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Updated: Dec 23 2021


  • 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
        • a gram - aerobic coccobacilli
      • transmission
        • respiratory droplets
    • Associated conditions
      • whooping cough
      • 100-day cough
    • Prevention
      • DTaP vaccine
        • vaccine against diphtheria, tetanus, and pertussis
        • acellular pertussis vaccine
        • 5 doses before school-age, completed by 4-6 years of age
      • Tdap vaccine
        • booster vaccine at 11-12 years of age
        • should also be given to pregnant mothers and those around them
  • Epidemiology
    • Demographics
      • infants are especially at risk
        • < 6 months of age
        • too young to be vaccinated
      • unvaccinated children
    • Risk factors
      • exposure to infected people
      • incomplete vaccination
      • HIV exposure
    • Pathogenesis
      • bacteria colonizes mucosal surface
      • pertussis toxin binds to and activates adenylate cyclase by inhibiting Gi
        • impairs phagocytosis, allowing the bacteria to survive
      • tracheal cytotoxin
        • impairs cilia, preventing normal clearance of respiratory secretions
      • low lung volume at the beginning of inspiration causes strong inspiration and inspiratory “whoop”
  • Presentation
    • Symptoms
      • catarrhal stage (first)
        • low-grade fevers
        • coryza
      • paroxysmal stage (second)
        • dry cough and whoop
        • post-tussive vomiting
      • convalescent stage (third)
        • recovery
    • Physical exam
      • whooping cough in children
        • dry cough on expiration
        • “whoop” on inspiration
      • 100-day cough in adults
        • post-tussive vomiting
        • paroxysmal cough
  • Differential
    • Mycoplasma pneumonia
      • distinguishing factor
        • also presents with a dry cough, but no whooping cough and no posttussive vomiting
  • Treatment
    • Management approach
      • infected patients should avoid exposure to vulnerable populations
      • exposed patients should still be treated
    • Medical
      • macrolides
        • indication
          • first-line therapy
        • drugs
          • clarithromycin
          • erythromycin
      • trimethoprim-sulfamethoxazole
        • indication
          • allergies to macrolides
  • Complications
    • Pneumonia
    • Failure to thrive
    • Death
      • especially in young infants
    • Apnea
      • especially in young infants
  • Prognosis
    • Can be fatal in infants
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