Pertussis natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
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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.[1] 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.
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 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. After paroxysms subside, a nonparoxysmal cough can continue for 2 to 6 weeks or longer.
Shown below is a table summarizing the main findings in each stage.[2]
| 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 |
| 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. |
Complications
This disease results in high morbidity and mortality in many countries every year. Complications of the disease[3] include:
- Pneumonia
- Encephalitis
- Pulmonary hypertension
- Secondary bacterial superinfection[4]
- Pneumonia
- Convulsions
- Nose bleeds (epistaxis)
- Ear infections (otitis )
- Encephalitis
- Bleeding in the brain (cerebral hemorrhage)
- Mental retardation
- 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.[2]
- Illness is generally less severe, and the typical “whoop” less frequently seen in adolescents and adults.[2]
References
- ↑ Hewlett EL, Edwards KM (2005). "Pertussis--not just for kids". New Eng J Med. 352 (12): 1215–1222.
- ↑ 2.0 2.1 2.2 Pertussis (whooping cough). CDC.gov. Accessed on June 15, 2014
- ↑ "Pertussis: MedlinePlus Medical Encyclopedia".
- ↑ 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.