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Section 2
Section 3
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Section 5
Appendices

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Section 3. Summaries of Infectious Diseases

Pertussis (Whooping Cough)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Pertussis begins with mild upper respiratory tract symptoms similar to the common cold (catarrhal stage) and progresses to cough and then usually to paroxysms of cough (paroxysmal stage) characterized by 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 can be atypical with a short catarrhal stage, gagging, gasping, or apnea as prominent early manifestations; absence of whoop; and prolonged convalescence. Sudden unexpected death can be caused by pertussis. Disease in older children and adults also can have atypical manifestations when the cough is not accompanied by paroxysms or whoop. The duration of classic pertussis is 6 to 10 weeks in children. Approximately one-half of adolescents with pertussis cough for 10 weeks or longer. Complications among adolescents and adults include syncope, sleep disturbance, incontinence, rib fractures, and pneumonia. Pertussis is most severe when it occurs during the first 6 months of life, particularly in preterm and unimmunized infants. Complications among infants include pneumonia (22%), seizures (2%), encephalopathy (<0.5%), and death. On the basis of cases reported to local and state health departments (1990–1999), 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. Rare pertussis deaths at older ages occur in people with underlying conditions, especially neuromuscular disorders.


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ETIOLOGY: Pertussis is caused by a fastidious, gram-negative, pleomorphic bacillus, Bordetella pertussis. Other causes of prolonged cough illness include Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydophila pneumoniae, Bordetella bronchiseptica, and certain respiratory tract viruses, particularly adenoviruses . . . [Go to Full Text]


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