Dr. Wojo. Healthy Living. Simplified.

There has never been an illness more accurately named than whooping cough (pertussis). If you haven’t already, you will be hearing a lot about whooping cough, because over the past few years the number of reported cases has skyrocketed! Whooping cough is a lower respiratory illness that is most common in children, but can and has been seen in all age categories. Let’s look a little more closely at this illness.

What is whooping cough? Whooping cough is a bacterial respiratory illness that is caused by Bordatella pertussis. The characteristic cough associated with this illness is very high pitched and quite severe. It is also associated with other cold-like symptoms.

Whooping cough was first diagnosed in the 16th century, but the bacteria were not isolated in the laboratory until 1906. Until the mid-1940s, there were more than 200,000 cases annually in the United States. After the development of the vaccine, that number began to steadily decline and by the early 1970s, there were only about 1,000 cases reported annually. Unfortunately, that number has begun to climb and the latest reports reveal an average of 4,000 annual cases.

What are the symptoms? The clinical features of whooping cough are divided into three stages. The first stage or catarrhal stage is characterized by a sudden onset of a runny nose, sneezing, mild cough, low fever and symptoms of a common cold. This usually occurs within seven to 10 days after exposure and this initial stage may last for up to two weeks. At the end of this stage, the cough begins to become more violent.

The second stage or paroxysmal stage is the time when the diagnosis of whooping cough is usually entertained. By this time, the cough is quite severe and the patient experiences sudden bursts of coughing with associated difficulties in breathing. Thick mucous may be present as well. In addition, the coughing may be so severe that the patient may turn blue and vomiting may be precipitated. After the bout of coughing, the patient will look almost completely normal.

The final state or convalescent stage is when recovery begins, which may last from weeks to months. The coughing fits become less in number and intensity, whereby they soon disappear. It is important to note that fever is not usually very high and not common during the course of the illness.

How is it diagnosed? The early diagnosis of whooping cough may be difficult, as the initial presentation is similar to the common cold or influenza. Once the second stage of the illness is entered and the patient experiences the severe bouts of high-pitched coughing, the clinician must think of this disease.

Diagnosis is made by laboratory testing of a swab that is taken from the nasal passage, but the bacteria can be difficult to isolate. Clinicians must be suspicious of the disease on the basis of history, exposure, clinical presentation and laboratory findings.

What is the treatment? This respiratory illness requires supportive treatment and antibiotics. Once the diagnosis is suspected, erythromycin or sulfa should be prescribed. The antibiotic must be taken for its full course, which is usually 14 days. The confirmation of the culture revealing whooping cough may take several days or weeks, so treatment is usually based on clinical suspicion.
Since whooping cough is highly contagious, all household members that are exposed to the infected patient must be treated with antibiotics for 14 days as well. Unfortunately, about 20 percent of all infected and symptomatic patients require hospitalization for respiratory support and intravenous antibiotics. The most common associated complication is pneumonia. Fortunately, death is rare and occurs in less than one percent of all cases.

What should I do? Prevention is the best medicine and this has been documented over the past 100 years of history. Immunization for whooping cough is accomplished in children in their first two years of life through the administration of the DPT (Diphtheria-Pertussis-Tetanus) vaccination. It is essential that all children be immunized and this vaccine is very safe. Reactions and side effects to this shot are now minimal, and the protection far outweighs the risks. The risks and complications of whooping cough are too great not to be immunized.