Pertussis

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 rhinorrhoea 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 immunisation with the acellular pertussis vaccine is advised. Booster vaccination is recommended for pregnant women. In the US, booster vaccinations are also recommended for non-pregnant adults.

Pertussis (also known as whooping cough) is an upper respiratory tract infection (URTI) characterised by a severe cough. Bordetella pertussis is the typical aetiological agent.[1]Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev. 2005 Apr;18(2):326-82. http://www.ncbi.nlm.nih.gov/pubmed/15831828?tool=bestpractice.com [2]Liang JL, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018 Apr 27;67(2):1-44. https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm http://www.ncbi.nlm.nih.gov/pubmed/29702631?tool=bestpractice.com Patients can be infectious for several weeks if it is left untreated. B pertussis will spontaneously clear from the nasopharynx within 3 to 4 weeks from the onset of the cough in about 80% to 90% of patients if untreated; however, infants who have not been vaccinated or treated can remain culture-positive for more than 6 weeks. Other Bordetella species that may rarely cause pertussis or pertussis-like cough include B parapertussis, B bronchiseptica, or B holmesii; these species are not vaccine-preventable. In China, pertussis is known as the '100-day cough'.