Pediatric Pertussis Clinical Presentation

  • Author: Hazel Guinto-Ocampo, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 27, 2012
 

History

Typically, the incubation period of pertussis ranges from 3-12 days. Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting from 1-2 weeks. The 3 stages of disease progression are as follows:

  • Stage 1: The initial (catarrhal) phase is indistinguishable from common upper respiratory infections with nasal congestion, rhinorrhea, and sneezing, variably accompanied by low-grade fever, tearing, and conjunctival suffusion. Pertussis is most infectious when patients are in the catarrhal phase, but pertussis may remain communicable for 3 or more weeks after the onset of cough.
  • Stage 2: Patients in the second (paroxysmal) phase present with paroxysms of intense coughing lasting up to several minutes. In older infants and toddlers, the paroxysms of coughing occasionally are followed by a loud whoop as inspired air goes through a still partially closed airway. Infants younger than 6 months do not have the characteristic whoop but may have apneic episodes and are at risk for exhaustion. Posttussive vomiting and turning red with coughing are common in affected children.
  • Stage 3: Patients in the third (convalescent) stage have a chronic cough, which may last for weeks.

Older children, adolescents, and adults may not exhibit distinct stages. Symptoms in these patients include uninterrupted coughing, feelings of suffocation or strangulation, and headaches.

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Physical

In patients with uncomplicated pertussis, physical examination findings contribute little to the diagnosis. In all patients with pertussis, fever is typically absent. Most patients do not have signs of lower respiratory tract disease. Conjunctival hemorrhages and facial petechiae are common and result from intense coughing.

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Causes

B pertussis and B parapertussis are the causative organisms for pertussis infection in humans. Bacteria spread via aerosolized droplets from coughing of infected individuals. Humans are the sole reservoir for the organisms.

Transmission can occur through direct face-to-face contact, sharing a confined space, or through contact with oral, nasal, or respiratory secretions from an infected source. Pertussis is highly contagious, with as many as 80% of susceptible household contacts becoming infected after exposure. Family members or relatives were the suspected source of infection in 75% of cases.[10]

Young infants, especially those born prematurely, and patients with underlying cardiac, pulmonary, neuromuscular, or neurologic disease are at high risk for contracting the disease and for complications.

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Contributor Information and Disclosures
Author

Hazel Guinto-Ocampo, MD  Consulting Staff, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Emergency Medicine, Nemours Children's Clinic, AI duPont Hospital for Children

Hazel Guinto-Ocampo, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Bryon K McNeil, MD  Medical Director, Bioterrorism and Emergency Preparedness, Clinical Assistant Professor, Departments of Internal Medicine and Emergency Medicine, Via Christ Regional Medical Center

Bryon K McNeil, MD is a member of the following medical societies: American Academy of Emergency Medicine and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Stephen C Aronoff, MD  Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine

Stephen C Aronoff, MD is a member of the following medical societies: Pediatric Infectious Diseases Society and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

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.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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A photomicrograph of Bordetella (Haemophilus) pertussis bacteria using Gram stain technique.
 
 
 
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