PERTUSSIS

I. Clinical course

  1. "Classic" presentation
    1. Cold-like sx, then
    2. "Catarrhal" stage, then
    3. "Paroxysmal" stage
    4. Usually afebrile throughout
    5. Can get pneumococcal superinfection; encephalitis, too
    6. n.b. babies can't whoop.
  1. Note that inmany cases--particularly in adolesents and adults--can often present just with a prolonged nonproductive cough--in one series, only 21% had paroxysmal nocturnal cough, 13% had fever, 6% had "whooping," and most had normal WBC and lymphocyte counts (Chest 115:1254, 1999--JW)

II. Tx:

  1. Erythro for pt and household contacts, traditionally x 2 wks (if < 1mo use Azithromycin per 2006 CDC guidelines); can use trimethoprim-sulfamethoxazole if macrolides contraindicated.
  2. 168 kids with cx-positive pertussis (& their household contacts) randomized to erythromycin estolate 40mg/kg/d (up to 1g/d) divided TID x 14d vs. 7d. Nasopharyngeal cx done at end of tx showed one member of each group remained cx-positive. After 14d f/u, there was one bacteriological relapse in 7d group and none in 14d group (Peds 100:65, 1997-JW)