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Pertussis

Also listed as: Cough - whooping; Whooping cough

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Pertussis, also known as whooping cough, is an extremely contagious bacterial infection characterized by violent coughing, followed by a "whoop" sound as the person tries to breathe in. Pertussis can be deadly to infants and small children. Children in the U.S. are routinely vaccinated for pertussis, but the disease is rising again, especially in infants who have not completed the series of vaccinations and in teens whose immunity has worn off. The vaccine keeps children from contracting the disease when they are most at risk, but teens and adults who have been vaccinated can still get a milder form of the disease.

Signs and Symptoms

The three phases of the disease are listed below.

Catarrhal phase (lasts 1 - 2 weeks):

• Upper respiratory infection. Can be mistaken for a heavy cold
• Low-grade fever (less than 100.4°F)
• Loss of appetite
• Very runny nose

Paroxysmal phase (lasts 1 - 4 weeks):

• Cough increases (2 - 50 times a day), and fever decreases
• Sudden, forceful breathing in causes the whooping sound
• A sudden intense bout of coughing (paroxysms) causes bulging and tearing eyes, tongue sticking out, and bluish discoloration
• Vomiting or choking may follow coughing bouts
• Pneumonia may develop

Convalescent phase (lasts 2 weeks to several months):

• Cough slowly goes away

What Causes It?

A type of bacteria called Bordetella pertussis causes pertussis, and it is spread through droplets coughed into the air. It is a highly contagious disease. Adults with a mild form can infect those who have not yet been vaccinated.

What to Expect at Your Provider's Office

Your health care provider may take a smear from your nose or throat. Your health care provider will prescribe an antibiotic, which helps prevent the disease from spreading, and ask you to avoid contact with others while you are contagious. Patients with complications, severe coughing bouts, or who are under one year of age are hospitalized.

Treatment Options

An infant with pertussis should be treated immediately by a doctor. In adults, treatment is largely to control symptoms and prevent spreading. Quarantine, parenteral fluid and nutrition, oxygen supplementation, and mechanical ventilation may be required.

Drug Therapies

• Antibiotics -- (usually azithromycin or erythromycin) reduce transmission and are effective even for infants.
• Corticosteroids such as betamethasone (0.075 mg daily per kilogram of body weight) may reduce severity and length of coughing fits, especially in infants.
• Albuterol (0.3 - 0.5 mg daily per kilogram of body weight) reduces the severity of coughing fits.
• Over-the-counter cough suppressants have no effect and should not be used.

Surgical and Other Procedures

• In cases of loss of consciousness, immediate resuscitation is essential to avoid brain damage and death.
• Suctioning of secretions, oxygen administration, parenteral fluids and electrolytes are used for infants and in those with protracted illness.
• Mist by tent may benefit infants.

Complementary and Alternative Therapies

Pertussis should be treated with antibiotics. Supplements, herbs, and homeopathy are useful as supportive therapies and may help quicken recovery. Talk with your doctor if you are using alternative therapies in addition to medication.

Nutrition

Note: Doses given are for children. Adults should double the amounts.

• Eliminate dairy, bananas, wheat, and meat products.
• Encourage small, frequent meals of vegetable broths, steamed vegetables, and fresh fruit (especially pineapple and grapes).
• Vitamin C (200 - 500 mg two times per day. Children over 4 years of age can have up to 3,000 mg per day in divided doses for short periods of time), zinc (10 - 15 mg per day), and beta-carotene (10,000 - 25,000 IU per day).

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Catarrhal stage: Choose two herbs from each of the first two categories. Combine in equal parts in a tea (½ cup every 3 - 4 hours), a tincture or glycerite (30 drops every 3 - 4 hours).

Paroxysmal stage: In addition to the above formula, combine 2 parts of catnip with two to four of the other antispasmodic herbs in a tincture or glycerite (20 drops every 1 - 2 hours).

Immune-stimulating herbs:

• Coneflower (Echinacea purpurea)
• Usnea lichen (Usnea spp. )
• Garlic (Allium sativum)
• Astragalus (Astragalus membranaceus)

Expectorants:

• Hyssop ( Hyssopus officinalis )
• Anise ( Pimpinella anisum )
• Elecampane (Inula helenium)
• Mullein (Verbascum densiflorum)

Antispasmodics:

• Indian tobacco (Lobelia inflata) (not more than ¹ /4 of combination)
• Bryonia ( Bryonia alba)
• Catnip (Nepeta cataria)
• Chamomile (Matricaria recutita)
• Jamaican dogwood ( Piscidia erythrina )
• Thyme (Thymus vulgaris)

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies as supplemental treatment for the symptoms of pertussis as long as the underlying infection has been appropriately treated. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconite -- Take during the first 24 hours that symptoms appear, particularly if they develop following exposure to cold weather. This remedy is most appropriate for individuals with a hoarse, dry, cough who complain of dry mouth, thirst, restlessness, worsened symptoms from cold air or lying on the side, and being awakened from the cough.
• Drosera -- for dry, spasmodic cough with sharp chest pain and a tickling sensation in the throat that may cause the individual to gag, choke, or vomit. This remedy is most appropriate for individuals who tend to be hoarse, become worse when lying down, and perspire during the night.
• Hepar sulphuricum -- for later stages of pertussis with wheezing, little mucus production, and coughing that comes on when any part of the body gets cold.
• Ipecacuanha -- spasmodic cough and gagging or vomiting. This remedy is commonly prescribed for infants.
• Phosphorus -- for several different types of cough, most particularly a dry, harsh cough described as a persistent tickle with sharp chest pain signified by the individual clutching his or her painful chest. This remedy is most appropriate for individuals who are often worn out and exhausted, have undue anxiety, even fear of death and require a lot of reassurance.
• Spongia -- for harsh, barking cough that produces no mucus and is associated with a tickling in the throat or chest that worsens when lying down and improves when the individual eats or drinks warm liquids. This remedy is often used if Aconite was not successful.

Physical Medicine

• Chest rubs. Use 3 - 6 drops of essential oil (camphor, thyme, eucalyptus, rosemary) with 1 tbs. food-grade oil (almond, flax, or olive).
• Castor oil pack. Apply oil to clean soft cloth, place on chest, and cover with plastic wrap. Place a heat source over the pack, and let sit for 30 - 60 minutes. Use daily.
• Place 3 - 6 drops of essential oil in a humidifier or a warm bath.
• Alternating hot and cold applications to the chest or back. Alternate 3 minutes hot with 1 minute cold.
• Wet Socks Treatment. Before going to bed, take a pair of thin cotton socks, wet them, and wring them out so they are just damp. Place on feet, and then place dry, thick (preferably wool) socks over them and go to bed. Socks should be dry by the morning. This pulls congestion and inflammation away from the head and chest.

Acupuncture

May enhance immunity and decrease duration and severity of infection.

Massage

Foot massage has a relaxing effect and can help induce sleep. Massaging along the acupuncture points that affect cough can be helpful.

Following Up

Complete recovery is expected unless there are complications.

Special Considerations

Vaccinations are 80 to 90 percent effective. They last about 12 years.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:452-453.

Behrman RE, Kliegman R, eds. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, Pa: WB Saunders Co; 1996.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:432.

Bove M. An Encyclopedia of Natural Healing for Children and Infants. New Canaan, Conn: Keats Publishing; 1996:205-208.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 67, 72.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 210-211.

Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Co; 1998.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1996.

Scott J. Natural Medicine for Children. London: Gaia Books Ltd; 1990:133-134.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 70-73.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 227-228.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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