Кашлюк. Симптоми коклюшу. Ускладнення коклюшу. Лікування коклюшу

Кашлюк. Симптоми коклюшу. Ускладнення коклюшу. Лікування коклюшу.

Кашлюк.

Кашлюк – це одна з найпоширеніших дитячих інфекцій. Кашлюк – гостре інфекційні захворювання.

Збудник коклюшу – бактерія (коклюшная паличка), звана бордетел (Bordetella pertussis). Коклюшна паличка (Bordetella pertussis) дуже нестійка і швидко гине в зовнішньому середовищі, тому єдиним джерелом інфекції є тільки хвора людина в усі дні хвороби, особливо в перші тижні.

Кашлюк є одним з найбільш заразних захворювань. Всі люди (діти, і дорослі) дуже сприйнятливі до коклюшу і, за відсутності імунітету, ймовірність захворіти після контакту з хворим досягає 100%. Хвороба поширюється повітряно-крапельним шляхом. Головна ознака коклюшу – це нападоподібний кашель, який майже не піддається лікуванню. Паличка, поширюючись при кашлі хворої людини, може викликати зараження здорової людини. Однак, заразитися кашлюк можна лише при тісному контакті з хворим, спілкуванні, грі, так як збудник коклюшу не розсіюється далі, більш ніж на 2-3м.

Дуже часто хворіють батьки дитини (але не в типовій формі), які заражають дітей (у 90% випадків при опитуванні з’ясовується, що в сім’ї хворої дитини тривало кашляв хтось із дорослих).

Вроджений імунітет, обумовлений материнськими антитілами, не розвивається, тому захворіти на кашлюк може навіть новонароджений. Зате після перенесеного захворювання імунітет виробляється стійкий і зберігається протягом усього життя. Контагиозность (ймовірність зараження при контакті) становить 90%. Дуже небезпечний для дітей молодше 2-х років. Частіше хворіють діти дошкільного віку.

Інкубаційний період, в середньому становить 5-9 днів, але може коливатися від 3-х до 20-ти.

Клініка коклюшу – симптоми кашлюку.

Захворювання триває приблизно 6 тижнів і ділиться на 3 періоди:

1) продромальний (катаральний),

2) пароксизмальний,

3) період одужання.

Катаральний період (триває протягом 1-2 тижнів) . Починається коклюш поступово – з’являється сухий, частий кашель, іноді невеликий нежить, температура тіла підвищується незначно – максимум 37,5-37,7 ° С, але часто буває, що температура тіла залишається нормальною. У цей період запідозрити у дитини коклюш практично неможливо, тому найчастіше хворому виставляють діагноз ГРЗ, бронхіт. Так як немає температури, така дитина продовжує відвідувати дитячий колектив і поширювати інфекцію (адже коклюш найбільш заразний саме в катаральному періоді розвитку захворювання). Хвора людина виділяє мікроби в зовнішнє середовище близько місяця, але кількість кашлюкових паличок постійно зменшується з кожним днем, починаючи з другого тижня хвороби, і стає дуже незначним десь через 3 тижні.

Поступово кашель посилюється, набуває приступообразную форму, особливо вночі. Катаральний період переходить в пароксизмальної період хвороби.

Пароксизмальний період (триває до 2-3-х місяців). Кашель стає пріступообразним – період спазматичного кашлю. Справа в тому, що кашель при кашлюку настільки характерний і має свої особливості, що лікареві необхідно лише почути його і діагноз буде встановлено відразу. Як правило, в цьому періоді постановка діагнозу вже не викликає жодних проблем.

Типовий коклюшний кашель – це напад, що складається з декількох кашльових поштовхів, серія з 5-15 швидких кашльових поштовхів, які без зупинки слідують один за одним, не даючи хворому можливості перепочити. Після закінчення нападу кашлю хворий робить глибокий вдих, який дуже часто супроводжується специфічним свистячим звуком. Цей звук називається репризи, причина його появи полягає в тому, що безпосередньо під час кашлю відбувається спазм голосової щілини, а коли дитина після серії кашльових поштовхів намагається зробити вдих, то при проходженні повітря через звужену голосову щілину виникає свистячий вдих.

Після кількох нормальний вдихів може початися новий пароксизм. Під час пароксизмів виділяється рясне кількість в’язкої слизової склоподібної мокротиння (зазвичай грудні та маленькі діти її проковтують, але іноді відзначається її відділення у вигляді великих бульбашок через ніздрі). Характерна блювота, що виникає в кінці нападу або при хах, викликаних наявність густого мокротиння. Під час нападу кашлю обличчя хворого червоніє або навіть синіє; язик висовується до відмови, можлива травматизація його вуздечки об край нижніх різців; іноді виникають крововиливи під слизову оболонку кон’юнктиви ока. Після нападу дитина стомлений. У важких випадках погіршується загальний стан.

Тяжкість перебігу коклюшу визначається саме частотою і тривалістю нападів. Поза нападу кашлю стан дитини майже не порушено.

Тривалість пароксизмального періоду коклюшу різна, але найчастіше триває в середньому десь 2-3 місяці. На початку пароксизмального періоду інтенсивність кашлю і кількість нападів збільшує, а потім поступово починає слабшати і зменшується тривалість самого нападу кашлю. У деяких дітей напади не часті, в інших бувають до 50 на добу.

Дуже важко протікає коклюш у дітей першого року, особливо перших шести місяців життя. У грудних дітей не буває типових нападів коклюшу. Замість цього у них після декількох кашльових поштовхів може наступити короткочасна зупинка дихання (тривають від кількох секунд до хвилини і навіть довше), яка може бути небезпечною для життя. У зв’язку з нестачею кисню у немовлят з’являються порушення з боку нервової системи та інші ускладнення.

Легкі і стерті форми захворювання зустрічаються у раніше вакцинованих дітей і дорослих, що занедужують повторно.

Період одужання починається з четвертого тижня; пароксизми стають не такими частими і важкими, рідше закінчуються блюванням, дитина починає краще себе почувати і краще виглядає. Середня тривалість захворювання – близько 7 тижнів (від 3 тижнів до 3 місяців). Пароксизмальний кашель може з’являтися знову протягом кількох місяців; як правило, його провокує ГРВІ.

Ускладнення коклюшу.

Особливо важко, зі значною летальністю, коклюш протікає у дітей перших місяців життя; у грудних дітей часто спостерігаються напади апное (зупинки дихання), пневмонія (запалення легенів), ателектази (25%), судоми (3%), енцефалопатія (1%).

Небезпечним є ураження легень (бронхопневмонія), особливо в грудному віці (ймовірність 15%).

Крім того, серйозним ускладненням є енцефалопатія, зміни в головному мозку, які внаслідок виникнення судом може призвести до смерті або залишити після себе стійкі пошкодження, глухоту або епілептичні напади.

Смертність висока в країнах, що розвиваються. У розвинених країнах смертність від кашлюку та його ускладнень досягає 0,04%.

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