Overview

• Upper respiratory tract infection caused by the gram-negative coccobacillus bacterium Bordetella pertussis. **Typically presents in children.
• Immunisation → infants are immunised at 2+3+4 months and 3-5 years. Pregnant women are also immunised.

Making Diagnosis

Clinical Features

• Catarrhal Phase (1-2 weeks) → viral URTI symptoms.
• Paroxysmal Phase (2-8 weeks) → cough increases in severity. Post-tussive vomiting (after coughing). Coughing bouts are worse at night and after feeding. Loud inspiratory woop when coughing ends. Infants may have spells of apnoea.
  • Persistent coughing may cause subconjunctival haemorrhages or anoxia leading to syncope and seizures.
• Convalescent Phase (weeks-months) → cough subsides.

<aside> 💡 Suspected If → person had acute cough lasting for >14 days without another apparent cause, and has ≥1 of … paroxysmal cough, inspiratory whoop, post-tussive vomiting, undiagnosed apnoeic attacks in young infants.

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Investigations

• Within 2-3 weeks of symptom onset → nasalpharyngeal swab with PCR testing/bacterial culture.

• If cough present for >2 weeks → test for anti-pertussis toxin IgG.

  <2 Weeks: nasopharyngeal swab, >2 weeks: IgG serology.

Management Plan

• Notifiable Disease (HPU).
• Admit if → <6 months old, significant breathing problems (apnoea, severe paroxysms, cyanosis), significant complications (seizures, pneumonia).
• Pharmacological Treatment (if admission not needed + onset of cough within 21 days, prescribe abx) → <1 month = clarithromycin. >1 months old + not pregnant = azithromycin. Pregnant = erythromycin.