Jun 20, 1981
British Medical Journal (Clinical research ed.)
I -F Vomiting may be so severe in infants with whooping cough that the mother is more worried by the vomiting than the cough. During the first one to two weeks of the illness (catarrhal phase) there is a short dry ~~~ ~ nocturnal cough. Later, bouts of 10 to 20 short coughs occur both day and night. The cough is dry and each cough is on the same high note or goes up in a musical scale. Vomiting may occur towards the end of a __________ long attack of coughing. The coughing is followed by a sharp indrawing of breath, which causes the whoop. Some children with proved pertussis infection never develop the whoop. Feeding often provokes a spasm of coughing, which may culminate in vomiting. Afterwards there is a short period when the child can be fed again without provoking more coughing. In uncomplicated cases there are no abnormal signs in the respiratory system. Whooping cough may occur in children who have been fully immunised against it. Bordetella pertussis may be isolated from a pernasal swab, which should be plated on a special culture medium immediately after being taken. A blood lymphocyte count of over lOx 1O9/1 with a normal erythrocyte sedimentation rate suggests whooping cough. A seven-day course of oral erythromycin or ampicillin reduces the infectiousness of the patient but does not usually affect the course of the disease if vomiting has already started. Symptomatic treatment with promethazine, salbutamol, or phenobarbitone to try to reduce the cough usually has little effect, and the parents can be consoled only by being told that the vomiting will eventually stop. If there are abnormal signs in the respiratory system, the child becomes generally ill, or the cough persists longer than six weeks a chest radiograph is necessary to exclude the secondary complications of bronchopneumonia or lobar collapse, which need treatment with physiotherapy and antibiotics. If the coughing attacks are severe admission to hospital may be necessary. Ideally a child should be admitted with his mother to an isolation room on the children's ward. 1 Ac....