WEBVTT - Ep 44 Pertussis: Whoop Here It Is 0:00:01.000 --> 0:00:05.160 My name is Catherine Hughes, and five years ago I 0:00:05.240 --> 0:00:11.319 gave birth to the most beautiful, gorgeous little boy. His 0:00:11.400 --> 0:00:16.200 name was Riley, and he had soft blonde hair and gorgeous, 0:00:16.400 --> 0:00:20.920 piercing blue eyes. But when Riley was about three weeks old, 0:00:21.320 --> 0:00:25.479 he started to get sick. I really thought it was 0:00:25.560 --> 0:00:27.280 just a cold. At first, it was just a bit 0:00:27.280 --> 0:00:30.159 of a runny nose, a bit of a sniffle, and 0:00:30.240 --> 0:00:33.400 I wasn't too worried. But then a couple of days later, 0:00:34.360 --> 0:00:38.080 I heard this tiny little cough and I'll never forget 0:00:38.080 --> 0:00:42.600 the sound it made. It was so small, so innocuous, 0:00:43.080 --> 0:00:45.920 but it was really a sign of what was to come. 0:00:47.520 --> 0:00:50.080 My husband was way for work, so I decided to 0:00:50.120 --> 0:00:52.480 call out a locum doctor to come visit our house 0:00:52.520 --> 0:00:55.600 one evening. Riley was about four weeks old at the time, 0:00:57.880 --> 0:01:03.920 and Riley appeared perfectly healthy. He was sound asleep and 0:01:04.200 --> 0:01:06.240 you just couldn't tell that there was anything wrong with 0:01:06.319 --> 0:01:09.039 him in between the coughing bouts. So the doctor looked 0:01:09.040 --> 0:01:12.839 at Riley reassured me that I was probably worrying too much, 0:01:13.200 --> 0:01:19.200 that Riley seemed to be perfectly okay. That evening, Riley 0:01:19.520 --> 0:01:22.800 slept and slept and slept and just did not want 0:01:22.800 --> 0:01:24.960 a breastfeed. He didn't want to wake up. He was 0:01:25.080 --> 0:01:29.480 so sleepy. I was feeling really uncomfortable at that stage, 0:01:29.560 --> 0:01:31.679 so my husband flew back in from work and we 0:01:31.720 --> 0:01:35.160 took him to hospital the next morning, and at hospital, 0:01:35.760 --> 0:01:37.880 he was admitted overnight because they were just a bit 0:01:37.920 --> 0:01:42.000 worried that he was not interested in breastfeeding anymore. But 0:01:42.120 --> 0:01:45.600 Riley didn't go home the next day. Each day that 0:01:45.640 --> 0:01:48.160 he stayed in hospital, he just seemed to grow worse 0:01:48.200 --> 0:01:52.600 and worse, and the coughing got more severe. It felt 0:01:52.600 --> 0:01:56.240 like every day there were just more tubes and wires 0:01:56.680 --> 0:02:02.080 and more doctors. Everything just got worse and worse. On 0:02:02.160 --> 0:02:06.080 his fourth day in hospital, we were moved into the 0:02:06.200 --> 0:02:11.320 pediatric intensive care unit. The doctors were concerned that he 0:02:11.440 --> 0:02:14.600 had developed pneumonia, and they were pretty confident at this 0:02:14.680 --> 0:02:18.760 stage that he had hooping cough. When the doctors diagnosed 0:02:18.840 --> 0:02:21.160 Riley with hooping cough, I actually felt a bit relieved 0:02:21.600 --> 0:02:26.320 because I thought that there'd be able to cure him. 0:02:27.360 --> 0:02:30.880 But there is no cure for hooping cough. You just 0:02:30.960 --> 0:02:33.000 kind of hope and pray that they get better as 0:02:33.040 --> 0:02:38.840 they are cared for in hospital, and Riley didn't get better. 0:02:40.639 --> 0:02:44.240 His organs started to shut down. By day five, his 0:02:44.400 --> 0:02:49.959 heart was under a lot of strain, and on day five, 0:02:50.000 --> 0:02:54.200 which was his last day in hospital, he was unconscious. 0:02:54.200 --> 0:02:57.720 They'd put him in a on life support and they 0:02:57.840 --> 0:03:01.000 tried to use echmo to save his life, and I 0:03:01.040 --> 0:03:03.760 just remember looking at his body on the bed. It 0:03:03.840 --> 0:03:06.280 was a big bed, a tiny little four week old 0:03:06.320 --> 0:03:09.000 baby on there, but he was so swollen and just 0:03:09.120 --> 0:03:12.519 covered in so many wires and tubes. It was really 0:03:12.600 --> 0:03:17.520 the most traumatic thing to say. And that afternoon we 0:03:17.600 --> 0:03:22.320 watched as this pink, foamy stuff started coming out of 0:03:22.360 --> 0:03:26.160 his lungs, and the doctors told us that there was 0:03:26.240 --> 0:03:30.840 nothing more that they could do. We'd asked about organ donation, 0:03:31.080 --> 0:03:35.320 but unfortunately, I think his organs were just too ravaged 0:03:35.960 --> 0:03:40.720 from the toxins released by the hooping cough bacteria. So 0:03:40.880 --> 0:03:43.800 at two in the afternoon, after five days in hospital, 0:03:43.880 --> 0:03:49.040 we took Riley off life support and he was just 0:03:49.560 --> 0:03:54.160 hot and swollen and so sick, and they took all 0:03:54.200 --> 0:03:56.160 the tubes and wires out and we had to say 0:03:56.640 --> 0:04:00.560 goodbye to our little baby or because he caught this 0:04:01.440 --> 0:04:06.640 horrible preventable hooping cough, and he was too young to 0:04:06.680 --> 0:04:09.480 be vaccinated. He was only thirty two days old when 0:04:09.520 --> 0:04:14.800 he died, and at the time, pregnancy vaccination hadn't been 0:04:15.280 --> 0:04:21.039 routinely recommended or funded in Australia, so newborn babies up 0:04:21.760 --> 0:04:26.080 Riley were extremely vulnerable to hooping cough and it cost 0:04:26.160 --> 0:05:08.720 him his life. 0:05:10.960 --> 0:05:14.520 Hi, I'm Aaron Welsh and I'm Erin Oman Updike and 0:05:14.560 --> 0:05:18.160 this is this podcast will kill you? Yeah, today it 0:05:18.200 --> 0:05:24.479 is today it is. Yeah. So you just heard from 0:05:24.720 --> 0:05:28.320 Catherine Hughes who was kind enough to come onto the 0:05:28.360 --> 0:05:31.360 podcast and share with you her story, and you're gonna 0:05:31.360 --> 0:05:33.479 hear a little bit more from her later on in 0:05:33.520 --> 0:05:38.400 the episode as well. So thanks again, Catherine. That was yeah. 0:05:38.680 --> 0:05:44.560 Yeah, it's a horribly depressing story that unfortunately isn't the 0:05:44.560 --> 0:05:48.520 only one out there. So today we're obviously talking about 0:05:48.960 --> 0:05:50.560 protessis whoopin cough. 0:05:51.120 --> 0:05:54.400 To get us to this episode, we are drinking. 0:05:54.279 --> 0:05:55.640 A very strong quarantine. 0:05:56.279 --> 0:06:00.719 Yes, it's basically all alcohol. It is call Three Women 0:06:00.800 --> 0:06:04.560 and a Baby and it's called that because the first 0:06:04.960 --> 0:06:08.800 really successful vaccine and that was in widespread use, was 0:06:08.800 --> 0:06:14.279 developed by three awesome women Woo woo girl power. Yeah, 0:06:14.320 --> 0:06:16.960 so what is in three Women and a Baby. 0:06:17.200 --> 0:06:21.080 Well, it's rye whiskey, of course, because whiskey, as we 0:06:21.120 --> 0:06:23.600 all know, is the cure for all children's ailments. 0:06:23.720 --> 0:06:27.360 Of course, don't do that at home. It's not not 0:06:27.440 --> 0:06:31.000 evaluated by the FDA or podcast. We're not being serious. 0:06:31.279 --> 0:06:31.359 No. 0:06:32.279 --> 0:06:37.760 It also has luxardo liqueur and chinar which is an 0:06:37.839 --> 0:06:39.560 artichoke liqueur which. 0:06:39.360 --> 0:06:42.080 Sounds weird, but it's quite tasty in context. 0:06:42.120 --> 0:06:46.840 It's bitter and delicious. Also my band name. 0:06:48.279 --> 0:06:52.040 Bitter. Yeah, that's a good band name actually. 0:06:53.760 --> 0:06:55.640 Garnish with a cherry and enjoy. 0:06:56.080 --> 0:06:58.680 And we'll post the full recipe for this quarantini as 0:06:58.720 --> 0:07:02.640 well as our non outcoholic plasy Burta on our website, 0:07:02.680 --> 0:07:04.400 this podcast will kill you dot Com and all of 0:07:04.400 --> 0:07:05.760 our social media channels. 0:07:06.160 --> 0:07:08.000 Making the plasy burrita is going to be a challenge 0:07:08.040 --> 0:07:08.679 for this one. 0:07:08.520 --> 0:07:11.840 But you'll you'll figure it out up with total faith, 0:07:13.040 --> 0:07:15.360 glad to do like I say, you'll figure it out. 0:07:15.520 --> 0:07:17.920 I'll just be nice jobs. 0:07:18.520 --> 0:07:20.560 Now now this feels like a group project again. 0:07:23.480 --> 0:07:25.520 I also want to give a quick shout out and 0:07:25.600 --> 0:07:30.040 thank you to a Kia and I'm sorry that we 0:07:30.120 --> 0:07:32.400 might have just pronounced your name wrong, but for sending 0:07:32.440 --> 0:07:35.520 us the most adorable gift package from Texas. 0:07:35.600 --> 0:07:35.880 Y'all. 0:07:36.160 --> 0:07:40.680 Oh my gosh, it's adorable. So many great things there. 0:07:40.880 --> 0:07:44.720 Did you guys know something called Techsaroni existed. It's macaroni 0:07:44.760 --> 0:07:49.040 in the shape of Texas. Okay, It's everything I needed 0:07:49.080 --> 0:07:50.400 in life, and I feel like. 0:07:50.360 --> 0:07:53.440 That should be sold in stores across the US. But 0:07:53.560 --> 0:07:58.520 Techsarroni version not like you know, Illinois, Illinois. No, I 0:07:58.520 --> 0:08:02.600 wouldn't eat that. Texas is a great shape for pasta. 0:08:02.640 --> 0:08:03.720 Whow it really is? 0:08:04.280 --> 0:08:06.800 I can't wait. We need to make mac and cheese 0:08:06.840 --> 0:08:07.760 together or something arin. 0:08:07.880 --> 0:08:09.440 Oh my gosh. Yeah. 0:08:09.480 --> 0:08:11.920 Anyways, thank you so much. That was really sweet of you, 0:08:11.960 --> 0:08:13.720 and sorry it took forever for me to check our 0:08:13.760 --> 0:08:14.400 po box. 0:08:15.120 --> 0:08:16.960 We should post pictures, yeah, we. 0:08:16.880 --> 0:08:19.400 Should of us eating macaroni and cheese. 0:08:19.560 --> 0:08:20.720 Yes, okay, cool? 0:08:21.080 --> 0:08:22.120 Cool? Okay? 0:08:22.240 --> 0:08:22.600 All right? 0:08:23.000 --> 0:08:24.080 Shall we jump right in. 0:08:24.400 --> 0:08:26.440 Let's do it. Should we take a quick break first? 0:08:26.560 --> 0:08:59.000 I think we need a breather, right, yeah, So protestis 0:08:59.520 --> 0:09:03.320 aka whooping cough. Let's talk about what these symptoms are. 0:09:03.720 --> 0:09:08.360 So protessis is caused by a bacterium and the name 0:09:08.400 --> 0:09:11.480 of the disease, a colloquial name whooping cough, tells you 0:09:12.200 --> 0:09:16.240 the most characteristic part of these symptoms, and that is 0:09:16.280 --> 0:09:21.920 this very distinctive whooping sound that is not actually during 0:09:21.960 --> 0:09:24.240 the cough, but it's as people try and take a 0:09:24.280 --> 0:09:27.079 breath of air in after an episode of coughing. 0:09:27.880 --> 0:09:32.360 And so is the whoop. Is that all ages that 0:09:32.440 --> 0:09:36.160 have whooping cough? Or is that mostly younger children? 0:09:36.320 --> 0:09:38.360 Good question. We'll talk a little bit more in a 0:09:38.400 --> 0:09:41.600 bit about the differences in symptoms. It can happen in 0:09:42.240 --> 0:09:46.200 people of any age, but it's most typical in younger 0:09:46.240 --> 0:09:48.880 age groups. Okay, and we'll talk about why in a bit. 0:09:48.960 --> 0:09:52.440 That's a really good question though. All right. So the 0:09:52.679 --> 0:09:58.040 bacterium that causes protessis is called Bordodella protessis. It's a 0:09:58.040 --> 0:10:01.520 little gram negative rod so again the gram negative means 0:10:01.520 --> 0:10:06.599 it's pink when we stain it. However, while Borddella protessis 0:10:06.720 --> 0:10:10.400 is the most common cause of whooping cough, there are 0:10:10.440 --> 0:10:14.559 a couple of other very closely related bacteria species, including 0:10:14.640 --> 0:10:20.880 Bordodella paraprotessis and Bordodella bronchosseptica that can in some cases 0:10:21.040 --> 0:10:26.280 cause a very clinically similar disease. But Borddella pertessis is 0:10:26.280 --> 0:10:28.440 the one that, for example, we have a vaccine four 0:10:28.559 --> 0:10:32.199 and kind of the most important of these species. 0:10:32.920 --> 0:10:34.920 Are you ready for questions? I feel like this is 0:10:36.320 --> 0:10:42.560 the aady Okay, So about these different bacterial species. Are 0:10:42.600 --> 0:10:48.000 they as globally prevalent as just Bordetella protessas good question. 0:10:48.120 --> 0:10:53.120 I know that Paraprotesis is pretty widespread globally. I would 0:10:53.160 --> 0:10:55.560 guess that bronchosseptica is as well. One of the big 0:10:55.559 --> 0:10:58.679 differences is that these other species are found in many 0:10:58.800 --> 0:11:03.080 other species of animals as well, whereas Bordadella pertessis is 0:11:03.080 --> 0:11:07.840 a human specific disease. Side note, though, Bordetella bronco septica 0:11:08.040 --> 0:11:14.080 causes kennel cough in dogs. Interesting huh So anyways, protestis 0:11:14.120 --> 0:11:18.960 is transmitted via respiratory droplets. I've seen estimates that the 0:11:19.080 --> 0:11:22.520 are not which, if you'll remember from previous episodes, is 0:11:22.600 --> 0:11:27.760 the number of secondary infections that a primary infection can cause. 0:11:28.200 --> 0:11:33.120 I've seen estimates ranging anywhere from five to fifteen. 0:11:34.080 --> 0:11:35.240 Wait, I know. 0:11:37.160 --> 0:11:41.800 That's bigger than measles. I was gonna say it, which 0:11:41.840 --> 0:11:44.800 doesn't seem right. Well, but I guess the r like 0:11:44.840 --> 0:11:47.880 the are not is it's an average Yeah. 0:11:47.920 --> 0:11:51.320 But anyways, in any case, this is a highly highly 0:11:51.400 --> 0:11:54.439 infectious disease. It spreads very easily. 0:11:54.600 --> 0:11:55.160 Yeah. 0:11:55.200 --> 0:11:58.760 In general, the incubation period, so the time between when 0:11:58.800 --> 0:12:01.840 you first get exposed and when you start to show symptoms, 0:12:02.240 --> 0:12:05.240 on average is about a week maybe ten days, but 0:12:05.320 --> 0:12:07.880 it can be quite a bit longer. And I think 0:12:07.920 --> 0:12:11.920 the reason that the range can be longer is twofold. 0:12:12.720 --> 0:12:15.120 Partly it has to do with infectious dose how much 0:12:15.120 --> 0:12:19.280 are you exposed to at the outset, But also it's 0:12:19.440 --> 0:12:23.679 very difficult to pinpoint when exposure might be in relation 0:12:23.880 --> 0:12:28.320 to symptoms because the onset of symptoms for this disease 0:12:28.760 --> 0:12:34.360 is kind of insidious, which means it's slow and you 0:12:34.480 --> 0:12:38.000 might not recognize at first, for like a week or 0:12:38.080 --> 0:12:43.400 more that what you're dealing with is actually protessis oh yeah, okay, 0:12:43.679 --> 0:12:47.880 so let's talk about how this little bacterium gets into 0:12:47.960 --> 0:12:52.040 you and causes disease, Okay, and then we'll talk about 0:12:52.040 --> 0:12:56.000 those insidious that's one of my favorite words, insidious symptoms. 0:12:56.559 --> 0:12:59.080 Yeah. Also it's going to end up convincing a lot 0:12:59.160 --> 0:13:00.720 of people that they have whooping cough. 0:13:00.840 --> 0:13:04.400 Probably, I mean, I mean I convinced myself that my 0:13:04.440 --> 0:13:07.640 baby had whooping cough. So you're not alone if this 0:13:07.720 --> 0:13:09.480 convinces you that you have whooping cough. 0:13:09.920 --> 0:13:12.320 Okay, we just apologize in advance, Yeah, we do. 0:13:13.520 --> 0:13:17.800 Uh So, Unlike many of the other diseases that we've 0:13:17.800 --> 0:13:22.320 talked about recently, including like syphilis and E. Coli, even dengay, 0:13:22.360 --> 0:13:27.760 this is a highly highly specific bacterium, So it doesn't 0:13:27.800 --> 0:13:31.920 just go throughout your whole body wreaking havoc. Bordetella. Protessis 0:13:32.360 --> 0:13:40.360 replicates only in association with the cciliated epithelium of your lungs. 0:13:40.480 --> 0:13:42.400 How does it only reproduce there? 0:13:43.679 --> 0:13:48.240 How it has? Okay, So protessis has a lot of 0:13:48.280 --> 0:13:53.200 different virulence factors on its surface, Yeah, that allow it 0:13:53.280 --> 0:13:57.320 to colonize our body and then cause the symptoms that 0:13:57.360 --> 0:14:00.360 it causes. It also has a number of different talks 0:14:00.360 --> 0:14:03.360 which are really ultimately responsible for a lot of the 0:14:03.400 --> 0:14:07.320 symptoms that we see. And so these virulence factors very 0:14:07.400 --> 0:14:12.760 specifically allow it to bind to the epithelium of our 0:14:12.920 --> 0:14:14.000 respiratory tract. 0:14:14.200 --> 0:14:16.320 Okay, And so those are the only. 0:14:16.160 --> 0:14:20.480 Cells that they bind to. Now, Borditella does not invade 0:14:20.480 --> 0:14:24.680 our cells, but it binds to these respiratory cells and 0:14:24.720 --> 0:14:27.920 then it replicates in association with those cells, So like 0:14:28.120 --> 0:14:29.200 next to those cells. 0:14:29.240 --> 0:14:31.960 What this is so weird? Okay, I know, isn't it? 0:14:32.000 --> 0:14:34.200 So this is a very like I don't know how 0:14:34.280 --> 0:14:37.680 much you're going to talk about the evolution of this pathogen. Yeah, 0:14:38.080 --> 0:14:41.240 but it seems to me like based on this, we've 0:14:41.280 --> 0:14:44.680 had a long association with this pathogen. Am I right? 0:14:44.760 --> 0:14:49.160 I'm going to withhold comment until okay the history that 0:14:49.160 --> 0:14:50.840 would be excellent. 0:14:51.160 --> 0:14:53.040 That would be my guess based on the fact that 0:14:53.080 --> 0:14:56.640 this is a bacterium that is highly specialized to these 0:14:56.680 --> 0:14:59.720 cells in our respiratory tract, and it's it's a human 0:14:59.720 --> 0:15:02.640 space pathogen, so it's not found in a bunch of 0:15:02.680 --> 0:15:05.640 other animals. Right, Okay, cool? 0:15:05.720 --> 0:15:09.680 But so are our human respiratory cells that much different 0:15:09.760 --> 0:15:11.920 than any other mammal respiratory cells? 0:15:12.680 --> 0:15:15.400 Oh than any other mammal I have absolutely no idea. 0:15:15.480 --> 0:15:18.120 I mean, I guess they're specific enough that the virulence 0:15:18.120 --> 0:15:21.560 factors that Bordetella protests has doesn't allow them to easily 0:15:21.560 --> 0:15:22.800 colonize other animals. 0:15:22.880 --> 0:15:25.400 Yeah, I'm just wondering what it is about the specificity. 0:15:25.440 --> 0:15:29.840 That's like a great question. I mean, it makes sense 0:15:29.960 --> 0:15:33.200 like that it would if it's going to specify on 0:15:33.240 --> 0:15:36.800 any cells. Respiratory epithelia are great because it's going to 0:15:36.880 --> 0:15:39.200 cause you to cough and sneeze and that's going to 0:15:39.280 --> 0:15:42.200 spread the pathogen really far. So from that perspective it 0:15:42.200 --> 0:15:45.880 makes sense. But the specificity to humans, I don't know, man, 0:15:45.920 --> 0:15:46.960 how does that ever happen? 0:15:49.360 --> 0:15:49.720 Right? 0:15:50.600 --> 0:15:55.680 And again, Bordtella has a number of different toxins that 0:15:55.800 --> 0:16:00.000 it releases that result in a lot of the damage 0:16:00.240 --> 0:16:03.880 and symptoms that we see. So in addition to like 0:16:04.200 --> 0:16:07.040 PILLI which we've talked about before, those sticky things that 0:16:07.080 --> 0:16:10.840 allow it to attach to the respiratory tract, two of 0:16:10.880 --> 0:16:15.080 the important toxins that it has are number one, a 0:16:15.120 --> 0:16:18.320 toxin called protessis toxin. It's a really good name for it. 0:16:19.320 --> 0:16:23.480 That actually blocks the ability of our white blood cells 0:16:23.760 --> 0:16:28.520 to get back into our lymph system. Ooh, So what 0:16:28.560 --> 0:16:31.600 that means is that you have white blood cells coming 0:16:32.120 --> 0:16:35.280 because they recognize bacteria. Right, they're like, oh man, we 0:16:35.360 --> 0:16:37.840 need to come in and help out. But then what 0:16:37.960 --> 0:16:40.120 those white blood cells want to do is then go 0:16:40.280 --> 0:16:43.680 back to our lymph nodes and regroup so that they 0:16:43.680 --> 0:16:45.880 can like figure out a plan of attack kind of 0:16:45.920 --> 0:16:49.760 m hm. So Protessa's toxin blocks their ability to do that, 0:16:50.240 --> 0:16:52.600 So you end up with a ton of white blood 0:16:52.600 --> 0:16:55.720 cells in the blood stream because they've all come out 0:16:55.760 --> 0:16:58.680 to try and figure out what's going on with these bacteria, 0:16:58.760 --> 0:17:00.560 but then they can't get back where they want to be. 0:17:00.920 --> 0:17:04.840 Oh my gosh. Yeah, okay, that's really interesting. 0:17:05.200 --> 0:17:08.720 It is, and it's one of the only systemic symptoms 0:17:08.840 --> 0:17:13.240 of a Bordetella protestis infection. Is this what we call lymphocytosis, 0:17:13.280 --> 0:17:15.359 A lot of white blood cells in your bloodstream? 0:17:15.480 --> 0:17:15.840 Okay? 0:17:16.400 --> 0:17:19.840 Because it is? Yeah, I mean you can get that 0:17:19.920 --> 0:17:23.040 in tons of other diseases, so it's certainly not specific 0:17:23.119 --> 0:17:26.840 at all, but it's one of the only like systemic 0:17:26.920 --> 0:17:32.560 manifestations because this is a very respiratory specific pathogen. And 0:17:32.600 --> 0:17:35.520 then it has other toxins which I forgot to write 0:17:35.520 --> 0:17:39.320 the name of down. Of course, I think tracheal toxin 0:17:39.440 --> 0:17:43.320 is one of them. Actually, that damage directly caused direct 0:17:43.400 --> 0:17:48.120 damage to the scillia of our respiratory epithelia and so ccilia. 0:17:48.200 --> 0:17:52.159 Are these little what do you call this aeron fingers 0:17:52.320 --> 0:17:53.080 like undulating? 0:17:53.400 --> 0:17:55.320 Undulating? 0:17:55.600 --> 0:17:59.680 Yeah, exactly, little projections on these cells that help to 0:18:00.040 --> 0:18:03.480 weep mucus and debris up and out of our respiratory track. 0:18:03.520 --> 0:18:06.120 We talked a lot about them in our cystic fibrosis episode. 0:18:06.320 --> 0:18:07.760 Yeah. 0:18:07.840 --> 0:18:12.120 Anyways, So these other toxins, trichial toxins and others that 0:18:12.280 --> 0:18:16.040 Bordetella produce caused damage to that system. So you're gonna 0:18:16.040 --> 0:18:18.640 get a build up of gunk in your lungs when 0:18:18.680 --> 0:18:22.159 you get infected with protessis. Now we know what it 0:18:22.200 --> 0:18:25.879 does in your body, how it's infecting you. So what 0:18:25.880 --> 0:18:27.400 does it look like when you get infected? 0:18:27.640 --> 0:18:30.240 M h, not good. 0:18:30.720 --> 0:18:34.240 It's not good. So there are three main phases to 0:18:34.640 --> 0:18:38.920 protessis what's called the catarrhal stage, I think that's how 0:18:38.960 --> 0:18:43.800 you pronounce it, the paroxysmal stage, and then the convalescent 0:18:44.000 --> 0:18:50.480 stage aka recovery. So the catarrhal stage is this very insidious, 0:18:51.000 --> 0:18:55.360 nondescript illness, and this is what can make it difficult 0:18:55.400 --> 0:19:00.040 to pinpoint exactly when you might have started showing symptoms. 0:19:00.080 --> 0:19:04.040 And what I think is worst about this phase is 0:19:04.080 --> 0:19:07.840 that the symptoms are quite mild in a lot of cases. 0:19:08.440 --> 0:19:11.760 So these include something like a runny nose, not a 0:19:11.800 --> 0:19:18.080 gunky nose, just kind of a watery, runny nose chariza, 0:19:18.320 --> 0:19:22.439 so like tearing from your eyes, like kind of like 0:19:22.480 --> 0:19:26.320 a like a viral eye infection might be okay, okay, 0:19:28.080 --> 0:19:30.520 like watery eyes, Maybe your eyes get a little red, 0:19:30.680 --> 0:19:33.800 maybe they're itchy, like maybe you think it's allergies. You 0:19:33.880 --> 0:19:37.080 might have some sneezing, And at first it starts off 0:19:37.080 --> 0:19:40.760 with a pretty mild cough, and that's how it begins, 0:19:42.240 --> 0:19:46.880 and in tiny kids actually across the board, if there 0:19:47.040 --> 0:19:50.240 is a fever, which often there isn't a fever at all. 0:19:51.320 --> 0:19:54.720 Even if there is a fever, it's usually pretty mild. 0:19:54.800 --> 0:19:57.880 Like we're talking maybe like one hundred and one, which 0:19:58.040 --> 0:20:01.360 is a pretty low grade fever. If you're talking about 0:20:01.400 --> 0:20:04.280 a kid who's like over age two, you mostly wouldn't 0:20:04.280 --> 0:20:07.439 even be concerned about a fever that low because kids 0:20:07.480 --> 0:20:12.080 get fevers from everything. Like every infection is going to 0:20:12.119 --> 0:20:13.639 give a kid a fever. So if a kid has 0:20:13.640 --> 0:20:17.440 a very low fever, you probably aren't going to be like, well, 0:20:17.440 --> 0:20:19.640 this kid is clearly very sick. You'll be like, oh, 0:20:19.640 --> 0:20:22.679 it's the little fever. They'll get over it, right, but 0:20:22.760 --> 0:20:26.199 that's it. Those are the symptoms. This lasts for like 0:20:26.280 --> 0:20:30.960 one to two weeks. It's super mild. The coughing sort 0:20:30.960 --> 0:20:34.640 of starts to get worse, but at this phase it's 0:20:34.960 --> 0:20:38.040 it doesn't have anything that makes it stand out. It's 0:20:38.080 --> 0:20:42.159 not more frequent at certain times of day, it's not 0:20:42.320 --> 0:20:46.879 super productive. It's just like a kind of normal cough. Okay, 0:20:47.680 --> 0:20:52.360 and again no fever. Then comes the paroxysmal phase, and 0:20:52.400 --> 0:20:56.280 this is the whooping cough of whooping cough. Okay, So 0:20:56.320 --> 0:20:59.320 the cough that starts out as mild in that catarrhal phase, 0:21:00.000 --> 0:21:05.200 it becomes paroxysmal. Paroxysmal means a sudden recurrence, so all 0:21:05.240 --> 0:21:07.960 of a sudden, out of the blue, people will have 0:21:08.080 --> 0:21:12.359 a massive coughing attack. These usually are like between five 0:21:12.480 --> 0:21:14.840 or ten, but they can be up to thirty coughs 0:21:14.880 --> 0:21:19.840 in a row, and they become also these paroxysms, these 0:21:19.920 --> 0:21:24.960 coughing attacks become more frequent at night and overall increase 0:21:25.000 --> 0:21:28.120 in frequency both throughout the day and the night, and 0:21:28.240 --> 0:21:31.760 each one becomes more severe than the last. 0:21:32.040 --> 0:21:36.240 Okay, And it's kind of almost. 0:21:35.920 --> 0:21:41.240 Hard to describe how terrible these coughs are so I 0:21:41.320 --> 0:21:45.239 actually found a paper from nineteen seventy five that's a 0:21:45.280 --> 0:21:48.199 really nice overview of protesses, and I'm going to just 0:21:48.400 --> 0:21:52.040 read this. The child possessed of the coughing fit is 0:21:52.080 --> 0:21:54.720 a pitiful sight, all the more so as the observer 0:21:54.880 --> 0:21:58.879 is helpless to alleviate or terminate the attack. Each attack 0:21:58.960 --> 0:22:02.960 consists of ten to thirty forceful coughs per spasm, and 0:22:03.080 --> 0:22:07.240 into each cough, the patient appears to concentrate all his energy. 0:22:07.720 --> 0:22:11.440 He leans forward, or, if standing, stands with legs spread, 0:22:11.800 --> 0:22:16.240 grasping the nearest object and leaning far forward, tongue protruded 0:22:16.280 --> 0:22:20.520 to the utmost, saliva and mucus streaming from nose and mouth, 0:22:21.080 --> 0:22:25.879 eyes bulging with tears streaming, his entire body racked with 0:22:25.960 --> 0:22:30.240 the total exertion of each cough. The coughing continues in 0:22:30.280 --> 0:22:34.920 a staccato series. The face becomes more and more cyanotic, 0:22:35.320 --> 0:22:39.959 which means blue, the neck bulges with venus congestion, and 0:22:40.080 --> 0:22:44.879 still the attack continues. Finally, when it seems certain that 0:22:44.960 --> 0:22:48.760 death is imminent, a final cough appears to clear offending 0:22:48.800 --> 0:22:51.960 secretions or mucus from the upper airway, and the first 0:22:52.000 --> 0:22:57.520 opportunity to inspire is offered with a massive effort. Inspiration ensues, 0:22:57.920 --> 0:23:01.760 air rushes into the lungs against a still narrowed glottis, 0:23:02.000 --> 0:23:04.520 and the characteristic whoop is produced. 0:23:05.200 --> 0:23:10.960 Oh my gosh, yeah, just taking a second to like breathe, 0:23:11.400 --> 0:23:14.320 right ah wow. 0:23:14.960 --> 0:23:18.280 Yeah, And so that's kind of a very classic description 0:23:18.400 --> 0:23:23.399 of what these paroxysms look like. They're horrible. I don't 0:23:23.440 --> 0:23:25.760 recommend googling them, but you can find a lot of 0:23:25.840 --> 0:23:27.080 videos of them online. 0:23:27.240 --> 0:23:31.760 Yeah, are the coughs productive? Are you coughing up mucus 0:23:31.800 --> 0:23:32.879 or gunk from your lungs? 0:23:33.280 --> 0:23:36.440 So, yes, and no, there is a lot of mucus 0:23:36.440 --> 0:23:38.760 in your lungs, and so it's thought that these coughing 0:23:38.800 --> 0:23:41.879 spasms are because of that mucus. It's like you trying 0:23:42.000 --> 0:23:46.080 really hard to get that mucus up. But especially because 0:23:46.560 --> 0:23:49.320 this is often a disease of very young infants, they're 0:23:49.359 --> 0:23:52.280 not good at coughing stuff up, so they may or 0:23:52.320 --> 0:23:54.879 may not actually cough anything up, but there is a 0:23:54.920 --> 0:24:01.200 lot of mucus there that could potentially be coughed up. Yeah, okay, Yeah. 0:24:01.240 --> 0:24:05.159 One of the sort of other characteristic things that happens 0:24:05.240 --> 0:24:10.040 after these paroxysms is what's called post tussive vomiting. So 0:24:10.080 --> 0:24:12.359 it's really common to cough so hard that you end 0:24:12.440 --> 0:24:20.400 up vomiting. Oh gosh, Yeah, it's horrific. And these episodes 0:24:21.000 --> 0:24:26.440 are so exhausting. I mean, imagine you are literally unable 0:24:26.520 --> 0:24:29.840 to breathe this whole time, which is why that inspiratory 0:24:30.000 --> 0:24:34.240 whoop is so like, it's so powerful. You're trying so 0:24:34.440 --> 0:24:38.160 hard to get air back into your lungs. That as 0:24:38.240 --> 0:24:41.399 these progress and become more and more frequent throughout the 0:24:41.560 --> 0:24:46.520 ensuing days and weeks, this can last for weeks. People 0:24:46.560 --> 0:24:49.240 tend to become very, very exhausted, so they might be 0:24:49.359 --> 0:24:52.520 sleeping most of the day and only awaken when they 0:24:52.560 --> 0:24:55.440 have these coughing fits and then fall kind of right 0:24:55.480 --> 0:24:56.119 back to sleep. 0:24:56.280 --> 0:24:59.320 It sounds so utterly exhausting. 0:24:59.280 --> 0:25:04.160 Yeah, oh god, and so especially in well in babies 0:25:04.200 --> 0:25:07.159 and in older children and adults. This can lead to 0:25:07.520 --> 0:25:10.480 weight loss because people might stop eating because they're just 0:25:10.560 --> 0:25:14.160 sleeping through like in between every coughing episode. 0:25:14.359 --> 0:25:14.479 Right. 0:25:15.320 --> 0:25:17.919 You can also get a lot of complications from the 0:25:17.960 --> 0:25:21.520 actual force of the coughing. You can burst blood vessels 0:25:21.520 --> 0:25:25.520 in your eyes or under your skin. You can cough 0:25:25.560 --> 0:25:28.600 out like a hernia. You coughing so hard that you 0:25:28.640 --> 0:25:32.639 like result in a hernia through your belly button. You 0:25:32.680 --> 0:25:37.520 can crack ribs, yeah, and often your chest wall will 0:25:37.560 --> 0:25:40.440 get really sore and tender, even if you don't break 0:25:40.480 --> 0:25:43.840 a rib, just because you're working those muscles so so 0:25:44.080 --> 0:25:50.119 hard to cough so much. And then there are a 0:25:50.240 --> 0:25:54.080