🌸written for pertussis:

1-clinical stages

2-complication

3-age related presentation

4-investigations

5-TTT

6-vaccination

باقي محاضرة الpertussis (mcq)

🌸🌸🌸

🌸Written for tetanus:
1-clinical manifestation
2-treatment
3-wound prophylaxis

🌸MCQ :

ال toxin
اسمه tetanospasmin

+فيه ٢ cases في بداية الباور

ليهمD.D:

1-pneumonia

2-bronchitis

3-T.B

4-pertussis

5-common cold

6-influanza

🌸 Pertussis (Whooping Cough)

1. Clinical Stages

Incubation (5–21 days): Asymptomatic; typically lasts ~7–10 days.
Catarrhal Stage (1–2 weeks): Nonspecific URI symptoms (mild cough, coryza, sneezing, low fever) and is highly infectious.
Paroxysmal Stage (2–6+ weeks): Classic repetitive coughing fits ending in a high-pitched “whoop” on inspiration. Attacks can cause facial reddening, cyanosis, bulging eyes, tongue protrusion, and post-tussive vomiting.
Convalescent Stage (2+ weeks): Gradual improvement where cough lessens in frequency and severity, though paroxysms may recur with future respiratory infections.

2. Complications

Infants: Highest morbidity, including apnea, cyanotic spells, pneumonitis (>10%), pulmonary hypertension, seizures, and encephalopathy. Subdural hemorrhage and death are the most severe outcomes.
Children/Adolescents: Pneumonia (bacterial superinfection), otitis media, and rarely rib fractures from violent coughing.
General: Hernias (umbilical, inguinal) or rectal prolapse from straining, subconjunctival hemorrhages, weight loss, and dehydration.

3. Age-Related Presentation

Infants (<1 year): Often no obvious whoop; instead present with apnea, bradycardia, and cyanosis during coughing spells. May have poor feeding and irritability.
Children (1–10 years): Classic presentation with loud whoop, choking spells, and post-tussive vomiting.
Adolescents/Adults: Often present with a prolonged cough without a whoop and is less severe.

4. Investigations

Laboratory: Marked leukocytosis with lymphocytosis is suggestive (often >50% lymphocytes, WBC >20,000) .
Microbiology: Confirm with PCR (preferred) or culture of nasopharyngeal specimens on special Bordetella media, optimally within the first 2–3 weeks of cough.

5. Treatment (TTT)

Antibiotics: Azithromycin is first-line (5-day course) for infants ≥1 month and contacts. Erythromycin or clarithromycin can be used for 7–10 days, and TMP-SMX is used if macrolides are contraindicated or the patient is ≥2 months.
Supportive Care: Hospitalize high-risk patients (infants, respiratory distress). Maintain hydration/nutrition, provide oxygen, and suction secretions if needed. Cough suppressants are not recommended in infants.
Infection Control: Isolate the patient (droplet precautions) until 5 days of therapy.

6. Vaccination

DPT: Routine for infants/children <7 years, given as a 5-dose series at 2, 4, 6, 15–18 months, and 4–6 years.
Tdap: One booster at 11–12 years. Given during each pregnancy (27–36 weeks) to protect the newborn. Adults who never had Tdap should get one dose.

🌸 Tetanus

1. Clinical Manifestation

Incubation period: 3–14 days.
Earliest sign: Feeding difficulty due to trismus (lockjaw).
Progression: Rigidity spreads to the neck, back, and limbs, leading to a fisting posture.
Spasms: Painful, stimulus-triggered spasms with preserved consciousness.
Characteristic signs: Risus sardonicus (grimace-like smile with clenched jaw) and Opisthotonus (severe back arching).

2. Treatment

Control of spasms: Diazepam or phenobarbitone in a quiet environment.
Neutralize toxin: Human Tetanus Immunoglobulin (HTIG) 500 units IM, or Antitetanic Serum (ATS) 5000 units IM.
Eradicate bacteria: Penicillin or metronidazole along with wound/umbilical care.
Supportive care: ICU management, airway maintenance, hydration, and gavage feeding.

3. Wound Prophylaxis

Clean all wounds.
Give ATS (3000 units IM) for dirty/deep wounds.
TT booster based on vaccination status: No booster needed if vaccinated <5 years ago; give a booster if >5 years ago; give a full 3-dose series if unvaccinated.

Pediatric