Pertussis/ Kali Khansi is an acute respiratory infection which is also known as whooping cough. It is caused by Bordetella pertussis.
There are 60 million cases of pertussis each year worldwide resulting in more than 5 lakh deaths. Widespread use of pertussis vaccine leads to more than 99% decline in cases.
Before vaccination was available pertussis was the leading cause of death due to communicable disease in children among 14 years of age in the USA.
The important role of vaccination in disease control is reflected in the continued high incidence of pertussis in developing countries and in other countries where vaccine coverage is low
Pertussis/ kali Khansi is highly contagious with attack rates as high as 100% in susceptible individuals exposed to coughing droplets in close range.
After intense exposure in the household, the rate of subclinical infection is as high as 80% in fully immunized or previously infected individuals
Clinical features
It is a prolonged disease and begins with catarrhal stage characterized by congestion running of the nose, low-grade fever, sneezing lacrimation and conjunctival congestion.
In the next stage, the paroxysmal cough becomes the most marked symptom. The cough is dry intermittent and in paroxysms.
The child is well looking, appearing play full which with an insignificant provocation burst into a paroxysm of uninterrupted cough on a single exhalation with the chest held forward tongue protruding maximally, bulging and watering and a loud whoop follows the cough. Vomiting is common and exhaustion is universal. This last for days to weeks Patients may have more than one paroxysms cough episode hourly.
Adolescents and adults do not have distinct stages. There may be a feeling of strangulation followed with uninterrupted cough, headache, diminished awareness, gasping breath without any whoop. Post cough vomiting is common and there is a long asymptomatic intermittent period lasting hours.
Treatment
The goal of therapy is to limit the number of cough paroxysms to maximize nutrition, rest and recovery without any complications.
Patients have usually admitted to the hospital particularly small children 3 to 6 months of age these are the patients who are at the highest risk of mortality
Disease-specific antibiotics are prescribed particularly the macrolides Azithromycin is the preferred agent of choice
Patients can be isolated so as to prevent the spread of disease and a course of Azithromycin for 5 days should be given to all the contacts
Complications
Infants less than 6 months of age have the highest mortality rate patients also develop pneumonia seizures encephalopathy.
Major complications include retinal haemorrhage central nervous system haemorrhage, staphylococcal streptococcal pneumonia, pneumothorax, subcutaneous emphysema inguinal and umbilical hernia
Vaccination : 3 doses of DPT given after one month of age at 6 weeks of the interval can reduce the risk of uses of Kali Khansi in children for years to come.
It is also important to repeat this vaccination at 5 years of age along with diphtheria and tetanus. Repeat vaccination is also recommended at 10 years of age to prevent transmission of disease in the adults and from there to the newborn babies
Author – Dr Geeta Yadav
