Pertussis (whooping cough) is an acute infectious disease caused by Bordetella pertussis. Toxins and other factors produced by the bacteria are responsible for clinical manifestations.
With the resurgence of pertussis in highly vaccinated populations, the disease continues to be a public health and medical concern.
Pertussis classically progresses through three identifiable stages: catarrhal, paroxysmal, and convalescent. Initial symptoms suggesting a mild upper respiratory tract infection are followed by episodes of severe coughing, often accompanied by an inspiratory whoop and posttussive emesis. Cough may persist for weeks. Fever is absent or low-grade.
Previously vaccinated or infected individuals often have milder disease. Illness in infants may be atypical and is associated with high rates of hospitalization and death. Pneumonia and hospitalizations for pertussis are also more common in older adults and people with pre-existing pulmonary disease.
The diagnosis is confirmed by identification of B pertussis by culture or nucleic acid amplification from nasopharyngeal specimens, or by serology.
Macrolide antibiotics are the preferred first-line agent for treatment and prophylaxis.
Universal childhood immunization with the acellular pertussis vaccine is advised; however, immunity following immunization is not durable. Booster vaccinations are recommended for all adults, including pregnant women.
History and exam
Key diagnostic factors
- inspiratory whooping
- posttussive vomiting
Other diagnostic factors
- neurologic complications
- unvaccinated or undervaccinated status
- close contact with an infected person, especially in the household
1st investigations to order
- culture of a nasopharyngeal aspirate or swab from the posterior nasopharynx
- nucleic acid amplification test (NAAT) of nasopharyngeal aspirate or posterior nasopharyngeal swab
Investigations to consider
- chest radiograph
- oral fluid testing
infants <1 month of age
infants and children ≥1 month of age and adults
- Viral upper respiratory infection (URI)
- Community-acquired pneumonia (CAP)
- Adult immunization schedule: recommendations for ages 19 years or older, United States, 2023
- Child and adolescent immunization schedule: recommendations for ages 18 years or younger, United States, 2023
DTaP vaccine (diphtheria, tetanus, polio, and pertussis)More Patient leaflets
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