Whooping cough:known as pertussis, is a highly infectious disease caused by the bacterium Bordetella pertussis. It is spread by aerosol droplets released during coughing, and disproportionately affects infants and young children.
Diagnosis
Signs and symptoms
Treatment
Referral
The paroxysmal phase -occurs about 1 week after the catarrhal phase and lasts between one and six weeks. Between coughing fits (paroxysms), the person is usually relatively well, and has undisturbed sleep
The convalescent phase- lasts up to 3months, gradual improvement in cough frequency and severity
The catarrhal phase -lasts between one and two weeks. Pertussis is rarely diagnosed during this stage unless there has been contact with a person who is known to be infected. Symptoms are often difficult to distinguish from those of other upper respiratory tract infections,
Inspiratory whoop
Post-tussive vomiting
Paroxysmal cough
Undiagnosed apnoeic attacks in young infants
similar to URTI- nasal discharge, conjuctivitis, malaise, sore throat, low grade fever, dry, unproductive cough
Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause
Clinical suspicion should be raised if the person is not fully immunized, or has been in contact with a person who is confirmed or suspected of having whooping cough.
consider alternative diagnosis if immunised
Differentials
infectious causes of cough- adenoviruses, Respiratory syncytial virus
non infectious causes of cough - asthma, COPD, post infection cough, GORD, underlying lung malignancy
Hospital admission (inform prior to allow to be isolated)
Is 6 months of age or younger and acutely unwell.
Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis).
Has a significant complication (for example seizures or pneumonia)
Public Health
within 3 days
confirmed with testing
Abx if onset of cough within 21 days
Prescribe clarithromycin for infants less than 1 month of age.
Prescribe azithromycin or clarithromycin for children aged 1 month or older, and non-pregnant adults.
Prescribe erythromycin for pregnant women
Prescribe co-trimoxazole if macrolides are contraindicated or not tolerated (off-label indication). However, co-trimoxazole is contraindicated during pregnancy, and is not licensed for use in infants younger than six weeks of age.
Advice
cough will take several weeks to resolve
seek medical advice if complications develop
Advise rest, adequate fluid intake, and the use of paracetamol or ibuprofen for symptomatic relief.
stay off work/nursery until 48 hours after Abx treatment has been completed or 21 days after onset of symptoms if not treated with Abx
Vaccinations when recovered