Pertussis

Also called whooping cough, pertussis is a highly contagious infection caused by Bordetella pertussis. It characteristically produces an irritating cough that becomes paroxysmal and often ends in a high-pitched, inspiratory whoop.

About half the time it strikes under-immunized children under age 1. It also occurs in persons age 20 years or older and in outbreaks in schools, nursing homes, facilities, and residential facilities.

Since the 1940s, immunization and aggressive diagnosis and treatment have significantly reduced mortality from whooping cough in the United States. Pertussis mortality in children under age 1 usually is a result of insufficient immunization. Pertussis also is dangerous in elderly people but tends to be less severe in older children and adults.

Causes

Whooping cough is caused by an infection of a very contagious bacteria called Bordetella pertussis. A few cases are reported most years and there are epidemics about every four years.

Symptoms and Signs

• Symptoms appear between 6 to 21 days after exposure to the bacteria.
• The disease starts with cold symptoms: runny nose and cough. Sometime in the first 2 weeks, episodes of severe cough develop and that can last 1 to 2 months. The person may look and feel fairly healthy between these episodes.
• During bouts of cough, the lips and nails may turn blue for lack of air. Vomiting may occur after severe coughing spells.
• During the severe coughing stage, seizures or even death can occur, particularly in an infant.

Diagnostic tests

Nasopharyngeal swabs and sputum cultures show B. pertussis only in the early stages of pertussis. Although fluorescent antibody screening of nasopharyngeal smears provides quicker results than cultures, it's less reliable.

Serologic assays are used to diagnose pertussis when cough persists longer than 2 to 3 weeks. Other common causes of respiratory infections include influenza virus, adenovirus, Mycoplasma pneumonia, Chlamydia pneumonia, and pyogenic bacteria.

Treatment

Infants and elderly patients usually require hospitalization and vigorous supportive therapy and fluid and electrolyte replacement. Other measures include adequate nutrition, oxygen therapy as warranted, and administration of antitussives and antibiotics, chiefly erythromycin, as ordered.

Prevention

The best means of prevention is immunization. This is best done during early childhood. The vaccine is not recommended after age 6 years. People in close contact with someone infected with whooping cough may be advised to take preventive antibiotics, even if they have been vaccinated. This is especially important in households with members at high risk for severe disease such as children under one year of age.

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