Whooping cough

Question 1

What is whooping cough?

Answer 1

Highly infectious notifiable upper respiratory disease

Question 2

Which bacterium causes whooping cough?

Answer 2

Bordetella pertussis

Question 3

How often does whooping cough peak?

Answer 3

Every 3-4 years

Question 4

At what ages is a pertussis vaccination given?

Answer 4

2,3,4 months of age

Booster at 3 years and 4 months

Question 5

When does immunity from the pertussis infection wane?

Answer 5

5-10yrs

Question 6

Describe the severity of whooping cough in adults/adolescents

Answer 6

Mild

Question 7

Describe the pertussis vaccine during pregnancy

Answer 7

Passive immunity through the transfer of maternal antibodies in-utero

Question 8

What class of bacteria is Bordetella pertussis?

Answer 8

Gram negative bacillus

Question 9

How does Bordetella pertussis spread?

Answer 9

Aerolised droplet infection

Question 10

Describe the pathophysiology of Bordetella pertussis

Answer 10

Bacteria attach to respiratory epithelium and produce toxins which paralyse the cilia and promote inflammation, impairing clearance of respiratory secretions which lead to cough

Question 11

How contagious is Bordetella pertussis?

Answer 11

Highly infectious with 90% of household contacts catching it

Question 12

What are some risk factors for pertussis infection?

Answer 12

Non vaccination

Exposure to infected individual

Question 13

List some differentials of whooping cough

Answer 13

Bronchiolitis
Viral induced wheeze
Bacterial pneumonia 
Asthma
TB

Question 14

What investigations are used for whooping cough

Answer 14

If cough <2weeks in duration - nasopharyngeal aspiration or nasopharyngeal swab for PCR

If cough >2weeks in duration - anti-pertussis toxin IgG serology is recommended for children <5yo, for children ages 5-17yo anti-pertussis toxin detection in oral fluid is recommended

FBC - lymphocytosis

Question 15

Give the limitation of serology testing for whooping cough after immunisation?

Answer 15

False positive

Question 16

Describe the symptoms of the catarrhal phase of whooping cough

Answer 16

Dry cough
Rhinitis
Conjunctivitis 
Irritability
Sore throat 
Low grade fever

Question 17

List the 3 stages of whooping cough

Answer 17

Catarrhal phase
Paroxysmal phase
Convalescent phase

Question 18

How long may the convalescent phase last?

Answer 18

3 months

Question 19

How long does the catarrhal phase last?

Answer 19

1-2 weeks

Question 20

How long does the paroxysmal phase last?

Answer 20

2-8 weeks

Question 21

Describe the symptoms of the paroxysmal phase

Answer 21

Severe paroxysms of coughing followed by an inspiratory gasp/whoop

Question 22

What is more common instead of the whoop in children <3yo?

Answer 22

Apnoea and cyanosis

Question 23

When are the paroxysm of coughing more common?

Answer 23

At night

Question 24

What is associated with paronym’s of coughing in a child <3mo?

Answer 24

Vomiting and apnoea and cyanosis

Question 25

What may be found on physical examination of a child with pertussis?

Answer 25

Petechiae on the face
Low grade fever
Conjunctival haemorrhage
Chest auscultation is usually normal

Question 26

Who should be admitted to hospital with whooping cough?

Answer 26

<6mo and acutely unwell
Significant breathing difficulties
Feeding difficulties
Significant complications

Question 27

Describe the management of whooping cough

Answer 27

Macrolide antibiotic <21days of cough - clarithromycin for those <1mo, azithromycin and clarithromycin for those >1mo
Co-trimoxazole is the 2nd line when clarithromycin is CI/poorly tolerated

Symptomatic relief - ibuprofen and paracetamol, fluids

Question 28

List some complications of whooping cough

Answer 28

Secondary bacterial pneumonia
Seizures
Encephalopathy
Otitis media

Question 29

Who are complications and poor mortality seen in?

Answer 29

Unvaccinated individuals