Complications.

(i) Orchitis: Quite common and may cause unbearable pain. Its ultimate sequel may be testicular atrophy that may rarely cause sterility.

(ii) Pancreatitis is uncommon and shows full recovery in 4 to 7 days

(Hi) Meningoencephalitis, which may precede, accompany or follow mumps, occurs in about 10% of the cases. It is a serious complication and can prove fatal.

(iv) Myocarditis, pericarditis etc.

(v) Nephritis

(vi) Hepatitis

(vii) Thyroiditis

(viii) Mastoiditis

(ix) Arthritis

(x) Deafness due to neuritis of auditory nerve

(xi) Facial palsy

(xii) Ocular paresis

Treatment. There is no specific therapy for mumps.

General measures are entirely symptomatic and include isolation, rest, antipyretics, local warm or cold applications, saline mouth wash, and, preferably, fluid diet during the initial stages of difficulty in chewing and swallowing.

The complications need to be tackled as per the individual merits of each. Many authorities favour the use of corticosteroids in the presence of orchitis.

Answer the questions:

1. What age group of patients is mostly affected by the disease?

2. How long is the incubation period?

3. What is the onset usually marked by?

4. How often does the bilateral parotid involvement occur?

5. What is the most alarming complication?

6. What does the treatment consist of?

 

Translate from Russian into English:

1. Наиболее часто болезнь начинается с повышения температуры тела до 38-39, возникает легкий озноб, околоушная железа (чаше на одной стороне) припухает, становится болезненной. 2. Через 1-2 дня обычно поражается и вторая железа, при этом лицо больного приобретает характерный вид, вследствие чего болезнь получила название «свинка». 3. Имеются жалобы на боли в околоушной области, усиливающиеся при жевании, открывании рта, иногда при глотании. 4. В ряде случаев боли иррадиируют в ухо, появляется шум в ушах.

Pertussis (Whooping cough)

Definition. Pertussis is an acute specific contagious disease of the respiratory tract characterized by a paroxysmal cough which ends in a prolonged inspiratory phase or "whoop", and frequently vomiting.

Etiology and epidemiology. The disease is caused by a bacillus described by Bordet and Gengou in 1906.

In the majority of cases, the disease is spread by direct contact or "droplet infection" from coughing, sneezing, etc. Because of the rapidity with which the Bacillus pertussis dies outside of the body, transmission by a third person or by a contaminated object is unusual, although possible. One attack produces immunity; reports of second attacks are rare.

Pertussis is universal in its distribution: it occurs the year around although it is less commonly encountered in the fall months.

Over 80 per cent of the cases are seen in children from one year to five years of age. However, no age is immune. Thus the newly born may be attacked and adults who have escaped the disease in childhood may contact it.

Symptomatology. The incubation period may last from two days to three weeks. Clinically the disease may be divided roughly into three stages — the catarrhal period, the paroxysmal stage, and the period of decline or convalescence. The catarrhal stage lasts from one to two weeks. Its onset is insidious, the early symptoms being indistinguishable from those of ordinary "cold" or mild bronchitis. There is a dry hacking cough which may or may not be accompanied by a slight elevation of temperature, especially in the late afternoon. The child often appears tired and listless. Gradually the cough becomes more severe and racking and is accompanied by suffusion of the patient's face during an attack; vomiting may ensue.

The paroxysmal stage, which lasts from four to six weeks, is characterized by the appearance of the typical whoop from which the disease draws its common name. There may be from five to ten coughs in rapid succession during expiration, followed by a long drawn out inspiratory phase in which the patient attempts to inhale air through the tightened vocal cords with the resultant prolonged crowing noise or "whoop". This process is frequently repeated on the next inspiration so that a typical paroxysm may consist of several "whoops". During the attacks the face becomes congested, the eyes teary and frequently the eyeballs protrude; the tongue, congested at times to the point of becoming purple, hangs from the mouth. In severe cases there is involuntary micturition or defecation and prolapse of the rectum may occur. Instances in which the paroxysms have been so violent as to cause hemorrhage, not only in respiratory tract conjunctivae and skin but even in the brain have been recorded.

The attack ceases only with the expulsion of the so-called "mucus plug" from the larynx. The mucus is either coughed up or drips from the nostrils in strings frequently blood streaked. Vomiting immediately subsequent to the cessation is very common; mucus and food are brought up together.

There may be as few as one or two attacks a day or as many as three or four an hour.

The patient usually has the premonition of the advent of an attack through a sensation of tickling in the throat, yawning, or sneezing, and will attempt to ward it off by breathing as slowly and in as shallow manner as possible. With the onset of the paroxysms the child will stand still holding onto the nearest object or a person for support until the attack is over.

In the third stage of convalescence, the vomiting ceases and the paroxysms decrease in number and severity. The average case requires between three and four weeks before the symptoms entirely abate, and even then subsequent paroxysms may occur, usually without vomiting, especially if the patient acquires a cold.

Laboratory aid. The early diagnosis of whooping cough is a matter of considerable importance since the disease is very contagious during the catarrhal period. Because its recognition clinically offers considerable difficulty in the early stages, and even later in mild or uncomplicated cases, it is fortunate that one may turn to the laboratory for assistance.

The blood shows an elevation of white blood cells, usually between 15,000 and 40,000 with a relative and absolute lymphocytosis. Therefore, a persistent cough increasing in severity, and an abnormally high white count with relatively increased lymphocytes; should always arouse suspicion of pertussis.

A second diagnostic aid is the "cough plate". The Bacillus pertussis has been found to grow best on a medium of glycerine-potato blood agar. Although the organisms can be recovered with a fair degree of constancy from the mucus brought up from the trachea they are obtained seldom and with great difficulty from the ordinary pharyngeal swab. It has been found, however, that if a plate of Petri-dish containing the medium just described is held open a few inches from the patient's mouth during a cough, it is possible to recover the typical oirganisms in about 80 per cent of early pertussis cases.

Complications. The most frequent complication of pertussis is bronchial pneumonia, which is present in over half of the fatal cases. It commonly develops during the paroxysmal stage and due to the debilitated condition of the patient; its advent should be viewed with great alarm. In the majority of cases the bronchopneumonic process is due to a secondary invasion by streptococci.

Pulmonary and subcutaneous emphysema occasionally occur. Empyema following bronchial pneumonia is rare.

Of the nervous complications, convulsions are most frequently encountered.

Hemorrhages, caused by the paroxysms of coughing in severe cases, not infrequently are present in various parts of the body: the skin, conjunctivae, brain, etc.

Deafness may be the result of an acute otitis media and, in rare instances, is caused by hemorrhage into the vestibular apparatus.

Ulceration of the frenum of the tongue from pressure of the incisor teeth is common, especially in young children, in whom it occurs in approximately half the cases.

Hernias, of any type, especially umbilical, may be caused by persistent violent coughing.

A dreaded complication, which is more properly a sequela, is pulmonary tuberculosis, due to the lighting up of a latent infection in the bronchial glands or lung parenchyma.

Differential diagnosis. In the catarrhal stage, the cough is identical in type with that of an ordinary bronchitis. As has been stated, the diagnosis of pertussis can frequently be made by examination of the blood which shows an early lymphocytosis and by employment of the "cough plates". The cough of measles may offer difficulties in differential diagnosis, however, the characteristic signs and symptoms of preeruptive measles — coryza, photophobia, Filatov — Koplik's spots, etc., — should readily settle the problem.

Prognosis. The most important single factor in determining the outcome of the disease is age; indeed, infants are very susceptible and because of their low resistance they are very prone to succumb, usually from the bronchial pneumonia.

Treatment. The convalescent serum as well as the vaccine are apparently of some value in the treatment of the disease.

Syntomycin and penicillin should be of benefit in the bronchopneumonia complicating pertussis.

So far as symptomatic treatment goes, various drugs have been employed, including employment of antipyrine in conjunction with bromides, codeine, etc.

Pertussis, with its dangerous complications, gives more opportunity for preventive nursing than many other diseases, and it presents several most interesting problems. Because of general bronchial irritation, and the danger of bronchopneumonia, fresh air is most essential for patients with this disease. Keep the patient warm, and out of draughts or the wind, but in the open air and sunshine. Except in the most severe cases he is usually better up and out of doors than in the house. Often a change of environment is advisable, especially if the home atmosphere is smoky or full of dust, which would cause increased irritation of the air passages.

A quiet, hygienic life, with freedom from excitement, will reduce the number and severity of paroxysms of coughing. Anything which induces laughter, tears, or fright will be apt to bring on an attack. Some of the nervous symptoms can be prevented by a quiet, calm mode of life.

The mouth and nose must be kept very clean at all times. Since vomiting after coughing occurs so often, great care must be taken to keep the child dry, and to change promptly any clothing soiled or wet by evacuations. After an attack, the mouth will need cleansing and rinsing with clear water, or a little solution of sodium bicarbonate to prevent nausea which might induce another attack. The bowels must, of course, be kept open, and this is done better by food than by cathartics.

As this disease runs a course of several weeks, the weight of the patient must be maintained. Resistance is greatly lowered in patients who suffer from malnutrition, so that a light but nutritious diet should be provided, with plenty of fruit juices. Smaller feedings, given frequently, lessen the danger of vomiting. For children, foods should be finely chopped, and given very, very slowly. No excitement should be permitted at any time, but especially at meal hours. Fluids are better given between meals, so as not to increase bulk in the stomach. A goodly amount of fluid should be taken during each day, since on no account must the patient be allowed to become in the slightest degree dehydrated. The temperature of all foods should be moderate; neither very hot nor very cold, since hot drinks or cold foods, such as ice cream, may quickly bring on spasms of coughing. When possible, the time of meals may be arranged to follow the attacks of coughing, and so prevent vomiting. If a patient vomits, let him rest 20 minutes, then feed him again. Usually the food will be retained the second time.

Isolation and quarantine. In general, a child should be isolated for forty days after the onset of the disease; contacts should be excluded from school for a fortnight following the exposure.