Pertussis – Clinical Picture, Diagnosis, Therapy and Prevention

Hripavac (pertusis) klinički je i javnozdravstveno važna visokokontagiozna akutna infekcija dišnog sustava koju uzrokuje gram-negativni pleomorfni bacil Bordetella pertussis (BP), u tipičnim slučajevima obilježena intenzivnim iscrpljujućim kašljem kod dojenčadi i male djece, s razmjerno učestalim težim, potencijalno i fatalnim komplikacijama, koja i danas obvezuje stručnjake i širu javnost na stalan oprez. I u visokorazvijenim sredinama hripavac se ističe kao problem među preventibilnim dječjim zaraznim bolestima. Porastom procijepljenosti i smanjenjem cirkulacije Bordetelle pertussis (BP) dramatično opada ukupna pojavnost hripavca, ali rastu pojavnost i epidemiološko značenje u male dojenčadi i odraslih osoba. Pojavnost hripavca u Hrvatskoj se kreće u zavidnom rasponu od 2,7 do 18,8 oboljelih na 100.000 stanovnika i procijepljenost od oko 90% kod primovakcinacije i revakcinacije. Ukupni letalitet od hripavca danas se procjenjuje na 0,1%, kod dojenčadi on doseže 0,5%-1%, a 75% umrlih su djeca mlađa od 12 mjeseci. Jedini poznati domaćin BP je čovjek. Hripavac se prenosi kapljičnim putem, kontagioznost mu kod osjetljivih osoba doseže i 100%, a kod kućnih kontakata 70-100%. Uz BP sindrom hripavca mogu izazvati i Bordetella bronchiseptica, adenovirusi, respiratorni sincicijski virus (RSV), Mycoplasma pneumoniae, Chlamydia trachomatis i drugi respiratorni virusi. Klinička slika infekcije bordetelom znatno ovisi o dobi oboljelih, ranijoj infekciji ili imunizaciji, pasivno stečenim protutijelima i dopunskim čimbenicima, poput stupnja izloženosti, naslijeđenih i stečenih značajki oboljelih, genotipa bordetele. Može biti tipična ili atipična, specifi čna u nekim subpopulacijama (novorođenčad, dojenčad, trudnice, odrasle infi cirane osobe). Zlatni standard etiološke dijagnoze ostaje dokaz BP kultivacijom, dokaz uzročnika iz nazofaringalnog sekreta direktnom imunofl uorescencijom (DFA) i lančanom reakcijom polimerazom (PCR). U serološkoj dijagnostici rabi se imunoenzimska metoda - ELISA. Etiološka terapija obuhvaća makrolide, a nadopunjava se uz simptomatsku i suportivnu terapiju. Prevencija i profi laksa obuhvaćaju cijepljenje, izolaciju i kemoprofi laksu.Pertussis is a highly contagious acute respiratory infection caused by gram-negative pleomorphic bacillus Bordetella pertussis (BP). Typical cases include whooping cough in infants and young children, with relatively frequent severe and potentially fatal complications. In spite of great progress in its prevention and therapy, pertussis remains an infectious diseases requiring continuous caution. Even in highly developed countries, pertussis represents a problem among preventable childhood diseases. Although the incidence of pertussis is dramatically reduced by high vaccination rates and reduced BP circulation, its occurrence and epidemiologic role in young infants and adults is increasing. The actual incidence of pertussis is probably much higher than that offi cially declared. In Croatia, it reaches 2.7 - 18.8 cases /100 000 inhabitants, while the primo- and revaccination rate is about 90%. Total pertussis lethality rate reaches 0.1%, and 0.5% - 1% in infants. Children below 12 months of age account for 75% of death cases. Man is the only BP host. Pertussis is spread by droplet infection and its contagiosity in susceptible persons is almost 100%, while in in-house contacts it is 70-100%. Besides by BP, pertussis can be caused by B. bronchiseptica, adenoviruses, RSV, M. pneumoniae, C. trachomatis and other respiratory viruses. The clinical picture of a bordetella infection largely depends on the patient age, previous infection or immunization, passively acquired antibodies and other factors (exposition rate, inherited and acquired patient characteristics, bordetella genotype). It can be typical or atypical, and specifi c in some subpopulations (newborns, infants, pregnant women, infected adults). The cultivation of B. pertussis remains the gold standard for the etiologic diagnosis. The enzyme-linked immunosorbent assay (ELISA) is frequently used. B. pertussis can be also directly detected in nasopharyngeal secretion by direct fl uorescent antibody test (DFA) and polymerase chain reaction (PCR). The etiologic pertussis treatment includes macrolides. It is usually supplemented with symptomatic and supportive measures. Prevention and prophylaxis are based on immunization, chemoprophylaxis and isolation