Pertussis Pertussis (whooping cough) is a respiratory tract infection characterized by a paroxysmal cough. The most common causative organism is Bordetella pertussis (see the image below), though Bordetella parapertussis has also been associated with this condition in humans. Pertussis remains a significant cause of morbidity and mortality in infants younger than 2 years. Signs and symptoms Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting 1-2 weeks. Stage 1 – Catarrhal phase Nasal congestion Rhinorrhea Sneezing Low-grade fever Tearing Conjunctival suffusion Stage 2 – Paroxysmal phase Paroxysms of intense coughing lasting up to several minutes, occasionally followed by a loud whoop Posttussive vomiting and turning red with coughing Stage 3 – Convalescent stage Chronic cough, which may last for weeks Diagnosis The diagnosis of pertussis is made by isolation of B pertussis in culture. A polymerase chain reaction (PCR) test can also be performed. The culture specimen should be obtained during the first 2 weeks of cough by using deep nasopharyngeal aspiration For PCR testing, nasopharyngeal specimens should be taken at 0-3 weeks following cough onset The CDC recommends a combination of culture and PCR assay if a patient has a cough lasting longer than 3 weeks Early serial monitoring of white blood cell (WBC) counts is warranted Management Goals of treatment Limit the number of paroxysms Observe the severity of cough and provide assistance when necessary Maximize nutrition, rest, and recovery Pharmacologic therapy Antimicrobial agents and antibiotics can hasten the eradication of B pertussis and help prevent spread Erythromycin, clarithromycin, and azithromycin are the preferred agents for patients aged 1 month or older Immunization Prevention through immunization remains the best defense in the fight against pertussis. CDC recommendations for vaccination are as follows: DTaP vaccine: Recommended at the ages of 2, 4, 6, and 15-18 months and at age 4-6 years; it is not recommended for children aged 7 years or older. Tdap vaccine: Recommended for children aged 7-10 years who are not fully vaccinated; as a single dose for adolescents 11-18 years of age; for any adult 19 years of age or older; and for pregnant woman regardless of vaccination history, including repeat vaccinations in subsequent pregnancies.
