Snapshot A 40-year-old man presents to the primary care physician after 3 weeks of a dry cough. He reports that he occasionally vomits after an episode of coughing and he hears “whoops” during some episodes. His childhood immunization history is incomplete, and the patient states not having had any immunizations in the past 20 years. A special nasopharyngeal swab is sent for analysis and antibiotics are given. Introduction Classification Bordetella pertussis login to view 1 more bullet transmission login to view 1 more bullet Associated conditions whooping cough 100-day cough Prevention DTaP vaccine login to view 3 more bullets Tdap vaccine login to view 2 more bullets Epidemiology Demographics infants are especially at risk login to view 2 more bullets unvaccinated children Risk factors exposure to infected people incomplete vaccination HIV exposure ETIOLOGY Pathogenesis bacteria colonizes mucosal surface pertussis toxin binds to and activates adenylate cyclase by inhibiting Gi login to view 1 more bullet tracheal cytotoxin login to view 1 more bullet low lung volume at the beginning of inspiration causes strong inspiration and inspiratory “whoop” Presentation Symptoms catarrhal stage (first) login to view 2 more bullets paroxysmal stage (second) login to view 2 more bullets convalescent stage (third) login to view 1 more bullet Physical exam whooping cough in children login to view 2 more bullets 100-day cough in adults login to view 2 more bullets Differential Mycoplasma pneumonia distinguishing factor login to view 1 more bullet Treatment Management approach infected patients should avoid exposure to vulnerable populations exposed patients should still be treated Medical macrolides login to view 6 more bullets trimethoprim-sulfamethoxazole login to view 2 more bullets Complications Pneumonia Failure to thrive Death especially in young infants Apnea especially in young infants Prognosis Can be fatal in infants