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pertussis (whooping cough, 100 day cough)

Etiology: Bordetella pertussis Epidemiology: 1) frequent cause of persistent cough in teenagers & adults -> 14-47% of teenagers with IgA to pertussis antigen(s) indicating past infection [3] 2) among adults women, obese people, & people with asthma more likely to be diagnosed with pertussis [10] 3) immunity from vaccine expires after 6-10 years [2] 4) vaccine appears to confer little protective effect [11] 5) epidemic (1284 cases through early May) 2012 Washington state [5,9] 6) decline in infant pertussis incidence (91%) in the U.K. after introduction of maternal immunization [12] 7) infants most often catch pertussis from their siblings (36%), mothers (21%), & fathers (10%) [18] 8) 2014 pertussis epidemic in California - incidence of 26 per 100,000 population - 175 cases per 100,000 among infants [13] 9) reappearance of pertussis 2018 likely due to waning of the vaccine's protection [21] Pathology: 1) B. pertussis attaches itself to ciliated respiratory epithelium of the respiratory tract 2) release of toxins which result in inflammation, epithelial necrosis, leukocytosis, lymphocytosis, accumulation of secretions, cough, bronchopneumonia, hypoxic episodes & encephalopathy Clinical manifestations: 1) whooping cough (inspiratory whoop) in infants [15] 2) chronic cough in teens & adults, not typical - catarrhal phase of low-grade fever & nasal congestion - progression to severe & persistent paroxysmal coughing (severe coughing fits) 3) post-tussive emesis [15,23] Laboratory: 1) Bordetella pertussis serology a) Bordetella pertussis IgA in serum indicates past infection b) Bordetella pertussis IgG in serum generally from immunization c) Bordetella pertussis IgM in serum indicates active infection 2) direct examination of smears a) specimen: nasopharyngeal swab or aspirate a) fluorescein-conjugated B. pertussis antiserum b) cross-reactivity with Legionella 3) Bordetella pertussis antigen in specimen a) specimen: nasopharyngeal swab or aspirate b) 4 major pertussis antigens [3] 4) Bordetella pertussis DNA - specimen: nasopharyngeal swab or aspirate 5) Bordetella pertussis culture a) normal healthy individuals are not carriers, thus isolation of organism represents disease b) rate of B pertussis isolation declines with duration of illness c) specimen: nasopharyngeal swab or aspirate d) media: - Regan-Lowe agar incubated at 36 C, examined for 6 days - colonies presumptively identified with fluorescein-conjugated B. pertussis antiserum (cross-reactivity with Legionella) - B. pertussis will not grow on blood-free media - B. pertussis usually requires 3-4 days to grow on chocolate agar - Jones-Kendrick transport medium or semi-solid charcoal agar for transport 6) see ARUP consult [8] Complications: - increased long-term risk of epilepsy (RR=1.7) [19] - rib fracture [20] Management: 1) antimicrobial agents probably play no role in therapy of pertussis but do render nasopharyngeal cultures negative within 1-2 days 2) macrolides within 3 weeks of cough onset a) may shorten duration of symptoms b) probably diminish infectivity c) erythromycin for 10-14 days d) clarithromycin for 5-7 days e) azithromycin for 5-7 days 3) for chronic cough, start macrolide within 3 weeks of onset [16,17] 4) Bactrim for 14 days, if macrolide contraindicated, & > 2 years of age [4] 5) amoxicillin is not active against Bordetella pertussis 6) vaccination: - DPT (DTaP), Tetramune, acellular Pertussis vaccine - CDC recommends booster for adolescents after 5 years, adults after 10 years (Adacel or Boostrix) - when pertussis is common in a community, the 1st dose of DTaP vaccine can be given to infants as early as 6 weeks of age [13] 7) droplet precautions [23]

Related

acellular Pertussis vaccine (Repevax) Bordetella pertussis

General

bacterial infection

References

  1. Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1161-62
  2. Prescriber's Letter 9(1):3 2002
  3. Journal Watch 25(2):17, 2005 Cherry JD, Chang SJ, Klein D, Lee M, Barenkamp S, Bernstein D, Edelman R, Decker MD, Greenberg DP, Keitel W, Treanor J, Ward JI. Prevalence of antibody to Bordetella pertussis antigens in serum specimens obtained from 1793 adolescents and adults. Clin Infect Dis. 2004 Dec 1;39(11):1715-8. Epub 2004 Nov 10. PMID: 15578376 - Lee GM, Lett S, Schauer S, LeBaron C, Murphy TV, Rusinak D, Lieu TA; Massachusetts Pertussis Study Group. Societal costs and morbidity of pertussis in adolescents and adults. Clin Infect Dis. 2004 Dec 1;39(11):1572-80. Epub 2004 Nov 10. PMID: 15578353
  4. Prescriber's Letter 13(2): 2006 Detail-Document#: 220213 (subscription needed) http://www.prescribersletter.com
  5. Johnson, K Cutbacks Hurt a State's Response to Whooping Cough New York Times, May 12, 2012 http://www.nytimes.com/2012/05/13/health/policy/whooping-cough-epidemic-hits-washington-state.html?_r=1
  6. National Institute of Allergy and Infectious Diseases (NIAID) Pertussis (Whooping Cough) https://www.niaid.nih.gov/diseases-conditions/pertussis-whooping-cough
  7. CDC: antimicrobial agents for the treatment and postexposure prophylaxis of pertussis http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm
  8. ARUP Consult: Bordetella pertussis - Whooping Cough The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/bordetella-pertussis
  9. Centers for Disease Control and Prevention Pertussis Epidemic - Washington, 2012 MMWR. July 20, 2012 / 61(28);517-522 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm
  10. Liu BC et al. Pertussis in older adults: Prospective study of risk factors and morbidity. Clin Infect Dis 2012 Dec 1; 55:1450. PMID: 22806592
  11. Wang K, Fry NK, Campbell H et al Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study. BMJ 2014;348:g3668 PMID: 24961836 http://www.bmj.com/content/348/bmj.g3668
  12. Amirthalingam G et al. Effectiveness of maternal pertussis vaccination in England: An observational study. Lancet 2014 Jul 16; PMID: 25037990 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960686-3/fulltext
  13. Winter K et al Pertussis Epidemic - California, 2014 MMWR. Weekly December 5, 2014 / 63(48);1129-1132 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a2.htm
  14. Wessels MR, Brigham KS, DeMaria A Jr. Case records of the Massachusetts General Hospital. Case 6-2015. A 16-year-old boy with coughing spells. N Engl J Med. 2015 Feb 19;372(8):765-73 PMID: 25693017 http://www.nejm.org/doi/full/10.1056/NEJMcpc1411928
  15. The NNT: Pertussis (Whooping Cough) Diagnostics and Likelihood Ratios, Explained http://www.thennt.com/lr/pertussis-whooping-cough/ - Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010 Aug 25;304(8):890-6 PMID: 20736473
  16. Hewlett EL, Edwards KM. Clinical practice. Pertussis--not just for kids. N Engl J Med. 2005 Mar 24;352(12):1215-22 PMID: 15788498
  17. Tiwari T, Murphy TV, Moran J; National Immunization Program, CDC. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis: 2005 CDC Guidelines. MMWR Recomm Rep. 2005 Dec 9;54(RR-14):1-16. PMID: 16340941
  18. Skoff TH et al Sources of Infant Pertussis Infection in the United States. Pediatrics. Sept 7, 2015 PMID: 26347437 http://pediatrics.aappublications.org/content/early/2015/09/01/peds.2015-1120
  19. Olsen M, Thygesen SK, Ostergaard JR et al Hospital-Diagnosed Pertussis Infection in Children and Long- term Risk of Epilepsy. JAMA. 2015 Nov 3;314(17):1844-9. PMID: 26529162
  20. Zambrano JA, Herman TN Rib Fracture Associated with Bordetella pertussis Infection. N Engl J Med 2018; 378:e4. January 18, 2018 PMID: 29342383 http://www.nejm.org/doi/full/10.1056/NEJMicm1701940
  21. Domenech de Celles M, Magpantay FMG, King AA, Rohani P. The impact of past vaccination coverage and immunity on pertussis resurgence. Science Translational Med. Mar 28, 2018: 10(434):eaaj1748 PMID: 29593103 http://stm.sciencemag.org/content/10/434/eaaj1748.full
  22. NEJM Question of the Week. May 15, 2018 https://knowledgeplus.nejm.org/question-of-week/545/
  23. Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2022