Pertussis used to have 100% penetrance in community
range of dz from barely symptomatic (subclinical) to severely symptomatic
People had lifelong natural immunity after getting it once
This no longer true because of vaccination
10,000 cases/year in US (seriously under-reported)
6-13 deaths/year, mostly kids under 6mo (who are too young to be immunized)
this is pretty low risk really (lots more deaths from rotoviral diarrhea)
incidence reporting increased steadily since 1980, doubled plus btw 1980-2004
disproportionate increase in adolescents & adults
vaccination schedule:
DTaP at 2, 4, 6 mo, 15-18mo, 4-6yrs (school entry)
CDC recommending Tdap booster at 11-12 years (mandated in Oregon or disenrolled from school)
immunity from vaccine not long lasting and not complete
Adults are principle carriers of Bordatella today
vaccination does not cause specific secretory IgA to be produced
Dogs get it too: kennel cough
Adults never used to get pertussis but now they do
because a generation was not exposed dt immunizations
immunizations declining now esp in OR
more kids are getting it
giving it to adults
(note added 9/1/10 after talking with pediatrician Don: he's seen two cases of young mothers who did not have teen booster who got pertussis, mild cases dt young immunization, gave it to their babies, and babies died)
Measles immunity is transmitted across placenta
kids didn't get it until 24 mo or so (after end of breast feeding period is my thought)
but now that moms are getting vaccinated instead of getting measles
infants are more susceptible to the disease
dangerous for them
1/2 of reported cases are in kids under 12 mo per Dr Taylor
1953 last big polio epidemic, Dr T was 2 years old (born 1951)
STAGES OF DZ
catarrhal phase 7-10 days
may not be identifiable
highly contagious
up to 90% of susceptible household contacts develop clinical dz
following exposure to index case
severity mb reduced with erythromycin, tho some strains are resistant
erythromycin mb poorly tolerated in children, GI intolerance, 2 wks tx required
alternate tx: azithromycin or clarithromycin
if macrolide allergies: use trimethorpim/sulfamethoxazoale
antibiotic prophylaxis generally recommended for contacts, mb mandated by state law
no systematic trials demonstrate efficacy of abx prophylaxis
after paroxysmal coughing phase begins
Bordatella can no longer be isolated in the throat
abx are ineffective in altering the course of the illness
homeopathy notes from here down
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TOP MENTIONS: dros, cupr, ip, am, carb-v, cor-r, coc-c,cina, pert, verat, spong, ant-t, bell, meph, bry, ambr, sep, sang, kali-c
--remedies indicated often not familiar polychrests
--"niche remedies"
SX and Rubrics:
paroxysmal coughing with whoop-impeded inspiration
< night, < after midnight
retching and vomiting with the cough
cyanosis with coughing paroxysms/spells
spasmodic cough
cough after first lying down
holds the chest due to painful cough
dyspnea/suffocation-->weakness
feeling of persecution/torment by illness (tubercular)
gagging, nausea, vomiting
mucus and/or spasm in resp and other organ systems
stomach-->retching dt mucus, spasmodic vomiting
Cough-whooping with assorted tiny sub-rubrics, all incomplete, can't rely on them
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Important Pertussis Remedies (be able to recognize these as such):
Pertussinum*
Drosera rotundifolia*
Cuprum metallicum
Coccus cacti*
Corallium rubrum*
Ipecacuanha
Antimonium tartaricum
Kali carbonicum
Viola odorata
Sanguinaria canadensis
Cina maritima
Arnica montana
Mephites
* - known principally in their role as "pertussis remedies" - but of course no remedy is restricted to a single nosological category
- there are many other possibilities; cases and epidemics will not be limited to the remedies in this list
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These remedies have txed approx 95% of Dr Taylor's cases so far.
What you need to know about Pertussis Remedies
PERTUSSINUM
use early in development or as prophylaxis, Dr T doesn't use this, he uses drosera
(coqueluchinum)
the nosode of Pertussis
Taken from the glairy and stringy mucus of whooping cough.
Taken during catarrhal stage.
May be useful in treatment of early, undeveloped cases; or for prophylaxis; early in an epidemic, prior to determination of the genus epidemicus.
DROSERA ROTUNDIFOLIA
use early or as prophylaxis (Dr T's pick)
early in an epidemic, prior to determination of the genus epidemicus
sundew, a carnivorous plant
in bogs, northern temperate zones around the world, Maine, Siberia
covers the common and generic sx of Pertussis
*most persecuted remedy in materia medica
*shortly after midnight
*after first lying down in bed
*holds chest during painful cough (Bry)
will be found if you repertorize the conventional case-description of Pertussis
may not describe individual case
even if you take most distinctive characteristics of other remedies dros comes up #2
CUPRUM METALLICUM
very severe cases only, send to ER, call ahead
*extreme paroxysms with suffocation & marked cyanosis
cough may end in convulsions, unconsciousness
violent paroxysms followed by stiffness, spasm, twitching, apneic spells
vomiting during recovery
*cramps in hands and feet with cough
stiffness, spams, cramps, twitchings, even convulsions after violent paroxysms of cough (other remedies may have these - esp. Drosera, Ipecacuanha - but these are more pronounced or severe in Cuprum)
> cold drinks
*cases calling for Cuprum will often demand hospital admission
Dr T says ER doc may send kid home saying they're better (because remedy was right)
COCCUS CACTI
bug on cactus from which red dye is taken by Navajos
*< immediately on waking in the morning
*< 6-7am (odd timing for Pertussis) as well as at night
< becoming heated
*burning pains characteristic of all insect remedies (apis)
> cold or open air, > cold drinks
burning of membranes after the mucus has been cleared
copious ropes of mucus which hang out of the mouth and nose
*strings of mucus hanging from nose and mouth, can't breathe, lungs burn
CORALLIUM RUBRUM
*only see with respect to cough
*icy feeling in air passages
< cold or open air (opposite Coccus cacti)
copious postnasal mucus drainage
may vomit strings of mucus (compare Coccus cacti)
short paroxysms of "minute-gun" coughs, paroxysms follow one another quickly
cough begins with gasping respiration
marked constriction of larynx during cough
IPECACUANHA
*prominent gagging and vomitting
horrible nausea accompany suffocative paroxysms
*<7pm (early for Pertussis)
< warm room, > open air
(compare Coccus cacti, but here it is open, and not necessarily cold, air)
*capricious, rejecting things for which he has been longing
*miserable and wishes everyone else to be
face muslces stiff during paroxysm
epistaxis from cough (another remedy has this more)
constriction of laryna and stridor begin before cough
IPECAC STUDY (unintentional)
placebo study by Herbert Benson, TM researcher, The Relaxation Response
the year that bendectine was taken off market
was B6 and benadryl, thought to be assoc with midline birth defects
Benson looking for tx of hyperemesis of pregnancy, gave to hospitalized preg wmn
gave water from glass with 1 drop of ipecac in it as "placebo" vs drug
16-20% effectiveness of placebo
ANTIMONIUM TARTARICUM
also seen in bronchitis cases along with phosphorus
rattling chest (rattling respiration & cough) (kali sulph also loud rattle)
thick, viscid mucus expelled with difficulty, and much relief
too weak to expel the mucus
vomits from unsuccessful effort to raise the mucus
KALI CARBONICUM
*< 2-3am (not just when albuterol wears off: overprescribed on this)
must sit up and bend forward during paroxysm
expectoration thick with cheesy taste, hard globs fly from mouth
VIOLA ODORATA
violet family
small niche remedy
coughing during daytime only
>> at night
dyspnea, long lasting spells of coughing
SANGUINARIA CANADENSIS
persistent cough after Pertussis, lasting weeks or months
cough reappearing with every cold
tickling behind sternum
usu not for acute phase pertussis
headache from occiput to R eye, pressure amel
burning in chest during cough
must sit up (Kali-c)
CINA MARITIMA
Artemisia family, chamomila relative
moxa is fuzz from under leaves another species of this
capricious angriness (compare Chamomilla, but worse!)
cough < talking or moving
must keep very still, not talk or move
sneezing with whooping cough
coughing with paroxysims on waking
twitching of extremities
grinding teeth in sleep
swallows after coughing with gurgling in esophagus and stomach
circumscribed redness of cheek with pale face and dark rings around eyes
ARNICA MONTANA
feels achy, can't get comfortable
*epistaxis or burst blood vessels in eyes with coughing
bleeds a lot under skin
holds chest with cough (compare Drosera, Bryonia)
fearful of each paroxysm
cries miserably after coughing
*expectoration thick, sticky yellow, may be bloody
averse to touch, to others approaching
MEPHITIS
skunk musk gland is source of remedy
wheezing respiration with suffocative spasmodic cough
paroxysms exclusively at night
likes to be cooled off, spraying
suffocative cough
> propped on pillows
wheezing resp and difficult expiration
vomiting during paroxyism, food regurgitated on lying even hours after meals
offensive expectoration
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*"We don't have to potentize our remedies; we do have to potentize our toxic remedies."--Dr Taylor