Pertussis in Emergency Medicine Clinical Presentation

  • Author: Joseph J Bocka, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Mar 22, 2012
 

History

Pertussis typically consists of 3 stages: incubation, catarrhal, and paroxysmal.

The asymptomatic incubation period lasts 7-10 days.

The catarrhal stage follows and lasts about 2-7 days. Findings include the following:

  • Minimal or no fever
  • Rhinorrhea
  • Anorexia
  • Mild but increasing cough

The paroxysmal stage follows, lasting about 1-8 weeks.

  • It is characterized by paroxysms of coughing, which are provoked by feeding (in infants) and exertion.
  • These paroxysms are less spontaneous than those observed in typical respiratory infections.
  • The inspiratory gasp or whoop eventually develops, especially in those aged 6 months to 5 years.

Infants younger than 6 months often have vomiting in association with the cough, which leads to dehydration.

  • Hypoxia tends to be more severe than what the child's clinical appearance suggests.
  • A substantial number of patients present with cyanosis and apneic spells.

Vaccinated adults usually develop only prolonged bronchitis without a whoop, whereas unvaccinated adults are most likely to have whooping and posttussive emesis.

About 12-32% of adults with persistent cough (>2 wk) have pertussis. On average, they wait a median of 3 weeks before seeking treatment.

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Physical

  • The classic inspiratory gasp or whoop primarily develops in those aged 6 months to 5 years. It is usually absent in those younger than 6 months and in most older vaccinated children and adults; however, it can often be observed in unvaccinated adults, as can posttussive emesis.
  • Hypoxia should be considered and assessed.
  • Dehydration is common on presentation.
  • Mild fever is common. Fever with a temperature of over 39°C is rare.
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Causes

The main causative organism is B pertussis.

Bordetella parapertussis and Bordetella bronchiseptica are less common than B pertussis and produce a clinical illness that is similar but milder to pertussis due to B pertussis.

Risk factors include the following:

  • Nonvaccination in children
  • Contact with an infected person
  • Epidemic exposure
  • Pregnancy
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Contributor Information and Disclosures
Author

Joseph J Bocka, MD  Attending Emergency Physician, Mansfield Hospital, Med Central Health System (Mansfield and Shelby, Ohio); Emergency Medical Service Medical Director, Multiple EMS Services; Medical Director, Richland County Jail

Joseph J Bocka, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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