cough can be very troublesome and can be due to copd, bronchitis, asthma, infections such as legionaires disease. Try to avoid suppressing a productive cough. If you wish to suppress a cough, it is known that aerosol nebulizers and expectorants are of little value. Codeine 15 mgs remains the best treatment.
Pertussis-1995 outbreak in Vt. (MMWR)
In Vermont, a clinical case of pertussis is defined as a cough illness lasting greater than or equal to 14 days and at least one of the following symptoms: paroxysmal cough, whoop, or post-tussive vomiting.
A confirmed case of pertussis requires a positive laboratory finding either by culture or polymerase chain reaction (PCR), or the patient must meet the clinical case definition for pertussis and have had direct contact with a person with laboratory-confirmed pertussis. During January-June 1996, a total of 10 cases of pertussis were confirmed in Vermont, including five culture-confirmed cases (Figure 1). During July 1996, three additional culture-confirmed cases were reported, all in infants aged less than 4 months. None of the three infants attended day care. On July 30, 1996, a pertussis alert was mailed to all primary-care and emergency department physicians in Vermont, advising them of these cases and requesting that pertussis be considered in the differential diagnosis of patients of all ages with persistent cough illness. During 1996, a total of 280 cases (incidence rate: 47.6 per 100,000 population) were identified throughout the state, including 165 laboratory-confirmed cases (160 by positive culture result and five by PCR). Ages of case-patients ranged from 27 days to 87 years: 12 (4%) were aged less than 1 year; 32 (11%), aged 1-4 years; 42 (15%), aged 5-9 years; 129 (46%), aged 10-19 years; and 65 (23%), aged greater than or equal to 20 years. Children aged 10-14 years accounted for 36% of all cases and for the highest incidence rate (235 per 100,000 population) (Figure 2). Pertussis cases occurred in children and/or adults in 69 schools, (range: 1-19 cases per facility). Among 171 cases identified in school-aged children (i.e., aged 5-19 years), most (64%) were culture-confirmed. Of the 65 case-patients aged greater than or equal to 20 years, 46 (71%) occurred in persons reporting contact with children who had confirmed pertussis or cough illness, including parents (21), neighbors or relatives (12), teachers (six), child-care providers (four), and school bus drivers (three). Symptoms of case-patients included paroxysmal coughing (93%), post-tussive vomiting (54%), and whoops (39%). The median duration of cough was reported as 33 days. Twelve (4%) case-patients were hospitalized, and six (2%) had radiologically confirmed pneumonia.
a barking cough, not toxic, low grade fever in child up to two years. Epiglottitis which is rarer today takes over at age two, but there is drooling and toxicity and often fever greater than 101. for croup there is racemic epinephrine and decadron (0.6 mg/kg im or po) and prednisolone 1mg/kg bid po, there is aerosolized saline for the simple case. The child may be expected to have persistent cough and stridor to some extent for several days even after treatment. It is wise to rule out epiglottitis via lateral neck x-ray.
Thorazine 25 mg im or po.