Pertussis (whooping cough) is a respiratory tract infection characterized by a paroxysmal cough. The most common causative organism is Bordetella pertussis (see the image below), though Bordetella parapertussis has also been associated with this condition in humans. Pertussis remains a significant cause of morbidity and mortality in infants younger than 2 years.

Signs and symptoms

Pertussis is a 6-week disease divided into catarrhal, paroxysmal, and convalescent stages, each lasting 1-2 weeks.

Stage 1 – Catarrhal phase

  • Nasal congestion
  • Rhinorrhea
  • Sneezing
  • Low-grade fever
  • Tearing
  • Conjunctival suffusion

Stage 2 – Paroxysmal phase

  • Paroxysms of intense coughing lasting up to several minutes, occasionally followed by a loud whoop
    • Chronic cough, which may last for weeksPosttussive vomiting and turning red with coughing
  • Diagnosis

    The diagnosis of pertussis is made by isolation of B pertussis in culture. A polymerase chain reaction (PCR) test can also be performed.

    • The culture specimen should be obtained during the first 2 weeks of cough by using deep nasopharyngeal aspiration
    • For PCR testing, nasopharyngeal specimens should be taken at 0-3 weeks following cough onset
    • The CDC recommends a combination of culture and PCR assay if a patient has a cough lasting longer than 3 weeks
    • Early serial monitoring of white blood cell (WBC) counts is warranted


    Goals of treatment

    • Limit the number of paroxysms
    • Observe the severity of cough and provide assistance when necessary
    • Maximize nutrition, rest, and recovery

    Pharmacologic therapy

    • Antimicrobial agents and antibiotics can hasten the eradication of B pertussisand help prevent spread
    • Erythromycin, clarithromycin, and azithromycin are the preferred agents for patients aged 1 month or older
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