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Pertussis complications
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- What happens if we break too many blood vessels? Can that lead to death?(5 votes)
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Video transcript
- Here's an example of a
family that's been exposed to a highly contagious respiratory infection called, Pertussis. This disease is also called Whooping Cough because of the distinct
noise an infected person typically makes when drawing in air after a lengthy coughing fit. And this isn't just a regular cough. It's a powerful, forceful
cough that continues until all the air has been removed
violently from the lungs. And it's triggered by a
reflex from the lung's responding to a build
up of mucous that occurs when the bacteria causes
damage in the airways. So let's look into how
this cough is generated. I've sketched out the muscles that play a role in the cough generation. The chest muscles here,
the abdominal muscles here, and the diaphragm muscle which
rests just below the lungs. And to cough, these muscle
contract inward, like this. And this. And the diaphragm relaxes,
pushing up on the lungs. And the consequence of
these muscles actions is to squeeze the lungs. Let's look specifically at the lungs. And I'm gonna erase the muscles here so that I can bring up
an image of the lungs. All these forces from the muscles reduce the volume of the lungs. So I'm showing that
here at the dotted line. Think of this as like a water balloon. If you have an untied water
balloon filled with water and then you use your
muscles to squeeze it the water comes spurting out the top. But the airways that the
air needs to travel through are swollen from the infection. Which means that the air
can't get out easily. And this causes air pressure
in the lungs to build. So in the water balloon example, think about if we had
tied the water balloon off at the top and then squeezed it. The water can't go
anywhere, so as we squeeze the balloon stronger and stronger the pressure builds
until the balloon bursts. And the same is true for the lungs. Even though we're not
tying off the airways, we're constricting them enough
that the air pressure builds and the lungs can actually tear. And all the muscles
squeezing can cause things, like a rib fracture. But remember that there's
a lot of other organs in the chest that'll be feeling the pressure from the muscle squeezing. The stomach, for example will respond by emptying it's contents, like the lungs. And result in vomiting
after coughing fits. And this is particularly a problem because if it happens frequently, dehydration and weight loss can occur. The bladder also empties it's content and leads to incontinence. And even circulation is affected. Blood has trouble returning to the heart through this big vein that
drains blood from the head. And it backs up. This means that the
blood, just like the air pushing it against
lungs that cause a tear, builds up and pushes
against blood vessels. And causes delicate
blood vessels to break. Leading to things like bloody nose, red eyes, and free blood in the head. And while a coughing fit is happening, a person could cough to the point where they faint from the
sudden decrease in oxygen. And even if fainting doesn't occur, extremities like the fingers will cyanos, or turn blue from a lack of oxygen. With all these complications,
you may be wondering why a violent reflex is so important. And it's because the
mucous that I'm drawing in the airways in pink
builds in the airway. Because airway damage
from Pertussis infection makes normal removal of
the mucous difficult. And built up mucous is dangerous because it's the perfect place for other bacteria that we breathe in to get stuck and cause yet another lung infection
in addition to Pertussis. Battling multiple lung
infections at the same time is a really difficult job for the body. So the mucus needs to be removed with this violent coughing reflex. And while all these complications
that we just discussed can happen to anyone with
Pertussis, there are some groups that have a higher risk
of developing them. So let's says that grandma has
an underlying lung condition. Her lung functions already compromised and adding Pertussis to her burden can lead rapidly to
respiratory damage and failure. Maybe dad has a weak or
suppressed immune system. And this means that his immune system may not be strong enough to
fight a Pertussis infection. Maybe grandpa had a vaccine,
but it was about 10 years ago and his immunity to the
disease has decreased over time, making him susceptible. Infants under one year old, but particularly those under six months are a high risk group. And this is for a couple of reasons. They have an underdeveloped immune system. They have small airways that can't accommodate too much swelling. And for infants younger than two months, they can't yet receive the
protective Pertussis vaccine. So all this means that about 50 percent of infants who have Pertussis
will be hospitalized to stabilize complications
from the infection. To break this down
further by complication, in the 50 percent of infants
who will be hospitalized from Pertussis, the vast
majority will have Apnea. Which is stopped breathing. The reason this probably
happens so often in infants is because muscles in
their airway tend to spasm in response to mucous building up. When a muscle spasm happens, it means the muscles don't
allow for breathing to occur. In the hospital, infants
will be closely monitored for Apnea and they may even need help breathing with machines. But if Apnea occurs,
and they stop breathing their bodies aren't
receiving enough oxygen to function correctly. So this means they are prone to seizures from the brain being denied oxygen. And about a quarter of
the infants hospitalized will have a secondary
respiratory infection. This goes back to what we
were talking about earlier about how mucous in airways a great environment
for bacteria to thrive. And unfortunately about
two percent of the time these infants will have
fatal respiratory failure. And there might actually be a way to tell which infants are most at risk for this. Lymphocytes are cells of the immune system that help fight diseases. And Pertussis releases a toxin in the body that causes lymphocytes
to divide to high levels. So average levels in
infants during the infection can be about 20,000 lymphocytes
per micro liter of blood. And generally the higher the counts, the more severe the infection, and the more severe the complications leading to respiratory failure.