Whooping cough

Last Updated on by FRCEM Intermediate

Overview

  • caused by the bacterium Bordetella pertussis
  • incubation period is about 7 – 10 days (range 5 – 21 days) and whooping cough is infectious for 3 weeks after the initial onset of symptoms
  • spread by aerosol droplets
  • Bacterial LRTI with paroxysmal cough ±whoop
  • whooping cough is a notifiable disease

Clinical features

  • Initial symptoms include coryza and cough. Gradually the cough progresses to severe coughing bouts (characteristic ‘whoop’ (inspiratory noise) at the end of a coughing bout), which can be prolonged

Investigations

  • B pertussis grown on C&S (nasopharyngeal aspirate)
  • PCR available

Management

  • Supportive
  • Treatment with antibiotics is thought to decrease infectivity and shorten symptoms only if given within three weeks of onset of symptoms /macrolide antibiotic is recommended first line: clarithromycin for infants < 1 month old, clarithromycin or azithromycin for children and adults and erythromycin for pregnant women
  • Prevention:
    • Immunisation- DTaP or Tdap vaccine -2, 3 and 4 months and in preschool-aged children ( 4 and 5 years)
    • Prophylactic erythromycin should be given to any close contacts who are particularly vulnerable, unvaccinated, partially vaccinated, or less than five years of age or pregnant women ≥ 32 weeks gestation)
    • Advise patients to stay away from nursery, school or work until 48 hours from the start of antibiotic treatment or three weeks after the coughing bouts started

Complications 

  • The illness can be prolonged and complications include
    • bronchiectasis,
    • neurological damage, and
    • prolonged apnoeic episodes.
    • Severe complications and deaths occur most commonly in infants under six months of age

Differential Dx

  • Croup (Laryngotracheobronchitis)
  • ‘flu
  • Bronchiolitis
  • Pneumonia( viral/bacterial/aspiration/TB)

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