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Whooping Cough Symptoms

Whooping cough (pronounced “hooping” with the “W” being silent) received its name because of the characteristic inspiratory “whooping” sound which follows profound coughing spasms. Most affected people do not usually “whoop”. The “whoop” is characteristically heard in school age children. Whooping cough is classically caused by a rod-shaped bacterium called Bordetella pertussisBordetella parapertussisoccasionally causes pertussis. During the period between 1922 and 1948, before the pertussis vaccine, pertussis was the leading cause of death from an infectious cause in children under the age of 14 years in the United States. Unfortunately, in recent years vaccination rates have declined. Many parents are refusing to vaccinate their children. The Centers for Disease Control in Atlanta reported 7,500 cases in 1996, the highest number since 1967.

Symptoms of Whooping Cough

Pertussis classically lasts 6 weeks and is divided into three stages. The first stage, lasting about 2 weeks, consists of runny nose, congestion, low grade fever, tearing, and sneezing. The second stage, lasting about 2 weeks, is characterized by a cough that is intermittent at first and evolves into the classic staccato cough with as many as 20 coughs in a row. These episodes may occur hourly. Infants under the age of 3 months may not have the classic “whoop”. Infants under the age of 3 months may have apnea with the coughing spells which makes pertussis in this age group particularly worrisome. If an infant turns blue or stops breathing during an episode of coughing, they should be hospitalized for observation until the coughing improves or no blue episodes are documented for a period of 48 hours. A clue to diagnosis at any age is the presence of post-tussive emesis–vomiting after coughing. The last stage, lasting about 2 weeks, is called the convalescence stage. During this stage, the cough progressively improves.

Immunization with DTaP (the “P” stands for pertussis) has certainly greatly reduced the number of school age children who get “whooping cough”. However, infants are not fully immunized against pertussis and immunity wanes 3 to 5 years after vaccination. Thus, it is only the young children who are immune. Adults probably get the illness fairly frequently. (Some studies cite as high as 20% of respiratory illnesses, with cough which lasts longer than 7 days, are caused by pertussis!) In adults and adolescents, the course may be relatively mild because of some retained immunity. They, nevertheless, are quite able to spread the infection to other individuals through respiratory droplets. Thus, adults and adolescents with even mild URI symptoms may be harboring a serious illness which may spread to an infant. This is why anyone with “cold” symptoms should stay away from infants. There is currently consideration into giving adults a “booster” immunization against pertussis with the hopes of reducing this source of infection to infants.

Whooping Cough Complications

The following complications can be seen with Whooping Cough:

  • Pneumonia–bacterial pneumonia
  • Pneumothorax
  • Seizures in infants
  • Effects from forceful coughing–hernias, nosebleeds, petechiae (broken capillaries in the face and neck region that appear as flat, tiny red dots), and rectal prolapse

Whooping Cough Treatment

The goals of treatment are to decrease the severity of the illness and decrease contagion. Macrolide antibiotics such as erythromycin (also azithromycin and clarithromycin) are effective. Trimethoprim/sulfamethoxazole may be used in cases of macrolide allergy. To decrease the severity of the illness the medication is best started during the early part of the illness when the symptoms are those of a typical “cold”. However, pertussis is not usually suspected until the appearance of the spasmodic cough or post-tussive emesis. If treatment is begun early into this coughing phase, it may also be somewhat effective. Treatment which is begun later may not alter the course of the illness, but it will reduce the risk that it will spread to other family members. All family members should nevertheless be treated, regardless of symptoms or immune status, with 14 days of erythromycin. All exposed individuals should have their immune status reviewed by their physician and additional immunization provided where indicated.

Other treatment modalities may be needed in severely ill patients, including hospitalization, oxygen, and even mechanical ventilation (a breathing machine).