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[Pertussis: diagnosis, clinical aspects and therapy]
1Universitäts-Kinderklinik Tübingen.
Abstract:
Isolation of the causative agent remains the "gold standard" for the early diagnosis of pertussis. For this purpose, the nasopharynx is swabbed with a calcium alginate swab. Cephalexin-containing charcoal horse blood medium is used for the transport of the swabs to the bacteriology laboratory. As an alternative, the isolation of bordetellae can be performed at the paediatrician's office by direct inoculation of charcoal horse blood agar plates. Long-lasting cough of unknown aetiology is the main field for pertussis serology (ELISA). Even today, severe courses of whooping cough requiring hospitalization are not rare, especially in infants. Erythromycin (given in high doses for 14 days) is the antibiotic of choice for pertussis. As an alternative to the macrolides, cotrimoxazole may be administered or amoxycillin. Salbutamol and the corticosteroids have been shown to be useful for the symptomatic treatment of severe pertussis in infants.
Insights
Early pertussis diagnosis relies on isolating the causative agent via nasopharyngeal swabs. Erythromycin is the preferred antibiotic for treating this highly contagious respiratory illness, especially in infants.
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
- Clinical Diagnostics
Background:
- Pertussis, or whooping cough, remains a significant concern, particularly for infants, often presenting with severe, hospitalization-requiring courses.
- Early and accurate diagnosis is crucial for effective management and control of pertussis transmission.
Purpose of the Study:
- To outline current diagnostic methods for pertussis, emphasizing the gold standard of bacterial isolation.
- To review recommended antibiotic treatments and symptomatic therapies for pertussis, especially in vulnerable populations.
Main Methods:
- Nasopharyngeal swabbing using calcium alginate swabs for bacterial culture.
- Transport of samples using cephalexin-containing charcoal horse blood medium.
- Direct inoculation of charcoal horse blood agar plates in pediatric settings for Bordetella isolation.
- Enzyme-linked immunosorbent assay (ELISA) for pertussis serology in cases of prolonged cough.
Main Results:
- Bacterial isolation from nasopharyngeal swabs is the definitive method for early pertussis diagnosis.
- Erythromycin, administered in high doses for 14 days, is the primary antibiotic treatment.
- Alternative antibiotics include cotrimoxazole or amoxicillin.
- Salbutamol and corticosteroids offer symptomatic relief for severe pertussis in infants.
Conclusions:
- Bacteriological isolation remains the gold standard for pertussis diagnosis.
- Effective antibiotic treatment, primarily with erythromycin, is essential.
- Supportive care with bronchodilators and corticosteroids is vital for managing severe infant cases.