Bordetella pertussis
Is your Emergency Department administering Tdap immunization boosters instead of dT boosters? Patients with wounds are getting updated not only for tetanus and diphtheria, but also now for pertussis.
Apparently there has been sharp rise in the national incidence of pertussis in 2010. The infection has been documented in both infants (underimmunized less than 3 months old) and adolescents/adults (loss of immunity after 10 years). In fact, the CDC has issued an epidemic warning in California.
How do you diagnose pertussis? What are the classic symptoms? Better yet, how do you rule-it out clinically?
You won't like the answer. It often presents like the common cold and clinical symptoms are minimally helpful in making the diagnosis. So, according to the American Academy of Pediatrics, you should treat anyone under the age of 3 months in whom you suspect pertussis. Complications from pertussis in infants include apnea, seizures, secondary pneumonia, and death. That means any with an innocent cough should be treated with azithromycin!
Take a listen to the paroxysmal cough and classic whoop:
The following is a meta-analysis article from JAMA on diagnosing pertussis in adolescents and adults.
Feel free to download this card and print on a 4'' x 6'' index card.
Reference
Cornia PB, Hersh AL, Lipsky BA, Newman TB, & Gonzales R (2010). Does this coughing adolescent or adult patient have pertussis? JAMA : the journal of the American Medical Association, 304 (8), 890-6 PMID: 20736473
