Whooping Cough

Question 1

Is whooping cough an upper respiratory tract infection or lower respiratory tract infection?

Answer 1

Upper respiratory tract infection

Question 2

What is whooping cough?

Answer 2

It refers to an upper respiratory tract infection caused by Bordetella pertussis

Question 3

Is Bordertella pertussis gram positive or negative?

Answer 3

Gram negative

Question 4

Why is whooping cough rarer nowadays?

Answer 4

This due to the fact that children and pregnant women are vaccinated against pertussis

However, the vaccine becomes less effective a few years after each dose

Question 5

Describe the immunisation schedule of Bordatella Pertussis

Answer 5

It is administered at 2, 3, 4 months and 3 -5 years

It is administered to pregnant patients between 16 - 32 weeks gestation

Question 6

What are the seven clinical features of whooping cough?

Answer 6

Mild Coryzal Features

Low Grade Fever

Paroxysmal ‘Whooping’ Cough

Cyanosis

Vomiting

Apnoeas

Seizures

Question 7

Describe the cough associated with whooping cough

Answer 7

The individual will suffer from intermittent coughing fits, which tend to occur at night and after feeding

These coughing fits are severe and intensify until the patient is completely out of breath

Due to this, individuals produce a loud inspiratory whoop when the coughing ends, in an attempt to forcefully inspire air against a closed glottis

The coughing fits may be ended by central cyanosis, vomiting or seizures

Question 8

What are the three phases of whooping cough?

Answer 8

Catarrhal Phase

Paroxysmal Phase

Convalescent Phase

Question 9

What is the catarrhal phase of whooping cough? How long does it persist for?

Answer 9

It is when the individual suffers from viral upper respiratory tract infection features

It tends to last between 1 - 2 weeks

Question 10

What is the paroxysmal phase of whooping cough? How long does it persist for?

Answer 10

It is when individuals suffer from parxysmal whooping cough fits

It tends to last between 2 - 8 weeks

Question 11

What is the convalescent phase of whooping cough? How long does it persist for?

Answer 11

It is when individuals experience gradual resolvement of their cough

It tends to occur between weeks to months

Question 12

What are the two investigations used to diagnose whooping cough?

Answer 12

Nasopharyngeal/Nasal Swab

Anti-Pertussis Toxin Immunoglobulin G Testing

Question 13

What two tests can be conducted on nasopharyngeal/nasal swabs to confirm whooping cough?

Answer 13

PCR testing

Bacterial culture

Question 14

When can nasopharyngeal/nasal swabs be used to diagnose whooping cough?

Answer 14

They must be conducted within 2-3 weeks of the clinical feature onset

Question 15

What is anti-pertussis toxin immunoglobulin G testing?

Answer 15

It involves detecting antibodies produced by the body’s immune response to a pertussis infection

Question 16

What sample is used to conduct anti-pertussis toxin immunoglobulin G testing in patients aged between 5-16 years old?

Answer 16

Oral fluid

Question 17

What sample is used to conduct anti-pertussis toxin immunoglobulin G testing in patients aged over 17 years old?

Answer 17

Blood

Question 18

When can anti-pertussis toxin immunoglobulin G testing be used to diagnose whooping cough?

Answer 18

When clinical features have been present for over 2 weeks

Question 19

What are the four diagnostic criteria of whooping cough?

Answer 19

A diagnosis can be obtained when individuals experience an acute cough that has persisted for more than 14 days without another apparent cause, and has one or more of the following features:

• Paroxysmal Cough
• Inspiratory Whoop
• Post-Tussive Vomiting
• Apnoea Attacks

Question 20

In most cases, how is whooping cough managed?

Answer 20

It can be managed at home, with simple supportive treatment (fluids, rest) and safety netting advice on when to seek further medical attention

Question 21

What advice should be given to parents about school exclusion in whooping cough?

Answer 21

They can return to school 48 hours after commencing antibiotics OR 21 days from onset of clinical features if no antibiotic administration

Question 22

What are the three indications for admission of whooping cough patients?

Answer 22

Child < 6 Months Old

Acutely Unwell Patients

Apnoea/Cyanosis/Severe Coughing Fit Features

Question 23

How do we pharmacologically manage whooping cough?

Answer 23

Macrolide antibiotics

Question 24

What three macrolide antibiotics are used to manage whooping cough?

Answer 24

Azithromycin

Erythromycin

Clarithromycin

Question 25

When do we administer macrolide antibiotics to manage whooping cough?

Answer 25

It is administered to all patients who present within 21 days of clinical features onset

Question 26

When should we administer prophylactic macrolide antibiotics?

Answer 26

It is recommended in close contacts of infected patients if they are in a vulnerable group

For example pregnant women, unvaccinated infants or healthcare workers that have contact with children or pregnant women

Question 27

What alternative antibiotic can be administered to manage whooping cough when macrolide antibiotics are contraindicated?

Answer 27

Co-trimoxazole

Question 28

Pertussis is a notifiable disease. What does this mean?

Answer 28

Public health need to be notified of all suspected and confirmed cases

Question 29

How long do the clinical features of whooping cough take to resolve?

Answer 29

8 weeks, however they can last several months

It can be referred to as the ‘100 day cough’ due to the potential long duration of the cough

Question 30

What are the four complications of whooping cough?

Answer 30

Pneumonia

Bronchiectasis

Subconjunctival Haemorrhage

Seizures