Pertussis natural history, complications and prognosis: Difference between revisions

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Latest revision as of 23:13, 14 January 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.; Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]

Overview

The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent. If left untreated, the majority of patients with clinical manifestations of pertussis develop low-grade fever and coryza (runny nose, occasional cough) for 1-2 weeks, followed by paroxysmal fits of whooping cough that may last 1-6 weeks, before finally recovering from the disease. Compared with children, adolescents and adults usually experience a milder course of the disease, and the characteristic whooping cough may be absent. Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for developing severe infection and life-threatening complications and death.^[1] Complications of pertussis include apnea, pneumonia, seizure, and death. Prognosis is generally excellent, but unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.

Natural History

The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.
Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor respiratory tract infections.
The cough, which is initially intermittent, becomes paroxysmal. In typical cases paroxysms terminate with inspiratory whoop and may be followed by post-tussive vomiting. Paroxysms of cough, which may occur more at night, usually increase in frequency and severity as the illness progresses and typically persist for 2 to 6 weeks or more.
The illness can be milder and the characteristic "whoop" may be absent in children, adolescents and adults who were previously vaccinated. After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for developing severe infection and life-threatening complications and death.

Shown below is a table summarizing the main clinical findings in each stage.^[1]

Natural History of Pertussis
Stage	Duration	Key features
Catarrhal	Usually 7-10 days; range of 4-21	- Low grade fever - Coryza - Mild occasional cough
Paroxysmal	Usually lasts 1-6 weeks, but may persist for up to 10 weeks	- Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree - Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms - Cyanosis - Vomiting and exhaustion - Paroxysmal attacks occur frequently at night, with an average of 15 attacks per 24 hours - Paroxysmal attacks increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease
Convalescent	Usually 7-10 days; range of 4-21	- Gradual recovery - Less persistent, paroxysmal coughs that disappear in 2-3 weeks - Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis

^{Timeline of pertussis clinical manifestations. Retrieved from Centers of Disease Control and Prevention (CDC) ^[2]}

Complications

Pertussis may cause serious and potentially life-threatening complications, especially among infants and young children. Patients who are not fully vaccinated are more predisposed to developing pertussis-related complications.^[3]^[4]^[5]

Prognosis

Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.^[1]
Treatment with an effective antimicrobial agent the infectious period but does not generally alter the outcome of the disease.
When treatment is initiated during the catarrhal stage, symptoms may be less severe.
Among adolescents and adults, pertussis is generally less severe, and the characteristic whooping cough is less frequently described.^[1]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014
↑ "Pertussis". www.cdc.gov. Centers for Disease Control and Prevention (CDC). 2015. Retrieved Jan 14 2016. Check date values in: |access-date= (help)
↑ Pertussis (whooping cough). Complications. CDC.gov. Accessed on June 15, 2014
↑ Mattoo S, Cherry JD (2005). "Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to 'Bordetella pertussis' and other Bordetella subspecies". Clin Microbiol Rev. 18 (2): 326–82. PMID 15831828.
↑ "Pertussis: MedlinePlus Medical Encyclopedia".

Template:WH Template:WS

[CDC1-1] 1.0 ^1.1 ^1.2 ^1.3 Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014

[CDC-2] "Pertussis". www.cdc.gov. Centers for Disease Control and Prevention (CDC). 2015. Retrieved Jan 14 2016. Check date values in: |access-date= (help)

[CDC2-3] Pertussis (whooping cough). Complications. CDC.gov. Accessed on June 15, 2014

[Mattoo_2005-4] Mattoo S, Cherry JD (2005). "Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to 'Bordetella pertussis' and other Bordetella subspecies". Clin Microbiol Rev. 18 (2): 326–82. PMID 15831828.

[urlPertussis:_MedlinePlus_Medical_Encyclopedia-5] "Pertussis: MedlinePlus Medical Encyclopedia".

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}; {{AE}} {{ADI}}
+{{CMG}}; {{AE}} {{YD}}; {{SSK}}; {{ADI}}; {{Rim}}
 {{Pertussis}}
 ==Overview==
-The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.  Because neither [[vaccination]] nor infection confers long-term immunity, infection of adolescents and adults is also common.<ref>{{cite journal |author=Hewlett EL, Edwards KM | title=Pertussis--not just for kids | journal=New Eng J Med | year=2005 | pages=1215-1222 | volume=352 | issue=12 }}</ref> Most adults and adolescents who become infected with ''Bordetella pertussis'' have been vaccinated or infected years previously.  When there is residual immunity from previous infection or immunization, symptoms may be milder, such as a prolonged [[cough]] without the other classic symptoms of pertussis.
+The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.  If left untreated, the majority of patients with clinical manifestations of pertussis develop low-grade fever and coryza (runny nose, occasional cough) for 1-2 weeks, followed by paroxysmal fits of whooping cough that may last 1-6 weeks, before finally recovering from the disease. Compared with children, adolescents and adults usually experience a milder course of the disease, and the characteristic whooping cough may be absent. Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for developing severe infection and life-threatening complications and death.<ref name=CDC1>[http://www.cdc.gov/pertussis/clinical/features.html Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014]</ref>  Complications of pertussis include [[apnea]], [[pneumonia]], [[seizure]], and [[death]]. Prognosis is generally excellent, but unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.
 ==Natural History==
-* The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.
+*The clinical course of the illness is divided into three stages: catarrhal, paroxysmal and convalescent.
+*Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor [[respiratory tract infection]]s.
+*The cough, which is initially intermittent, becomes paroxysmal.  In typical cases paroxysms terminate with inspiratory whoop and may be followed by post-tussive vomiting.  Paroxysms of [[cough]], which may occur more at night, usually increase in frequency and severity as the illness progresses and typically persist for 2 to 6 weeks or more.
+*The illness can be milder and the characteristic "whoop" may be absent in children, adolescents and adults who were previously vaccinated.  After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
+*Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for developing severe infection and life-threatening complications and death.
-Shown below is a table summarizing the main findings in each stage.
+Shown below is a table summarizing the main clinical findings in each stage.<ref name=CDC1>[http://www.cdc.gov/pertussis/clinical/features.html Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014]</ref>
+{| class="wikitable"
-{|
+|+ style="text-align: center;" | Natural History of Pertussis
 |-
-| '''Stage''' || '''Duration''' || '''Key features'''
+| style="padding: 0 5px; background:"#C0C0C0"; font-size: 100%; width: 30%" align=center |'''Stage'''||style="padding: 0 5px; background:"#C0C0C0"; font-size: 100%; align=center |'''Duration'''||style="padding: 0 5px; background:"#C0C0C0"; font-size: 100%; align=center |'''Key features'''
 |-
-|  Catarrhal ||  Usually 7-10 days; range of 4-21 || [[Low grade fever]]<br> [[Coryza]] <br> Mild occasional [[cough]]
+|style="font-size: 100; padding: 0 5px; background:"#C0C0C0"; align=left | Catarrhal || style="font-size: 100; padding: 0 5px; align=left |Usually 7-10 days; range of 4-21 || style="font-size: 100; padding: 0 5px; align=left |- [[Low grade fever]]<br> - [[Coryza]] <br> - Mild occasional [[cough]]
 |-
-|  Paroxysmal || Usually lasts 1-6 weeks, but may persist for up to 10 weeks ||
+|  style="font-size: 100; padding: 0 5px; background:"#C0C0C0"; align=left |Paroxysmal || style="font-size: 100; padding: 0 5px; align=left |Usually lasts 1-6 weeks, but may persist for up to 10 weeks || style="font-size: 100; padding: 0 5px; align=left |- Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree<br>
-Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial tree.<br>
+- Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms<br>
-Long aspiratory effort accompanied by a high-pitched "whoop" at the end of the paroxysms<br>
+- [[Cyanosis]]<br>
-Cyanosis<br>
+- [[Vomit]]ing and exhaustion<br>
-[[Vomit]]ing and exhaustion<br>
+- Paroxysmal attacks occur frequently at night, with an average of 15 attacks per 24 hours<br>
-Paroxysmal attacks occur frequently at night, with an average of 15 attacks per 24 hours.<br>
+- Paroxysmal attacks increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease
-Paroxysmal attacks increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then gradually decrease.
 |-
-|  Convalescent || Usually 7-10 days; range of 4-21 || Gradual recovery <br> Less persistent, paroxysmal [[cough]]s that disappear in 2-3 weeks<br>
+| style="font-size: 100; padding: 0 5px; background:"#C0C0C0"; align=left |Convalescent || style="font-size: 100; padding: 0 5px; align=left |Usually 7-10 days; range of 4-21 || style="font-size: 100; padding: 0 5px; align=left |- Gradual recovery <br> - Less persistent, paroxysmal [[cough]]s that disappear in 2-3 weeks<br>
-Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis.
+- Paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis
 |}
+<br>
-===Catarrhal Stage===
+[[Image:Pertussis Timeline.jpg|900px]]<br>
-Pertussis has an insidious onset with catarrhal symptoms that are indistinguishable from those of minor respiratory tract infections.
+<sup>Timeline of pertussis clinical manifestations. Retrieved from Centers of Disease Control and Prevention (CDC) <ref name=CDC> {{cite web |url=http://www.cdc.gov/pertussis/about/signs-symptoms.html |title=Pertussis  |date=2015 |website= www.cdc.gov |publisher= Centers for Disease Control and Prevention (CDC) |access-date= Jan 14 2016}}</ref></sup>
-===Paroxysmal Stage===
-* The cough, which is initially intermittent, becomes paroxysmal. In typical cases paroxysms terminate with inspiratory whoop and can be followed by posttussive vomiting.
-* Paroxysms of cough, which may occur more at night, usually increase in frequency and severity as the illness progresses and typically persist for 2 to 6 weeks or more. The illness can be milder and the characteristic "whoop" absent in children, adolescents and adults who were previously vaccinated.
-===Convalescent Stage===
-After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
 ==Complications==
-This disease results in high [[morbidity]] and [[mortality]] in many countries every year.  Complications of the disease<ref name="urlPertussis: MedlinePlus Medical Encyclopedia">{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm |title=Pertussis: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref> include:
+Pertussis may cause serious and potentially life-threatening complications, especially among infants and young children. Patients who are not fully vaccinated are more predisposed to developing pertussis-related complications.<ref name=CDC2>[http://www.cdc.gov/pertussis/clinical/complications.html Pertussis (whooping cough). Complications. CDC.gov. Accessed on June 15, 2014]</ref><ref name=Mattoo_2005>{{cite journal |author=Mattoo S, Cherry JD | title=Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to ''''Bordetella pertussis'''' and other ''Bordetella'' subspecies | journal=Clin Microbiol Rev | year=2005 | pages=326-82 | volume=18 | issue=2 | pmid = 15831828 }}</ref><ref name="urlPertussis: MedlinePlus Medical Encyclopedia">{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm |title=Pertussis: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
+* [[Sleep apnea]] (most common)
+* [[Epistaxis]]
 * [[Pneumonia]]
-* [[Encephalitis]]
+* [[Otitis media]]
-* [[Pulmonary hypertension]]
+* [[Pneumothorax]]
-* Secondary bacterial [[superinfection]]<ref name=Mattoo_2005>{{cite journal |author=Mattoo S, Cherry JD | title=Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to ''Bordetella pertussis'' and other ''Bordetella'' subspecies | journal=Clin Microbiol Rev | year=2005 | pages=326-82 | volume=18 | issue=2 | pmid = 15831828 }}</ref>
+* [[Pulmonary hypertension|Refractory pulmonary hypertension]]
-* [[Pneumonia]]
+* [[Urinary incontinence]]
-* [[Convulsions]]
+* [[Hernia]]
-* [[Nose bleeds]] ([[epistaxis]])
+* [[Rectal prolapse]]
-* [[Ear infections]] ([[otitis ]])
+* [[Rib fracture]]
-* [[Encephalitis]]
+* [[Seizures]]
-* [[Bleeding in the brain]] ([[cerebral hemorrhage]])
+* [[Subdural hematoma]]
-* [[Mental retardation]]
+* [[Encephalopathy]]
-* [[Slowed or stopped breathing]] ([[apnea]])
-* [[Death]]
 ==Prognosis==
-* Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.
+* Unvaccinated or incompletely vaccinated infants younger than 12 months of age have the highest risk for severe and life-threatening complications and death.<ref name=CDC1>[http://www.cdc.gov/pertussis/clinical/features.html Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014]</ref>
+* Treatment with an effective [[Pertussis medical therapy|antimicrobial agent]] the infectious period but does not generally alter the outcome of the disease.
-* Illness is generally less severe, and the typical “whoop” less frequently seen in adolescents and adults.
+*When treatment is initiated during the catarrhal stage, symptoms may be less severe.
+* Among adolescents and adults, pertussis is generally less severe, and the characteristic whooping cough is  less frequently described.<ref name=CDC1>[http://www.cdc.gov/pertussis/clinical/features.html Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014]</ref>
 ==References==
@@ Line 70: / Line 66: @@
 [[Category:Emergency medicine]]
 [[Category:Pulmonology]]
-[[Category:Needs overview]]
-[[Category: Needs content]]
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