Whooping cough / Pertusis

Question 1

Whooping cough Abx for under 1 months of age

Answer 1

Clarithromycin

Question 2

Define Whooping cough

Answer 2

an URTI caused by Bordetella pertussis (a gram negative bacteria)

Question 3

Whooping cough Dx Ix

Answer 3

• nasopharyngeal or nasal swab with PCR testing or bacterial culture can confirm the diagnosis within 2 weeks of the onset of symptoms
• anti-pertussis toxin immunoglobulin G for Sx > 2/52 (oral fluid / bloods)

Question 4

Whooping cough mainstay Tx

Answer 4

Macrolide

Question 5

3 Phases ‘CPC’

Whooping Cough clinical presentations

Answer 5

Catarrhal phase: lasts 1-2/52 Fever, sore throat, dry couhg
Paroxysmal phase: lasts 2-8/52 coughing fit followed by an inspiratory ‘whooping’ gasp sound
Convalescent phase: lasts 3/12 gradually decreases in frequency and severity

Question 6

Whooping cough complications

Answer 6

• Secondary bacterial pneumonia (up to 20% of infants)
• Seizures
• Encephalopathy (rare)

Question 7

Whooping cough causative bacteria

Answer 7

Bordetella Pertussis

Question 8

2,3,4 - 3.4

Pertusis vaccine schedule for children

Answer 8

• 2 moths
• 3 months
• 4 months
• 3 years 4 months (booster)

Question 9

FBC findings in whooping cough

Answer 9

Lymphocytosis +/- increase WBC

Question 10

Whooping cough Tx for age > 1 month

Answer 10

Azithromycin OR Clarithromycin

Question 11

Whooping cough Tx for pregnant women

Answer 11

1st line: Erythromycin
2nd line: Azithromycin
3rd line: Clarithromycin

Question 12

Whooping cough Tx if macrolide is contraindicated

Answer 12

co-trimoxazole

Question 13

When is co-trimoxazole contraindicated in whooping cough Tx

Answer 13

1. Pregnant woman
2. Infants < 6months

Question 14

School exclusion guidance

Answer 14

1. 48 hours after starting of Abx
2. 14 days from the onset of coughing if not treated

Question 15

When should pregnant women receive their whooping cough vaccine for optimal protection

Answer 15

before 32 weeks

Question 16

Whooping cough complications

Answer 16

• secondary bacterial pneumonia (common)
• Seizures: typically due to hypoxia or a lack of oxygen to the brain during a prolonged coughing fit
• Apnoea: coughing fits –> Resp failure
• Dehydration: vomiting from coughing fits
• Failure to thrive: reduced feeding

Question 17

When should Abx be prescribed in treating whooping cough

Answer 17

• Within 14 days of onset of the cough
  OR
• Withing 21 days of onset of the cough if someone in the househol is vulnerable

Question 18

What is the most sensitive investigation for Dx whooping cough

Answer 18

PCR

Question 19

when is hosp admission indicated for whooping cough

Answer 19

• infants < 6 months
• Resp distress / complication

Question 20

Bordetella Pertusis on gram stain

Answer 20

Gram-negative coccobacillus