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.
Pertussis (also known as whooping cough) is an upper respiratory tract infection (URTI) characterized by a severe cough. Bordetella pertussis is the typical etiological agent. 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."
History and exam
Key diagnostic factors
- inspiratory whooping
- posttussive vomiting
Other diagnostic factors
- absent or low-grade fever
- decreased appetite
- age <6 months
- baby born to mother who became infected at ≥34 weeks gestation
- no or incomplete immunization
- school teachers or healthcare workers (transmission)
- close contact with an infected person, especially a sibling
- household contact with an infected person
1st investigations to order
- culture of a nasopharyngeal aspirate or swab from the posterior nasopharynx
- PCR of nasopharyngeal aspirate
Investigations to consider
- direct fluorescent antibody test
infants <1 month of age
infants and children ≥1 month of age
M. Nawal Lutfiyya, PhD, FACE
Senior Research Scientist
Academic Health Center
University of Minnesota
Twin Cities Campus
MNL declares that she has no competing interests.
Carrie Sharkey-Asner, MD
Clinical Assistant Professor
Department of Family and Community Medicine
University of Illinois-Chicago
College of Medicine
CSA declares that she has no competing interests.
Anette Faye-Lund, MD
Department of Pediatrics
Hospital of Vestfold
AFL declares that she has no competing interests.
Alexander K.C. Leung, MBBS
Alberta Children's Hospital
University of Calgary
AKCL declares that he has no competing interests.
- Upper respiratory infection (URI)
- Community-acquired pneumonia (CAP)
- Respiratory syncytial viral (RSV) infection
- Recommended child and adolescent immunization schedules for ages 18 years or younger, United States, 2020
- Pertussis: guidance, data and analysis
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)More Patient leaflets
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