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Sunday, July 13, 2008

Some aspects of Whooping Cough with homoeopathic mode of treatment-

Whooping Cough is a type of catarrh of the entire respiratory tract which produces paroxysmal cough and a typical stridor or ‘whoop’ caused by Bordetella pertussis, a gram negative, coccobacillus. Though Bordetella pertussis is the main causative agent, a few cases, milder in nature may be caused by Bordetella parapertussis, the incidence of cases varying in different countries. Very rarely, the disease may be caused by Bordetella bronchiseptica. A whooping cough like clinical picture may also be caused by some other respiratory pathogens like adenoviruses and Mycoplasma pneumoniae. Whooping Cough is one of the most infectious of bacterial diseases and the non-immune contacts seldom escape the disease. One characteristic feature of whooping cough is that the infection is limited to the respiratory tract and the bacilli do not invade the bloodstream.

Host & reservoir of infection-Humans are both the natural hosts and reservoirs of infection.

Age- It is a disease of childhood occurring common between 1-5 years of age. However, no age is exempt.

Sex- The disease is relatively commoner in the female than in the male at any age.

Spread of infection- Infection is transmitted by droplets and fomites contaminated with oropharyngeal secretions.

Source of infection- Source of infection is a patient in the early stage of the disease. In adolescents and adults the disease is often atypical with the presentation of bronchitis who then serves as a source of infection to infants and children. Chronic carriers are not known.

Incubation Period- 7-14 days.

Pathology- It produces a local infection. The organism is not invasive. It multiplies on the surface epithelium of the respiratory tract and causes inflammation and necrosis of the mucosa which in turn may invite secondary bacterial invasion. The whole respiratory tract starting from nasopharynx down to bronchi is thus involved in a necrotizing inflammation along with inflammation of the peribronchial and tracheobronchial lymphoid tissue. As the disease progresses, inflammation of the lung produces a diffuse bronchopneumonia with desquamation of the alveolar epithelium. The stickiness of exudates causes obstruction of bronchioles and atelectasis.

Onset- Insidious.

Clinical Features- The disease usually lasts 6-8 weeks. The course of the disease is protracted and may be divided into three stages- each lasting approximately two weeks-

(1) The catarrhal stage- Clinical diagnosis at this stage is difficult. It has an insidious onset with malaise, anorexia, mucoid rhinorrhoea, conjunctivitis and a dry irritating cough. This is the stage of maximum infectivity.

(2) The paroxysmal stage-It is so called because of the characteristic paroxysms of coughing. It begins about a week later. The cough increases in intensity and comes on in distinctive bouts. The cough is more prominent at night and is increased on crying and during feeding. The characteristic feature of paroxysms of cough is that there is no apparent inspiration in between them which ends in a crowing inspiratory sound, the classic inspiratory whoop. Children under 6 months usually do not produce whoop. During this stage, there is no fever unless complicated by some other infection. These paroxysms usually terminate in vomiting. Conjunctival suffusion and petechiae and ulceration of the frenulum of the tongue may also be seen.

(3) Convalescent stage- During this stage, cough becomes less frequent and sputum is less tenacious.

Complications- The paroxysmal stage is mainly associated with complications. Bronchitis, lobar pneumonia, atelectasis, rectal prolapse etc. Cerebral anoxia may occur, especially in younger children. The respiratory complications are self-limited, the atelectasis resolving spontaneously but the neurological complications may result in permanent sequelae like epilepsy, paralysis, retardation, blindness or deafness. Bronchiectasis may be a late sequel.

Laboratory Investigations- The initial diagnosis of whooping cough is usually based on the symptoms. The following may be done-

(1) Blood examination -Blood examination shows high W.B.C count. Total count is also high with about 90% lymphocytes. No immature lymphocytes are present.

(2) Culture of the organism- The most accurate method of diagnosis of whooping cough is to culture the organisms obtained from swabbing mucus out of the nasopharynx. Unfortunately the organism is delicate. So it is unusual to get a positive culture in whooping cough. In other words, if a swab is negative, the patient can still have whooping cough.
(3) Serological Tests- Serological diagnosis is generally of no use. ELISA may be used for demonstration of specific secretory IgA antibody in nasopharyngeal secretions in culture negative cases. A better and more modern way of detecting the organism is by detecting its unique DNA pattern by means of polymerase chain reaction (PCR).

Control and prevention- Maternal antibodies do not seem to give protection against the disease. Affected individuals should be isolated to prevent contact with others. But this is seldom practicable, as infectivity is highest in the earliest stage of the disease when clinical diagnosis is difficult. Active immunization with triple antigen comprising of pertussis vaccine in combination with diphtheria and tetanus toxoid is recommended for consecutive three months starting at three months of age of the infant.

Treatment- Of the different medicines, Bell (Belladonna) 6, Dros (Drosera) 6 and Aralia (Aralia Racemosa) 6 are some of the medicines used most frequently. Each of them is administered three times daily, giving a gap of at least one hour between two different medicines. The medicines should be continued for at least one week or till cough persists. Then gradually the medicines should be stopped. If there is associated chest congestion, Ant.t (Antimonium Tartaricum ) 6 should be used thrice daily along with the above medicines.

Labels- Epilepsy, Bronchitis, Lobar pneumonia, Atelectasis, Rectal prolapse, Paralysis, Ulcer, Rhinorrhoea, Conjunctivitis, Retardation, Blindness, Deafness Polymerase chain reaction (PCR), Tetanus toxoid, Diphtheria, ELISA.etc.


anurag said...

Well u r doin a gr8 job by giving people homoepathic remedy on ur blog.....

Regarding ur comment on my blog:-

Well I would have liked it more if u would have commented on the content of my blog rather clicking on ADs...Sorry to say that!!

David Chin said...

Anurag is right. Blogging is not about counting clicks or ads at all. I am afraid that you may have lost the plot.

Anonymous said...

I'll have to agree.