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Section 3. Summaries of Infectious Diseases
Pertussis
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Pertussis begins with mild upper respiratory tract symptoms (catarrhal stage) and progresses to cough and then usually to paroxysms of cough (paroxysmal stage), often with a characteristic inspiratory whoop and commonly followed by vomiting. Fever is absent or minimal. Symptoms wane gradually over weeks to months (convalescent stage). Disease in infants younger than 6 months of age may be atypical; apnea is a common manifestation, and whoop often is absent. Similarly, older children and adults can have atypical manifestations, with prolonged cough with or without paroxysms and no whoop. The duration of classic pertussis is 6 to 10 weeks. Complications include seizures, pneumonia, encephalopathy, and death. Pertussis is most severe when it occurs during the first 6 months of life, particularly for preterm and unimmunized infants. On the basis of cases reported to local and state health departments (1990–1999), pneumonia, seizures, and encephalopathy occurred in 22%, 2%, and <0.5%, respectively, of infants younger than 12 months of age with pertussis. The case fatality rate was approximately 1% in infants younger than 2 months of age and <0.5% in infants 2 to 11 months of age. However, because most infants reported to have pertussis are hospitalized, complication rates are likely to be representative of more severe illness.
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ETIOLOGY: Bordetella pertussis is a fastidious, gram-negative, pleomorphic bacillus. Other infectious agents may cause a similar cough illness: Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydia pneumoniae, Bordetella bronchiseptica, and certain adenoviruses.
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EPIDEMIOLOGY: Humans are the only known hosts of B pertussis. Transmission occurs by close contact via aerosolized droplets from patients with disease. Pertussis occurs endemically with 3- to 5-year cycles of increased
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