Whooping Cough (Pertussis)

Whooping Cough (Pertussis): Overview

Whooping cough is a highly-contagious, life-threatening upper respiratory infection known for affecting infants and small children.  Its main symptom is uncontrollable, violent coughing that can make it hard to breathe.  A deep "whooping" sound is often heard when the patient tries to inhale.

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Incidence; Causes and Development

Although it used to affect mainly infants and young children, most are now immunized so most cases are seen in adolescents and adults.

This upper respiratory infection is caused by Bordetella pertussis or Bordetella parapertussis bacteria.  It spreads through tiny airborne bacteria-containing droplets that result from an infected person coughing or sneezing.

Signs and Symptoms

Symptoms initially mimic those of the common cold, and start about one week after exposure to the bacteria.  Serious symptoms begin about 1-2 weeks later, involving severe bouts of coughing, vomiting, and even unconsciousness.  Infants can suffer choking spells.

In children over 6 months old, the cough often ends with a "whoop" noise as the patient tries to catch a breath.  This noise is rare among the very young and adults.

Further symptoms include a runny nose, fever that is usually slight (under 102F / 38.9C), diarrhea (which can increase dehydration), and nose bleeds.

Diagnosis and Tests

Whooping cough should be suspected when vomiting occurs along with coughing.  Diagnosis can be difficult when the symptoms are not obvious; in the very young, similar symptoms can be caused by pneumonia.

Diagnosis can be confirmed by having a mucus sample analyzed in a laboratory.  However, this takes time and treatment is often started before the diagnosis is certain.

Treatment and Prevention

Patients under 18 months old need constant supervision in case their breathing stops.  Hospitalization should be considered, particularly for infants with severe cases.  Hospital treatments include a high-humidity oxygen tent, intravenous fluids (if coughing makes drinking difficult), sedatives for young children.

Note: Conventional cough medications (cough mixtures, expectorants, cough suppressants) should not be used.

Vaccinations are recommended for infants and children.  During an outbreak, children should avoid school or other gatherings until at least 2 weeks after the last reported case.

Prognosis; Complications; Seek medical attention if...

The infection usually lasts around 6 weeks.  In infants there is a marked risk of death, so close monitoring is essential.

Infants suffering from whooping cough can become dehydrated and have difficulty breathing.  This is a serious disease which can cause permanent disability and even death.

Other possible complications resulting from whooping cough include pneumonia, permanent seizure disorder, ear infections, brain damage due to lack of oxygen, cerebral hemorrhage, or mental retardation.

More serious symptoms that require urgent medical attention include bluish skin (if the patient is not getting enough oxygen), apnea (episodes where breathing stops) or slowed breathing, convulsions, high fever, persistent vomiting, or dehydration.

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Whooping Cough:

Signs, symptoms & indicators of Whooping Cough (Pertussis):

Lab Values - Cells

(Highly) elevated lymphocyte count

A complete blood count may show large numbers of lymphocytes in a pertussis patient.

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Recommendations for Whooping Cough (Pertussis):

Drug

Antibiotics

Antibiotics such as erythromycin help if the disease is diagnosed early.  However, most patients are diagnosed too late, when antibiotics are no longer effective except in helping to reduce the patient's ability to spread the disease.

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