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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. Cough illness in immunized children and adults can be mild and unrecognized. The duration of classic pertussis is 6 to 10 weeks. 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 (less than 0.5%), and death. Case-fatality rates are approximately 1% in infants younger than 2 months of age and less than 0.5% in infants 2 through 11 months of age.


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ETIOLOGY

Pertussis is caused by a fastidious, gram-negative, pleomorphic bacillus, Bordetella pertussis. Other causes of sporadic prolonged cough illness include Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydophila pneumoniae, Bordetella bronchiseptica, and certain respiratory tract viruses, particularly adenoviruses and respiratory syncytial viruses.


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EPIDEMIOLOGY

Humans are the only known hosts of B pertussis. Transmission occurs by close contact with cases via aerosolized droplets. Neither infection nor immunization provides lifelong immunity. Lack of natural booster events and . . . [Go to Full Text]