Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 33-10: Bordetella Pertussis Infection (Whooping Cough) + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Predominantly occurs in infants under age 2 years Adolescents and adults are reservoir of infection Two-week prodromal catarrhal stage of malaise, cough, coryza, and anorexia Paroxysmal cough ending in a high-pitched inspiratory "whoop" Absolute lymphocytosis, often striking; nasopharyngeal culture confirms diagnosis +++ General Considerations ++ An acute infection of the respiratory tract caused by Bordetella pertussis, a gram-negative coccobacillus Infection is transmitted by respiratory droplets Neither immunization nor disease confers lasting immunity to pertussis The diagnosis often is not considered in adults, who may not have a typical presentation; cough persisting more than 2 weeks is suggestive of pertussis +++ Demographics ++ Pertussis causes high morbidity and mortality in many countries Incidence of pertussis has increased steadily since the 1980s + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Symptoms of classic pertussis last about 6 weeks and are divided into three consecutive stages The catarrhal stage Characterized by its insidious onset Lacrimation, sneezing, and coryza, anorexia, and malaise Hacking night cough that tends to become diurnal The paroxysmal stage Characterized by bursts of rapid, consecutive coughs followed by a deep, high-pitched inspiration (whoop) The convalescent stage Usually begins 4 weeks after onset of the illness with a decrease in the frequency and severity of paroxysms of cough +++ Differential Diagnosis ++ Viral or bacterial pneumonia Asthma Other causes of chronic cough in adults Postnasal drip Gastroesophageal reflux disease Tuberculosis Mycobacterium avium complex Bronchiolitis, eg, respiratory syncytial virus (children) Croup (children) + Diagnosis Download Section PDF Listen +++ ++ The white blood cell count is usually 15,000–20,000/mcL (rarely, as high as 50,000/mcL or more), 60–80% of which are lymphocytes The organism can be cultured from the nasopharynx using a special medium (eg, Bordet-Gengou agar) + Treatment Download Section PDF Listen +++ ++ Erythromycin, 500 mg four times daily orally for 7 days Azithromycin, 500 mg once daily orally for 1 day, then 250 mg once daily for 4 days Clarithromycin, 500 mg three times daily for 7 days Trimethoprim-sulfamethoxazole 160 mg–800 mg orally twice a day for 7 days Treatment shortens the duration of carriage and may diminish the severity of coughing paroxysms + Outcome Download Section PDF Listen +++ +++ Prevention ++ Immunizations (Table 30–7) Acellular pertussis vaccine is recommended for all infants, combined with diphtheria and tetanus toxoids (DTaP) Infants and susceptible adults with significant exposure should receive prophylaxis with an oral macrolide Adults of all ages (including those > 64 years) should receive a single dose of Tdap Pregnant women Should receive a dose of Tdap during each pregnancy regardless of prior vaccination history, ideally between 27 and 36 weeks of gestation to maximize the antibody response of the pregnant woman and the passive antibody transfer to the infant Tdap should be administered immediately postpartum for any woman who was not previously vaccinated with Tdap and for whom the vaccine was not given during her pregnancy The CDC has eliminated the recommendation for a 2-year period window between receiving the Td and Tdap vaccines based on data showing that there is no increased risk of adverse events ++Table Graphic Jump LocationTable 30–7.Recommended adult immunization schedule—United States, 2020.View Table||Download (.pdf) Table 30–7. Recommended adult immunization schedule—United States, 2020. +++ When to Refer ++ Pertussis must be reported to the public health authorities +++ When to Admit ++ Adults must be admitted if respiratory insufficiency (eg, hypoxia) is present + References Download Section PDF Listen +++ + +DeSilva M et al. Tdap vaccination during pregnancy and microcephaly and other structural birth defects in offspring. JAMA. 2016 Nov 1;316(17):1823–5. [PubMed: 27802536] + +Nguyen VTN et al. Pertussis: the whooping cough. Prim Care. 2018 Sep;45(3):423–31. [PubMed: 30115332] + +Winter K et al. Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis. Clin Infect Dis. 2017 Jan 1;64(1):3–8. [PubMed: 27624955]