Whooping Cough

Whooping cough, also known as Pertussis, is an acute infectious disease caused by the bacterium Bordetella pertussis,  which once was one of the most common childhood diseases and a major cause of childhood mortality in the US. Prior to the availability of pertussis vaccine in the 40s, more than 200,000 cases of Whooping cough were reported annually. Since widespread use of the vaccine began, incidence has decreased more than 98%, to an average of about 4,400 cases per year since 1980.

Symptoms of Whooping Cough

Once you become infected with whooping cough, it takes a few days to a few weeks for symptoms to appear. When they do, they're usually mild at first and resemble those of a common cold, such as:

• Red, watery eyes
• A runny nose
• Nasal congestion
• Sneezing
• A mild fever
• Dry cough
• Malaise and loss of appetite

Symptoms of Whooping cough become worse after a week or two, and usually include:

• Coughing attacks, up to 15 coughs in a row, that end with a high-pitched whoop sound as you gasp for air. These may be so severe that you vomit or turn red or blue from the effort.
• Severe coughing attacks that bring up thick phlegm.
• Fatigue from coughing so much.

In adults, symptoms of whooping cough may resemble those of bronchitis, a respiratory infection that causes a nagging cough. Babies and infants with whooping cough may not whoop at all, or at least not as loudly as older children do. Some children with whooping cough may experience choking spells and turn blue in the face as they struggle to breathe after a coughing fit.

Severe coughing can result in tiny red spots caused by ruptures in blood vessels at the skin's surface (petechiae) in the skin of your upper body, as well as small areas of bleeding in the whites of your eyes. You may even bruise or break a rib if your coughing episodes are severe. Coughing may be worse at night.

With time, coughing usually lessens, but the cough can persist for six weeks or longer. Some people may even experience recurring episodes of coughing over the course of a year, especially when they contract a cold or other respiratory infection.

Whooping Cough Stages

The incubation period of pertussis is commonly 7–10 days, with a range of 4–21 days, and rarely may be as long as 42 days. The clinical course of the illness is divided into three stages.

The first stage, the catarrhal stage, is characterized by the insidious onset of coryza (runny nose), sneezing, low-grade fever, and a mild, occasional cough, similar to the common cold. The cough gradually becomes more severe, and after 1–2 weeks, the second, or paroxysmal stage, begins.

It is during the paroxysmal stage that the diagnosis of pertussis is usually suspected. Characteristically, the patient has bursts, or paroxysms of numerous, rapid coughs, apparently due to difficulty expelling thick mucus from the tracheobronchial tree. At the end of the paroxysm, a long inspiratory effort is usually accompanied by a characteristic high-pitched whoop. During such an attack, the patient may become cyanotic, turn blue. Children and young infants, especially, appear very ill and distressed. Vomiting and exhaustion commonly follow the episode. The patient usually appears normal between attacks.

Paroxysmal attacks occur more frequently at night, with an average of 15 attacks per 24 hours. During the first 1 or 2 weeks of this stage the attacks increase in frequency, remain at the same level for 2 to 3 weeks, and then gradually decrease. The paroxysmal stage usually lasts 1 to 6 weeks, but may persist for up to 10 weeks. Infants younger than 6 months of age may not have the strength to have a whoop, but they do have paroxysms of coughing.

In the convalescent stage, recovery is gradual. The cough becomes less paroxysmal and disappears in 2 to 3 weeks. However, paroxysms often recur with subsequent respiratory infections for many months after the onset of pertussis. Fever is generally minimal throughout the course of pertussis.

Older persons (i.e., adolescents and adults), and those partially protected by the vaccine may become infected with B. pertussis, but usually have milder disease. Pertussis in these persons may present as a persistent (>7 days) cough, and may be indistinguishable from other upper respiratory infections. Inspiratory whoop is uncommon. B. pertussis is estimated to account for up to 7% of cough illnesses per year in older persons.

Even though the disease may be milder in older persons, these infected persons may transmit the disease to other susceptible persons, including unimmunized or incompletely immunized infants. Adults are often found to be the first case in a household with multiple pertussis cases.

Call your doctor immediately if you experience prolonged, severe coughing spells, especially if these spells make you turn red or blue, are followed by vomiting or occur together with a whooping sound when inhaling.

Whooping Cough Symptoms to W