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Pertussis

Pertussis. Kate Goheen March 25, 2009 Weill Cornell Medical College Class of 2010. Case Presentation. 4 m.o. male with h/o Klinefelter Syndrome, bilateral hip dysplasia and club feet CC: cough and difficulty breathing

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Pertussis

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  1. Pertussis Kate Goheen March 25, 2009 Weill Cornell Medical College Class of 2010

  2. Case Presentation • 4 m.o. male with h/o Klinefelter Syndrome, bilateral hip dysplasia and club feet • CC: cough and difficulty breathing • HPI: mild cough for one week, worsening, with one 10-second episode of coughing and cyanosis which prompted mother to come to ER • ER: mild respiratory distress, wheezing and retractions • T 99.1 HR 152 RR 66 O2 sat 99% • Plan: admit to 4B for bronchiolitis

  3. Hospital Course • HD#1 • Patient started on albuterol Q2 • One witnessed episode of coughing and cyanosis <10 seconds • Nebs changed to racemic epinephrine and levalbuterol • DFA and cx sent for pertussis • Started on azithromycin

  4. Hospital Course Cont’d • HD#2 • Febrile to 101.3 • CXR showed RLL infiltrate, WBC 15.1 (N32%, L59%) • Cefuroxime added • Levalbuterol maintained Q6 • HD#4 • DFA and cultures negative • Discharged to home on cefuroxime and azithromycin

  5. What is Pertussis? Whooping cough, “The Cough of 100 Days”

  6. Infants are at high risk of complications Infants accounted for 92% of US pertussis deaths in 2000-2004. Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. Kretsinger, Katrina et al. MMWR Recommendations and Reports December 15, 2006 / 55(RR17);1-33.

  7. Annual Reported of Cases of Pertussis in the US, 1922-2003 Pertussis- Not Just for Kids. Hewlett, Erik and Edwards, Kathryn. NEJM 352;12 March 24, 2005, p. 1215-1224.

  8. Spread of Pertussis: Then vs. Now

  9. Why is the Incidence of Pertussis Increasing? • Increased awareness and reporting • Better tests • Waning immunity in adults

  10. Immunized kids also get pertussis Clinical Presentation of Pertussis by Vaccine Group in Infants 6-24 Months Old *P < .001 Clinical presentation of pertussis in unvaccinated and vaccinated children in the first six years of life. AU Tozzi AE; Rava L; Ciofi degli Atti ML; Salmaso S SO. Pediatrics 2003 Nov;112(5):1069-75.  

  11. Pertussis is milder in immunized adults and adolescents • Persistent cough can be the only symptom • Whooping in 20-40% • Post-tussive emesis in about half • “Scratchy throat” in 33% • Sweating episodes in 40-50% pts over 30 y.o. • 13-32% of adults with cough >6 days have serologic evidence of B. pertussis infection Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. Kretsinger, Katrina et al. MMWR Recommendations and Reports December 15, 2006 / 55(RR17);1-33.

  12. Diagnosis and Treatment • Pertussis can only be recovered in first 3-4 weeks of illness, very hard to culture • Do culture and PCR • Tx: 5 days of azithromycin for patients and contacts Centers for Disease Control and Prevention. Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis. 2005 CDC guidelines. MMWR 2005; 54:10.

  13. Vaccine Schedule: Expanded to Adults! • DTaP • 2, 4, 6 months • 15-18 months • 4-6 years • Tdap • 11-12 years • One dose between 19-64 (instead of Td) • Any adult in contact with infant <1 y.o.

  14. Conclusions • Pertussis is still around! • Infants have high morbidity and mortality • Suspect pertussis in any patient with a prolonged cough, even if vaccinated • Encourage parents and grandparents to get Tdap boosters

  15. Thank you! Questions? Comments?

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