Snapshot A 2-month-old female infant presents with a 5 day history of cough, post-tussive emesis, and episodic spells of apnea. Mom reports that her 16-year-old cousin, who babysits, has been coughing for 2 weeks. There is no history of immunization. Temperature is 100.4°F (38°C), pulse is 160/min and respirations are 68/min. Physical exam reveals a dehydrated infant, who is coughing and in respiratory distress. Fine crackles are heard bilaterally on auscultation. Patient was admitted to ICU and a complete bood count showed a WBC of 15,000 mm3 with 40% lymphocytes. Chest radiography shows peribronchial cuffing. Nasopharyngeal swab was sent for culture. Introduction Classification bacteria other gram-negative Bordetella B. pertussis Presentation Whooping cough a form of bronchitis catarrhal stage severe congestion and rhinorrhea 14 days in length most contagious paroxysmal stage coughing episodes with gasping for air 14-30 days in length when most patients present convalescent stage decreased frequency of coughing 14 days Evaluation Physical exam cough with whooping on inspiration post-tussive emesis subconjunctival hemorrhage CXR butterfly pattern Labs lymphocytosis PCR of nasal secretions B. pertussis toxin ELISA Culture Differential Respiratory syncytial virus infection Tuberculosis Foreign body aspiration Reactive airway disease/asthma Treatment Antibiotics erythromycin azithromycin antibiotics are most effective during catarrhal stage Isolation patients may return to school after 5 days of antibiotics Hospitalize infants < 6 months of age life-threatening in very young patients Prophylaxis of close contacts macrolides Prognosis, Prevention and Complications Prognosis increased mortality in infants < 6 months of age Prevention DTaP vaccine 5 doses given in childhood immunity wanes in adolescence adolescents are primary reservoir single dose of Tdap given as a booster (11 - 18 years) Complications apnea pneumonia seizures death esp. in infants < 4 months