Whooping cough (Pertussis)

Question 1

How do young infants with whooping cough sometimes present?

Answer 1

Apnoeas with cyanosis - not the classical symptoms

Question 2

What is the bacterial cause of whooping cough?

Answer 2

Bordetella pertussis

Question 3

Is bordetella pertussis gram +ve or -ve?

Answer 3

Gram -ve

Question 4

When are the immunisation times for Bordetella pertussis?

Answer 4

Infants - 2,3,4 months

Childhood - 3-5 years

Pregnant women at 16-32 weeks - was started as newborns are very vulnerable to whooping cough and 14 died in an outbreak in 2012

Question 5

What are the symptoms of whooping cough?

Answer 5

Symptoms:

• Coughing bouts - night and feeding
• Spells of apnoea
• Syncope /seizures from anoxia
• Symptoms may last 10-14 weeks and be more severe in infants

Signs:

• Central cyanosis
• Inspiratory whoop
• Subconjunctival haemorrhages from coughing

Question 6

What would an FBC show in whooping cough?

Answer 6

Marked lymphocytosis

Question 7

What is the diagnostic criteria for whooping cough?

Answer 7

14 days of acute coughing, WITHOUT another apparent cause

AND at least one of:

• paroxysmal cough
• inspiratory whoop
• post-tussive vomiting
• undiagnosed apnoeic attacks in young infants

Question 8

What does the laboratory diagnosis of whooping cough include?

Answer 8

• Nasal culture for Bordetella pertussis - may take several days or weeks
• PCR and serology (if available)

Question 9

How do you manage whooping cough?

Answer 9

Conservative:

• Admission if:
  
  • under 6 months or acutely unwell
  • sig breathing difficulty (apnoea, paroxysms, cyanosis)
  • complications (pneumonia, seizures)
• Notify the Health Protection Unit HPU (notifiable disease in UK)
• School exclusion - 48 hours after commencing antibiotics (or 21 days from onset of cough if no antibiotics)
• Symptomatic relief with analgesia and fluid intake

Medication:

• Antibiotics - oral macrolide, only if <21 days since start of cough, given for 7 days
  
  • <1 month = clarithromycin
  • >1 month = azithromycin
  • Pregnant = erythromycin (if not vaccinated then give after 36 weeks to prevent transmission to the newborn)
  • Macrolide C/I = co-trimoxazole (not to be used in pregnancy or <6 weeks age)
• Treat household contacts with prophylactic antibiotics

Question 10

What should you tell parents about the treatment and course of infection of whooping cough?

Answer 10

Inform the parents that, despite antibiotic treatment, the disease is likely to cause a protracted non-infectious cough that may take weeks to resolve (10-14 weeks)

Once the acute illness has been dealt with, advice parents to complete any outstanding immunisations

Question 11

Is whooping cough a notifiable disease?

Answer 11

Yes

Question 12

How effective is antibiotic treatment at changing the course of the illness?

Answer 12

Antibiotic therapy has not been shown to alter the course of the illness

Question 13

What are the complications of whooping cough?

Answer 13

Complications

• subconjunctival haemorrhage
• pneumonia
• bronchiectasis
• seizures

Question 14

How long can whooping cough last?

Answer 14

10-14 weeks

Question 15

Why was the vaccination of pregnant women started for whooping cough?

Answer 15

• In 2012 an outbreak of whooping cough resulted in the death of 14 newborns. As a temporary measure, a vaccination programme was introduced in 2012 for pregnant women. This was successful (the vaccine is thought to be >90% effective in preventing newborns developing whooping cough).
• It was however decided in 2014 to extend the whooping cough vaccination programme for pregnant women.
• Women who are between 16-32 weeks pregnant will be offered the vaccine.

Question 16

What antibiotics could you prescribe for whooping cough and how long for?

Answer 16

Azithromycin 1 week