Respiratory therapists who have encountered pertussis know it is characterized by the hallmark “whooping” sound that has given it the name most people associate with it: whooping cough.
Effective vaccines have been around for decades, but effectiveness wears off over time and many people fail to be re-immunized.
According to the CDC, infants are at greatest risk for both getting pertussis and having serious complications from it.
What do respiratory therapists need to know about this condition? We asked AARC member Alexandre T. Rotta, MD, FCCM, the Linsalata Family Chair in Pediatric Critical Care and Emergency Medicine and chief of the Division of Pediatric Critical Care at UH Rainbow Babies & Children’s in Cleveland, OH, to tell us.
Three clinical phases
“Pertussis is a highly contagious bacterial respiratory disease caused by Bordetella pertussis,” Dr. Rotta said. “These bacteria attach to cilia that line the respiratory tract, causing mucosal edema and ciliary damage through a toxin-mediated mechanism.”
He goes on to note that B. pertussis only infects humans and some primates and is transmitted when bacteria are spread through aerosolized droplets from coughing or sneezing from an infected individual to a susceptible individual sharing the same breathing space.
In its typical presentation, Dr. Rotta says pertussis has three clinical phases that evolve over the course of six weeks:
- A catarrhal phase characterized by non-specific symptoms of congestion, sneezing, rhinorrhea, and low-grade fevers that is usually indistinguishable from a mundane viral upper respiratory infection.
- A paroxysmal phase marked by a dry cough that evolves into inexorable fits of coughing. Some patients emit a forceful inspiratory gasp at the end of each coughing cluster, which is the audible “whoop” seen in pertussis.
- A convalescence stage when the number, severity, and duration of the coughing episodes diminish and eventually resolve.
Pertussis can be treated by antibiotics, with macrolides being the preferred agents, continues Dr. Rotta, noting that such treatment “limits the spread of disease and may shorten the duration of symptoms if used in the catarrhal or early paroxysmal phases.”
He emphasizes young children — especially those who have not been immunized and those under six months of age — are most severely affected by pertussis.
“In these patients, the coughing paroxysms can be severe enough to preclude proper oral nutrition, thus requiring hospital admission for hydration and close monitoring,” Dr. Rotta said.
Complications can be severe
Pertussis can lead to pneumonia and, in severe cases, acute hypoxemic respiratory failure and even death.
“Other complications of pertussis include seizures, encephalopathy, apnea, spontaneous rib fractures, pneumothorax, and pneumomediastinum,” Dr. Rotta said. “Infants may need oxygen supplementation to prevent severe hypoxemia during long paroxysms of cough, despite having normal oxygen saturation when relaxed.”
Dr. Rotta emphasizes that once the diagnosis is made on an index case, all household contacts should receive a course of antibiotics to prevent infection and control its spread, regardless of age, symptoms, or immunization status.
Keep the conversation going
Have you seen a rise in pertussis cases this season? Start a discussion at AARConnect.