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Pertussis

Whooping cough

 

Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the person tries to take a breath.

Causes

 

Pertussis, or whooping cough, is an upper respiratory infection. It is caused by the Bordetella pertussis bacteria. It is a serious disease that can affect people of any age and cause permanent disability in infants, and even death.

When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air. The disease is easily spread from person to person.

The infection often lasts 6 weeks, but it can last as long as 10 weeks.

 

Symptoms

 

Initial symptoms are similar to the common cold . In most cases, they develop about a week after exposure to the bacteria.

Severe episodes of coughing start about 10 to 12 days later. In infants and young children, the coughing sometimes ends with a "whoop" noise. The sound is produced when the person tries to take a breath. The whoop noise is rare in infants under 6 months of age and in older children or adults.

Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells and long pauses in breathing are common.

Other pertussis symptoms include:

  • Runny nose
  • Slight fever , 102°F (38.9°C) or lower
  • Diarrhea

 

Exams and Tests

 

The initial diagnosis is most often based on the symptoms. However, when the symptoms are not obvious, pertussis may be hard to diagnose. In very young infants, the symptoms may be caused by pneumonia instead.

To know for sure, the health care provider may take a sample of mucus from the nasal secretions. The sample is sent to a lab and tested for pertussis. While this can offer an accurate diagnosis, the test takes some time. Most of the time, treatment is started before the results are ready.

Some people may have a complete blood count that shows large numbers of lymphocytes.

 

Treatment

 

If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most people are diagnosed too late, when antibiotics aren't very effective. However, the medicines can help reduce the person's ability to spread the disease to others.

Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.

An oxygen tent with high humidity may be used.

Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids.

Sedatives (medicines to make you sleepy) may be prescribed for young children.

Cough mixtures, expectorants, and suppressants are most often not helpful. These medicines should NOT be used.

 

Outlook (Prognosis)

 

In older children, the outlook is most often very good. Infants have the highest risk for death, and need careful monitoring.

 

Possible Complications

 

Complications may include:

  • Pneumonia
  • Convulsions
  • Seizure disorder (permanent)
  • Nosebleeds
  • Ear infections
  • Brain damage from lack of oxygen
  • Bleeding in the brain (cerebral hemorrhage)
  • Intellectual disability
  • Slowed or stopped breathing ( apnea )
  • Death

 

When to Contact a Medical Professional

 

Call your provider if you or your child develops symptoms of pertussis.

Call 911 or get to an emergency room if the person has any of the following symptoms:

  • Bluish skin color, which indicates a lack of oxygen
  • Periods of stopped breathing ( apnea )
  • Seizures or convulsions
  • High fever
  • Persistent vomiting
  • Dehydration

 

Prevention

 

DTaP vaccination , one of the recommended childhood immunizations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are most often given to children at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years.

The TdaP vaccine should be given at age 11 or 12.

During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings. They should also be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case.

It is also recommended that adults age 19 and older receive 1 dose of the TdaP vaccine against pertussis.

TdaP is especially important for health care professionals and anyone having close contact with a baby younger than 12 months old.

Pregnant women should get a dose of TdaP during every pregnancy between 27 and 36 weeks of pregnancy, to protect the newborn from pertussis.

 

 

Open References

References

Braman SS. Postinfectious cough: ACCP evidence-based clinical practice guidelines. Chest . 2006;129(1):138S-146S. PMID: 16428703 www.ncbi.nlm.nih.gov/pubmed/16428703 .

Kim DK, Bridges CB, Harriman KH; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older -- United States, 2015. MMWR Morb Mortal Wkly Rep . 2015; 6;64(4):91-92. PMID:25654609 www.ncbi.nlm.nih.gov/pubmed/25654609 .

Long SS. Pertussis (Bordetella pertussis and Bordetella parapertussis). In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 197.

Strikas RA; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Child/Adolescent Immunization Work Group. Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years -- United States, 2015. MMWR Morb Mortal Wkly Rep . 2015; 6;64(4):93-94. PMID: 25654610 www.ncbi.nlm.nih.gov/pubmed/25654610 .

United States Centers for Disease Control and Prevention. Vaccine information statement: Tdap vaccine (Tetanus, diphtheria and pertussis). Available at: www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.pdf . Accessed August 7, 2015.

 
  • Respiratory system overview

    Respiratory system overview - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system overview

    illustration

    • Respiratory system overview

      Respiratory system overview - illustration

      Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

      Respiratory system overview

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Pertussis

       
         

        Review Date: 7/10/2015

        Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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