Pulmonology Book

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Whooping Cough

Aka: Whooping Cough, Bordetella pertussis, Pertussis
  1. See Also
    1. Bacterial Pneumonia
  2. Epidemiology
    1. Pertussis is a common cause of adult Chronic Cough
      1. With waning immunity, teens and adults are reservoir
      2. Most cases occur in over age 10 years
    2. Infants are infected by adults
      1. Infant immunity <1 year is incomplete
      2. Infants comprise >50% of all childhood infections
      3. Infection most severe in infants including death
  3. Etiologies
    1. Bordetella pertussis
    2. Bordetella parapertussis
  4. Pathophysiology
    1. Incubation period: 7 to 10 days
  5. Signs and symptoms
    1. Catarrhal Stage (1-2 weeks)
      1. Low grade fever
      2. Malaise
      3. Mild Conjunctivitis
      4. Rhinitis
      5. Sneezing
      6. Lacrimation
    2. Paroxysmal Cough Stage (2-4 weeks with peak at 2 weeks)
      1. Infants under age 6 months
        1. Apnea
        2. Persistent cough (not in spasms)
        3. Decreased oral intake
      2. Older infants, children and adults
        1. Gradually progressive cough in spasms
        2. Inspiratory whoop (not heard in adults)
        3. Vomiting may occur with severe cough
        4. Cyanosis following coughing spasms
        5. Fine rales on lung exam
        6. CoughSyncope
    3. Convalescent Stage (1-2 weeks)
      1. Coughing spasms resolve over 1-3 months ("80 day cough")
  6. Differential Diagnosis
    1. Catarrhal stage
      1. Viral Upper Respiratory Infection (e.g. Adenovirus)
    2. Paroxysmal stage
      1. Mycoplasma pneumoniae
      2. Chlamydia pneumoniae
    3. Convalescent stage with persistent cough
      1. Asthma
      2. Gastroesophageal Reflux
      3. Acute Sinusitis with post nasal drainage
  7. Diagnosis
    1. See Bordetella Pertussis Test
    2. Treatment and reporting based on clinical suspicion
    3. Clinical suspicion criteria
      1. Major Criteria: Acute cough for 14 days
      2. Minor criteria (requires one)
        1. Paroxysmal cough
        2. Post-tussive Emesis
        3. Inspiratory Whoop
        4. Pertussis outbreak
  8. Management
    1. Pertussis is a clinical diagnosis (see diagnosis above)
      1. Treatment and reporting based on clinical suspicion
      2. Report clinically suspected cases before confirmation
      3. Start antibiotics before confirmation if suspected
    2. Antibiotic Course
      1. Fourteen days is considered standard for Erythromycin
        1. American academy of pediatrics recommends 14 days
      2. Seven Day course appears as effective for eradication
        1. Halperin (1997) Pediatrics 100:65-71
      3. Start treatment early (best efficacy)
    3. Pediatric antibiotic dosing
      1. Azithromycin for 5 days (preferred)
      2. Clarithromycin for 14 days
      3. Erythromycin
        1. Child: 40-50 mg/kg/day divided qid for 14 days
        2. Adults: 500 mg PO qid for 14 days
      4. Bactrim (not as effective as Macrolides)
        1. Indicated for Macrolide allergy or GI intolerance
        2. Do not use in pregnancy, Lactation, age <2 months
        3. Dosing
          1. Child: 8 mg/kg Trimethoprim divided bid x14 days
          2. Adult: Bactrim DS one tablet bid for 14 days
          3. Maximum dose: 320/1600 mg TMP/SMX
  9. Management: Prevention of spread
    1. Quarantine
      1. Pertussis patients are off work and out of school
      2. May return after 5 days on antibiotics or
      3. Three weeks after paroxysmal stage ends
    2. Prophyaxis: Treat close contacts with exposure within 3 weeks
      1. Contacts are positive, yet asymptomatic
      2. Use same antibiotic course as above
      3. Monitor contacts for 20 days for onset of symptoms
  10. Prevention
    1. Diphtheria Tetanus Acellular Pertussis Vaccine (DTaP)
      1. Primary Series for 5 doses by age 5 years
    2. Tdap (Boostrix, Adacel)
      1. Use for 12 year old booster (instead of Td)
      2. Give Adacel once as booster in age 19-65 years
        1. Can replace one Td booster
  11. Complications (usually limited to infants)
    1. Hospitalization
    2. Superimposed Bacterial Pneumonia
    3. Dehydration
    4. Encephalopathy
    5. Death (rate has rising for infants)
  12. References
    1. Gilbert (2001) Sanford Antimicrobial, p. 25
    2. Birkebaek (1999) Clin Infect Dis 29:1239-42
    3. Gregory (2006) Am Fam Physician 74:420-7

Pertussis (C0043167)

Definition (MSHFRE) Infection respiratoire provoquée par Bordetella pertussis et caractérisée par des quintes de toux se terminant par une inspiration prolongée et sifflante en "chant du coq".
Definition (NCI) A contagious bacterial respiratory infection caused by Bordetella pertussis. It is characterized by severe and uncontrollable cough, resulting in a whooping sound during breathing following the cough.
Definition (CHV) whooping cough due to bordetella pertussis
Definition (MEDLINEPLUS)

Whooping cough is an infectious bacterial disease that causes uncontrollable coughing. The name comes from the noise you make when you take a breath after you cough. You may have choking spells or may cough so hard that you vomit.

Anyone can get whooping cough, but it is more common in infants and children. It's especially dangerous in infants. The coughing spells can be so bad that it is hard for infants to eat, drink or breathe.

Before there was a vaccine, whooping cough was one of the most common childhood diseases and a major cause of childhood deaths in the U.S. There are fewer cases today because there are both pertussis-only vaccines and combination vaccines for tetanus, diphtheria and pertussis. If you have whooping cough, treatment with antibiotics may help if given early.

Centers for Disease Control and Prevention

Definition (NCI) A serious bacterial infection of the lungs and breathing tubes that spreads easily. Pertussis begins like a cold, but develops into severe coughing and gasping for air. Long spells of coughing may cause vomiting, and broken blood vessels in the eyes and on the skin.
Definition (MSH) A respiratory infection caused by BORDETELLA PERTUSSIS and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath.
Definition (CSP) respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath; whooping cough.
Concepts Disease or Syndrome (T047)
MSH D014917
ICD9 033.0
ICD10 A37.0
SnomedCT 27836007
English Cough, Whooping, Pertusses, Whooping Cough, Whooping cough due to bordetella pertussis (B. pertussis), PERTUSSIS, Whooping cough due to Bordetella pertussis, pertussis (diagnosis), pertussis, pertussis due to Bordetella pertussis, pertussis due to Bordetella pertussis (diagnosis), Bordetella pertussis, Whooping Cough [Disease/Finding], Bordetella pertussis Infection, Respiratory, bordetella caused disease pertussis, disease caused by bordetella pertussis, whooping cough, Infection due to Bordetella pertussis, Pertussis (disorder), Bordetella; pertussis, whooping cough, infection; Bordetella pertussis, pertussis; Bordetella pertussis, whooping cough, whooping cough; Bordetella pertussis, Pertussis, Whooping cough due to bordetella pertussis [B. pertussis], Whooping cough due to B. pertussis, Whooping cough due to bordetella pertussis
Dutch kinkhoest door Bordetella pertussis (B. pertussis), Bordetella; pertussis, kinkhoest, infectie; Bordetella pertussis, kinkhoest; Bordetella pertussis, pertussis; Bordetella pertussis, kinkhoest, Kinkhoest door Bordetella pertussis, pertussis, Kinkhoest, Hoest, kink-, Pertussis
French Coqueluche à Bordetella pertussis (B. pertussis), Infection respiratoire à B. pertussis, Infection respiratoire à Bordetella pertussis, Coqueluche
German Keuchhusten durch Bordetella pertussis (B. parapertussis), Keuchhusten durch Bordetella pertussis, Keuchhusten, Pertussis
Italian Pertosse da Bordetella pertussis (B. pertussis), Pertosse
Portuguese Tosse convulsa por Bordetella pertussis (B. pertussis), Tosse convulsa, Coqueluche, Tosse Comprida, Tosse Convulsa, Pertússis
Spanish Tosrferina por Bordetella pertussis (B. pertussis), pertussis, coqueluche, infección por Bordetella pertussis, pertussis (trastorno), tos convulsa, tos ferina (trastorno), tos ferina, Tos ferina, Tosferina, Pertussis, Tos Ferina, Tos Convulsa, Tos Convulsiva
Japanese 百日咳菌性百日咳, ヒャクニチゼキキンセイヒャクニチゼキ, ヒャクニチゼキ, 百日咳, 百日ぜき
Swedish Kikhosta
Czech pertuse, černý kašel, Černý kašel vyvolaný Bordetella pertussis (B.pertussis), Pertuse
Finnish Hinkuyskä
Russian KOKLIUSH, КОКЛЮШ
Korean 백일해균에 의한 백일해
Croatian HRIPAVAC
Polish Zakażenie Bordetella pertussis, Krztusiec, Koklusz
Hungarian Bordetella pertussis okozta szamárköhögés (B. pertussis), pertussis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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