With the resurgence of pertussis in highly vaccinated populations, the disease continues to be a public health and medical concern.
Three identifiable stages typical in childhood cases: catarrhal, paroxysmal, and convalescent.
Initial symptoms may be similar to a cold, with rhinorrhea and lacrimation, or a dry cough followed by episodes of severe coughing. Fever may be absent or low-grade.
Inspiratory whooping is a characteristic symptom in children but may be absent in infants, adolescents, and adults.
Culture of the bacterium Bordetella pertussis from nasal secretions can confirm the diagnosis, especially early in the course of the disease. A negative culture does not exclude the diagnosis. Other diagnostic tests include polymerase chain reaction (PCR) and serology.
Macrolide antibiotics are the preferred first-line agent for treatment and prophylaxis.
Universal childhood immunization with the acellular pertussis vaccine is advised. Booster vaccinations are recommended for all adults, including pregnant women.
Cocooning is a prevention strategy to protect newborns and infants.
- inspiratory whooping
- posttussive vomiting
- absent or low-grade fever
- decreased appetite
1st Tests To Order
- culture of a nasopharyngeal aspirate or swab from the posterior nasopharynx
- PCR of nasopharyngeal aspirate
Other Tests to Consider
- direct fluorescent antibody test
children <1 month of age
children ≥1 month of age or nonpregnant adults
- no macrolide allergy
- azithromycin, clarithromycin, or erythromycin
- macrolide allergy or resistance