Whooping Cough
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Whooping Cough

(Pertussis)

En Español (Spanish Version)

Definition

Whooping cough is a bacterial infection of the respiratory tract. The bacteria invade the lining of the respiratory tract and airways, causing inflammation and increasing the secretion of mucus. It is very contagious, and in some cases can be serious.

Upper Respiratory Tract

Normal Upper Airway During Sleep

© 2008 Nucleus Medical Art, Inc.

Causes

Whooping cough is caused by the bacterium Bordetella pertussis . It is spread by:

  • Inhaling droplets from the sneeze or cough of a person infected with whooping cough
  • Having direct contact with the respiratory secretions of a person infected with whooping cough

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Age: late infancy and early childhood
  • Not being immunized
  • Living in the same house or working in close contact with someone infected with whooping cough
  • Living in close quarters (such as a dormitory or nursing home)
  • Living in crowded, unsanitary conditions
  • Pregnancy

Symptoms

Symptoms usually begin 1 to 2 weeks (at most, three weeks) after exposure to the bacterium. Initial symptoms last about 7 to 14 days. They include:

  • Runny nose and congestion
  • Sneezing
  • Watery, red eyes
  • Mild fever
  • Dry cough, which marks the onset of the second stage:
    • The cough becomes progressively worse over days to weeks (usually lasting 2-6 weeks).
    • Prolonged coughing spells come on suddenly and frequently end with a forceful inhale or whoop.
    • The whoop is not often heard in young infants.
    • In severe cases, coughing may cause a person to have trouble breathing or turn blue from lack of oxygen.
    • Vomiting as a result of coughing is common.

Complications may include:

  • Seizures
  • Periods of apnea (no breathing)—more common in infants
  • Pneumonia
  • Collapsed lungs (rare)
  • Abdominal and inguinal hernias
  • Bleeding, swelling, and/or inflammation of the brain, possibly causing neurologic damage
  • Death (rare)—occurs more commonly in infants; mortality is 1% to 2% before age one year.

The final stage is marked by slowly decreasing duration and severity of coughing spells. The average duration of illness is about six weeks, with a range or 3 weeks to 3 months. Fits of coughing may recur for months. In the majority of cases, patients recover fully.

Diagnosis

Whooping cough can be difficult to diagnose, especially in older children and adults. This is because:

  • At first, symptoms are very similar to those of the common cold .
  • Later, symptoms can be very similar to bronchitis (especially in adults).

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

  • Blood tests
  • Swab of nose and throat for culture
  • Chest x-ray

Treatment

Treatment may include:

Medication

Antibiotics, usually erythromycin or azithromycin , are used. They are most effective when started in the early stages.

Treatment of Symptoms

To help reduce vomiting and lessen the chances of dehydration :

  • Eat small, frequent meals.
  • Drink plenty of water, fruit juices, and clear soup.

Hospitalization

This may be necessary for those who develop pneumonia. Patients are usually isolated to prevent spreading the disease to other people.

Prevention

The best means of prevention is immunization. All children (with few exceptions) should receive the DTaP vaccine, which protects against diphtheria , tetanus , and pertussis. This is a series of five shots and a booster shot.

Children seven years and older and adults who have not been vaccinated should also receive a vaccination series. For those 11 years and older who have been vaccinated, a booster shot is recommended with Tdap (to protect against diphtheria, tetanus, and pertussis in adolescents and adults). *

People in close contact with someone infected with whooping cough may be advised to take preventive antibiotics, even if they've been vaccinated. This is especially important in households with members at high risk for severe disease, such as children under one year of age.

RESOURCES:

American Medical Association
http://www.ama-assn.org

Center for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES:

AboutKidsHealth
http://www.aboutkidshealth.ca/

The Child, Youth, and Family Health Network
http://www.reseaudesanteenfant.ca/

References:

American Medical Association website. Available at: http://www.ama-assn.org/ .

Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics . 17th ed. Philadelphia, PA: Saunders; 2004.

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .

Harrison's Online website. Available at: http://harrisons.accessmedicine.com/ .

Kleigman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia PA: Saunders; 2007.

The Merck Manual of Medical Information . Simon and Schuster, Inc; 2000.

Virginia Department of Health website. Available at: http://www.vdh.state.va.us/ .

*Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm . Updated January 10, 2008. Accessed January 28, 2008.



Last reviewed February 2008 by David L. Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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