parapertussis. It is he who provokes bronchospasm and affects the afferent fibers of the vagus nerve. The cough that occurs as a result of such exposure is at first normal, and then paroxysmal. But, we repeat, in this regard, it is not entirely correct to compare ordinary whooping cough and parawhooping cough: the clinical manifestations of the first are much more pronounced.
• Cytotoxin, dermatonecrotoxin. Damage the tissues of the respiratory tract. As a result, blood flow increases, which contributes to the rapid spread of the pathogen throughout the body.

Symptoms

The incubation period of parawhooping cough lasts from 4-5 days to 2 weeks, and in many cases the clinical manifestations are blurred and implicit. If your child has a strong immune system, the symptoms of the disease may not be noticed at all, and the baby’s well-being will be quite satisfactory.

• rhinitis;
• conjunctivitis (inflammation of the outer layer of the eye);
• hyperemia of the pharynx;
• a slight increase in temperature is possible (up to 38 degrees, no more than 3 days).

The form of the disease is entirely determined by the characteristics of the cough and other characteristic clinical manifestations.

Erased

Occurs in two out of three cases. It is characterized by tracheobronchial cough, and an accurate diagnosis can only be made using laboratory tests. We especially note: in children, treatment in this case will most likely be symptomatic.

Whooping cough

It is observed in 12-15% of cases. Cough shocks follow one after another during one exhalation, after which temporary relief occurs. Breathing is accompanied by whistling sounds (reprise). The typical duration of this phase is 2-3 days.

The most characteristic clinical manifestations:

• forced body position during an attack;
• facial redness;
• expansion of the eye vessels;
• swelling of veins in the neck, head and face;
• vomiting is possible.

Bacterial carriage

It is possible to say that the presence of parapertussis infection in the body is one of the forms of the disease with certain reservations. There are no clinical manifestations, and there is usually no reason to seek medical help. Bacterial carriage occurs in 10-15% of cases.

Diagnostics

Detecting parawhooping cough is a rather difficult task, since the presence of infection in the body can only be reliably determined by the results of laboratory tests. Taking your child to the doctor after every sneeze is unlikely to be advisable, but if his condition gradually worsens, it definitely makes sense. And here it is important to understand that parawhooping cough in children (symptoms and treatment can vary quite widely) is a disease that can sometimes be extremely dangerous.

Doctors to contact:

• pediatrician (best);
• infectious disease specialist;
• pulmonologist

Bacteriological diagnostics

When does it really make sense? Taking into account the fact that identifying Bordetella parapertussis is a rather lengthy procedure, and some types of research require specialized and very expensive equipment, it can be recommended in the following cases:

• your local pediatrician suspects that your child has parawhooping cough, since there are certain external manifestations of the disease (and not just a cough);
• the baby's cough lasts longer than 1 week;
• the child has long-term contact with adults working in preschool institutions with an increased risk of infection.

Types of laboratory tests:

• A swab from both nasal sinuses and the posterior wall of the nasopharynx. The examination is usually carried out twice a day. The final result of the analysis will be ready in 6-7 days, and its accuracy highly depends on the quality of the reagents.
• Serological reaction. It allows you to identify not the infection itself, but specific antibodies and their titers, which are formed as a result of the body’s immune response. The data obtained should be assessed taking into account the characteristics of the course of the disease in a particular child.
• Enzyme immunoassay. A relatively inexpensive but very sensitive test that accurately measures serum immunoglobulins A, M and G (the latter at later stages). It is carried out 2-3 weeks from the date of onset of the disease.
• PCR diagnostics. Polymerase chain reaction is one of the most promising diagnostic methods with extremely high accuracy. The examination is carried out in the second week of the disease, but due to its high cost and complexity, it is used quite rarely in domestic clinics.
• Agglutination reaction. An effective method for diagnosing parawhooping cough in the later stages. It allows you to detect agglutinating (sticking together) antibodies to the pathogen. It is rarely used in real life, since most sick children are almost completely healthy by 2-3 weeks, so there is no particular point in additional research.

To confirm the diagnosis and identify the exact picture of the disease, a chest x-ray may be needed.

Treatment of parawhooping cough

Most often, there is no need for any special therapeutic measures, and the baby only requires a gentle regime. Consequently, therapeutic measures in most cases come down to...:

• ...walks in the fresh air;
• ...limitation of physical and psycho-emotional stress.

Nonspecific drug therapy:

• sedatives: tincture of motherwort, valerian, peony;
• antispasmodics: calcium gluconate, belladonna extract;
• vitamins A, C and P;
• desensitizing drugs (if there is a severe allergic reaction).

• mucolytics: ambroxol, stoptussin, bronchicum, lazolvan;
• expectorants and drugs to improve respiratory tract motility: sinetos, coldrex-broncho, tussin, bromhexine;
• means of central action: sinekod;
• bronchodilators: aminophylline, berodual.

If absolutely necessary, the child may be prescribed antibiotics or tranquilizers like Seduxen. But such treatment requires mandatory consideration of all potential risks.

One of the childhood infectious diseases is parawhooping cough. Its symptoms and cyclical nature resemble tracheobronchitis.

Etiology of the disease

Parapertussis is an acute anthroponotic bacterial infection, which cannot be distinguished from a mild form of whooping cough by its symptoms. This infection was given the number A37.1 in ICD-10.

The disease is usually acute. Young children are susceptible to infection; adults rarely get sick. The disease in adults is characterized by a mild, mild form.

Doctors diagnose parawhooping cough 20–25 times less often than whooping cough. These two diseases do not provide cross immunity. A person who has had whooping cough can be infected with parawhooping cough and vice versa.

The disease has several forms. Considering the type of pathology, experts divide parawhooping cough into:

• typical. The disease occurs with pronounced symptoms;
• atypical. He is asymptomatic.

Parawhooping cough can occur in mild to moderate forms. It depends on the individual characteristics of the immune system. Very rarely complications may occur.

What is the difference between whooping cough and parawhooping cough, says Dr. Komarovsky:

Pathogen, routes of infection

Parawhooping cough affects the respiratory system and nervous system (central). The causative agent of the infection is parapertussis (Bordetella parapertussis).

Infection is carried out by airborne droplets. When you cough violently, the bacteria that cause parawhooping cough become airborne. The carrier of the virus remains infectious for several weeks.

How is it different from whooping cough and other diseases?

To diagnose parawhooping cough, it is necessary to conduct bacteriological and serological studies. A serological reaction is carried out between pertussis and parapertussis diagnosticums.

If paratussis is suspected, the patient undergoes the following tests:

• for pertussis/parapertussis in vitro;
• interpretation of immunological analysis;
• microbiological (material is taken from the back wall of the pharynx);
• blood for antibodies (hemotest) to the infectious agent;
• radiography.

We present the main differences between whooping cough/parawhooping cough in the form of a table.

Reasons

Whooping cough and parapertussis have similar pathogenic properties, but different biochemical characteristics. The causative agent of the disease passes from a sick child to a healthy one. Epidemics occur more often in preschool and educational institutions. In such institutions, children come into very close contact with each other.

The disease can manifest itself in representatives of different age categories. Children aged 3–6 years are most often affected. The virus affects vaccinated people who have previously had the disease.

Causes and symptoms of parawhooping cough:

Symptoms

The main signs of parawhooping cough are:

• malaise;

Parapertussis has a three-stage clinical picture:

1. Catarrhal period. Signs of infection are mild or completely absent.
2. Spasmodic period. Lasts 10 – 14 days. The patient is bothered by a severe paroxysmal cough.
3. Recovery.

If a child has a prolonged paroxysmal cough, rarely accompanied by an increase in temperature, doctors often diagnose parawhooping cough. The disease develops with symptoms similar to diseases of the respiratory system.

Paroxysmal cough cannot be eliminated with antitussive drugs. Experts divide the symptoms of parawhooping cough into 4 clinical groups:

1. Incubation period (5 – 15 days). There are no signs of infection.
2. Catarrhal period. The patient is worried about weakness, headaches, and general malaise.
3. Spasmodic period. He is characterized by attacks of wet cough, which intensify at night. Coughing may cause vomiting.
4. Recovery. Signs of the disease weaken and gradually disappear.

Treatment of parawhooping cough

In the treatment of parawhooping cough, medications of the following groups are used:

• antispasmodics;
• bronchodilators;
• mucolytics;
• (they are used for complications);
• antihistamines.

The following activities will help speed up the onset of recovery:

• walks in the fresh air (daily);
• exclusion of contact with the irritant;
• adherence to daily routine;
• wet cleaning in the room with the patient;
• exclusion of psycho-emotional and physical fatigue;
• humidifying the air in a room with a sick child;
• dietary nutrition (exclude smoked, spicy, salty, sour foods).

It is permissible to use traditional methods of treatment after consultation with a doctor. The following remedies help eliminate a painful cough:

• fennel fruit tincture;
• radish juice with honey.

Quarantine for parawhooping cough should be observed for 14 days. It is necessary to isolate a sick child from others for 25 days.

Consequences and complications

There are usually no complications with parawhooping cough. If an infection is combined with a cold, the following complications may occur:

• pneumonia;
• bronchitis.

In rare cases, severe whooping cough can cause the following complications:

• pneumothorax;
• emphysema;
• rectal prolapse.

Prevention

There is no specific prevention for parapertussis. Vaccinated children and those who have had it before can get sick.

Patients are isolated from the team for 25 days (until they receive 2 negative results from a bacteriological test in the laboratory).

All prevention of parawhooping cough is represented by the following actions:

1. Isolation of the sick person for 25 days.
2. Quarantine (14 days).
3. Isolation of bacteria carriers until 2 negative results of bacterial examinations are performed.

Vaccination

Vaccination against parapertussis does not guarantee against infection of a child. The body is unable to develop immunity to this disease. Even a person who has been sick once can become infected again.

How to avoid getting whooping cough from someone who is sick

To avoid becoming infected with parawhooping cough, you need to isolate the sick child from the group for 25 days.

The probability that a child will become infected in the first week is 90–100%. You can become infected in the second week in 65%, in the third – 35%, in the fourth – 10%.

No one can guarantee that your child will not get parawhooping cough in a preschool or educational institution.

Forecast

With parawhooping cough, the prognosis is favorable.

How to treat parawhooping cough, watch our video: