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