Pertussis

1. Predominantly in pts. <2 yo

   Nota:

   • adolescents/adults are reservoirs
2. 2 week prodromal catarrhal stage

   Nota:

   • malaise, cough, coryza, and anorexia
3. "Whooping" Cough

   Nota:

   • Paroxysmal cough ending in a high-pitched inspiratory “whoop”
4. Absolute lymphocytosis

1. Bordetella pertussis
   1. Transmitted via respiratory droplets
2. Incubation

   Nota:

   • 7-17 days

Nota:

• &lt;2 yo

1. Time span

   Nota:

   • Time span of 6 weeks with 3 phases
2. 3 Phases
   1. Catarrhal stage (1-2 weeks)

      Nota:

      • insidious onset, with lacrimation, sneezing, coryza, anorexia, malaise, and a hacking night cough that becomes diurnal  *Most contagious during this stage*
   2. Paroxysmal stage (2-4 weeks)

      Nota:

      • bursts of rapid, consecutive coughs, followed by a deep, high-pitched inspiration “whoop,” *may have a post-cough emesis*
   3. Convalescent stage (4-6 weeks after onset)

      Nota:

      • 4-6 weeks after onset of illness with a decrease in function and severity of paroxysms of cough
3. Lymphocytosis

   Nota:

   • WBC is usually 15,000-20,000 mcL with 60-80% lymphocytes
4. Cough lasting more than 2 weeks

   Nota:

   • Cough lasting more than 2 weeks in adults is suggestive of illness

1. Isolation of Organisms

   Nota:

   • Isolation of organism from nasopharyngeal PCR or throat culture
   1. Bordet-Gengou agar medium

      Nota:

      • Bordet-Gengou agar medium for throat culture: most sensitive during first 2 weeks of illness
2. PCR assays

   Nota:

   • PCR assays for nasopharyngeal swab: sensitive up to 4 weeks of illness

1. Supportive

   Nota:

   • oxygenation, nebulizers, mechanical ventilation as needed
2. Macrolide Abx

   Nota:

   • Treatment shortens the duration of carriage and may diminish the severity of coughing paroxysms
   1. Erythromycin

      Nota:

      • 500 mg 4x/day orally for 7 days
   2. Azithromycin

      Nota:

      • 500 mg orally 1 day and 250 mg for next 4 days
      • Better tolerated, and preferred treatment if pt &lt; 1 month
   3. Clarithromycin

      Nota:

      • 500 mg orally 2x/day for 7 days
   4. Trimethoprim-sulfamethoazole

      Nota:

      • 160 mg – 800 mg orally 2x/day for 7 days

1. Acellular pertussis vaccine

   Nota:

   • 5 doses of DTaP at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years
   • - Recommended for all infants
   •  - Combined with diphtheria and tetanus (DTaP) 
   • - Booster recommended to adolescents and adults (11-18 years) 
   • - Booster recommended during each pregnancy (during 27- 36 weeks gestation)
2. Macrolide Abx

   Nota:

   • Same antibiotic regimen recommended for those in contact with an active case of pertussis, where exposure to the active case occurs within 3 weeks of the onset of the active case’s cough

Nota:

• Mortality increases in infants due to apnea/cerebral hypoxia

Nota:

• Pneumonia, encephalopathy, otitis media, sinusitis, and seizures