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Pertussis

Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the patient tries to take a breath.

Alternative Names

Whooping cough

Causes

Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis bacteria. It is a serious disease that can affect people of any age and cause permanent disability in infants, and even death.

When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person.

The infection usually lasts 6 weeks, but can last as long as 10 weeks.

Symptoms

Initial symptoms, similar to the common cold , usually develop about a week after exposure to the bacteria.

Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a "whoop" noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults.

Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells and long pauses in breathing are common.

Other pertussis symptoms include:

Exams and Tests

The initial diagnosis is usually based on the symptoms. However, when the symptoms are not obvious, pertussis may be difficult to diagnose. In very young infants, the symptoms may be caused by pneumonia instead.

To know for sure, the health care provider may take a sample of mucus from the nasal secretions and send it to a lab, which tests it for pertussis. While this can offer an accurate diagnosis, the test takes some time, and treatment is usually started before the results are ready.

Some patients may have a complete blood count that shows large numbers of lymphocytes.

Treatment

If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren't very effective. However, the medicines can help reduce the patient's ability to spread the disease to others.

Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.

An oxygen tent with high humidity may be used.

Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids.

Sedatives (medicines to make you sleepy) may be prescribed for young children.

Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used.

Outlook (Prognosis)

In older children, the outlook is generally very good. Infants have the highest risk of death, and need careful monitoring.

Possible Complications


When to Contact a Medical Professional

Call your health care provider if you or your child develops symptoms of pertussis.

Call 911 or get to an emergency room if the person has any of the following symptoms:

Prevention

DTaP vaccination , one of the recommended childhood immunizations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are usually given to children at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years.

The Tdap vaccine should be given at age 11 or 12.

During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case.

It is also recommended that adults age 19 and older receive one dose of the Tdap vaccine against pertussis.

Tdap is especially important for healthcare professionals and anyone having close contact with a baby younger than 12 months old.

Pregnant women should get a dose of Tdap during every pregnancy between 27 and 36 weeks of each pregnancy, to protect the newborn from pertussis.

References

Braman SS. Postinfectious cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):138S-146S.

United States Centers for Disease Control and Prevention. Vaccine information statement: Tdap vaccine (Tetanus, diphtheria and pertussis).  Available at: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.pdf. Accessed March 5, 2014.

Updated: 8/22/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team. Editorial Update: 09/23/2014.


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