Case Study: Bordatella Pertussis

Case Summary A 6 week old male infant presents to the pediatrician with a 10 day history of coughing, turning red, choking spells and gasping for breath.  He has had vomiting associated with these choking spells for the past two days.  The infant's mother reports it feels like he has a fever but she has not checked his temperature.  

Vital signs taken in the clinic show a pulse of 164 (elevated), temperature of 100.6 and a respiratory rate of 72.  On exam, you note the child is coughing.  Lung sounds are clear.  You order a chest X-Ray which reveals no abnormalities. A CBC shows the child has an elevated white blood cell count of 14,500 with 70% lymphocytes. 

Diagnosis

This child was diagnosed with bordatella pertussis, commonly known as whooping cough.  

Treatment

Erythromycin is the most effective medication for treatment of whooping cough.  It reduces the course of infection by 5 to 10 days.  Cough may persist long after the course of antibiotics is complete. 

Disease Overview

Pertussis is an infection of the respiratory tract most common in infants and children.  Infants younger than 6 months are susceptible as they have not yet been vaccinated.  Children between the ages of 11 and 18 are also at risk as their immunity from the vaccine may be waning.  The infection is most contagious prior to symptom onset.  Children typically present with coughing spells which may last 1 to 2 weeks.  During coughing spells, children may turn red or purple in color.  A whooping sound can sometimes be heard with inspiration at the end of the coughing spell.  Between spells, the child usually feels well.  Clincal findings reveal elevated respiratory and pulse rates as well as elevated lymphocyte levels.   Nasopharyngeal swab culture may be used for diagnosis.

The CDC reports that 2012 is on track to have the most cases of whooping cough in decades with 18,000 cases already reported in the US this year.  Encourage your patients to immunize their children and keep up to date with their TDap in order to prevent the spread of infection.