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
Infants and Children
- Pertussis can cause serious and potentially life-threatening complications in infants and young children who are not fully vaccinated.[3]
- In infants younger than 12 months of age who get pertussis, about half are hospitalized. Hospitalization is most common in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis approximately:[4][3]
- 67% will have apnea
- 23% get pneumonia
- 1.6% will have seizures
- 1.6% will die
- 0.4% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin)
- Other complications can include anorexia, dehydration, difficulty sleeping, epistaxis, hernias, otitis media, and urinary incontinence.[3]
- More severe complications can include refractory pulmonary hypertension, pneumothorax, rectal prolapse, and subdural hematomas.[3]
Adolescents and Adults
- Adolescents and adults can also develop complications from pertussis, but they are usually less severe in this older age group, especially in those who have been vaccinated.
- In one study, hospitalization rates were 0.8% for adolescents and 3% for adults with confirmed pertussis. Pneumonia was diagnosed in 2% of each group. The most common complications in another study of adults with pertussis were:[3]
- Weight loss (33%)
- Urinary incontinence (28%)
- Syncope (6%)
- Rib fractures from severe coughing (4%)
- Other complications can include anorexia, dehydration, epistaxis, hernias, and otitis media.
- More severe complications can include encephalopathy as a result of hypoxia from coughing or possibly from toxin, pneumothorax, rectal prolapse, subdural hematomas, and seizures.
This disease results in high morbidity and mortality in many countries every year. Complications of the disease[5] include:
- Pneumonia
- Encephalitis
- Pulmonary hypertension
- Secondary bacterial superinfection[6]
- 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
- ↑ 3.0 3.1 3.2 3.3 3.4 Pertussis (whooping cough). Complications. CDC.gov. Accessed on June 15, 2014
- ↑ Tanaka M, Vitek CR, Pascual FB, Bisgard KM, Tate JE, Murphy TV (2003). "Trends in pertussis among infants in the United States, 1980-1999". JAMA. 290 (22): 2968–75. doi:10.1001/jama.290.22.2968. PMID 14665658.
- ↑ "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.