PERTUSSIS


I. Clinical features

  1. "Classic" presentation
    1. Cold-like sx, then
    2. "Catarrhal" stage, then
    3. "Paroxysmal" stage
    4. Usually afebrile throughout
    5. Can get pneumococcal superinfection; encephalitis, too
    6. n.b. babies can't whoop.
  1. Inm any cases--particularly in adolesents and adults--can often present just with a prolonged nonproductive cough--in one series, only 21% had paroxysmal nocturnal cough, 13% had fever, 6% had "whooping," and most had normal WBC and lymphocyte counts (Chest 115:1254, 1999--JW)

II. Diagnosis

  1. Culture
    1. "Gold standard" for confirmation
    2. Isolation is difficult as the organism is fastidious and its growth is inhibited by other nasopharyngeal flora
    3. Should be from posterior nasopharynx
    4. Most sensitive within first 2wks of illness
    5. More sensitive in young children than adolescents/adults
    6. Sensitivity reduced after initiation of antibiotic therapy
  2. PCR
    1. Highly specific
    2. Preferable to culture due to increased sensitivity and rapidity of results
  3. Serology-Not of clinical utility though used for epidemiologic studies

III. Treatment:

  1. Erythro for pt and household contacts, traditionally x 2 wks (if < 1mo use Azithromycin per 2006 CDC guidelines); can use trimethoprim-sulfamethoxazole if macrolides contraindicated.
  2. 168 kids with cx-positive pertussis (& their household contacts) randomized to erythromycin estolate 40mg/kg/d (up to 1g/d) divided TID x 14d vs. 7d. Nasopharyngeal cx done at end of tx showed one member of each group remained cx-positive. After 14d f/u, there was one bacteriological relapse in 7d group and none in 14d group (Peds 100:65, 1997-JW)

IV. Immunization against Pertussis (including "Cocooning" approach)-Click here for info.