twiter1A mom brings in her 5-year-old daughter to the ED for a persistent cough of over 2-weeks.  She states the cough gets so bad at times that the patient has difficulty breathing.  The patient is nonimmunized based on religious belief.

Diphtheria Pertusis (Whooping Cough) in an Unvaccinated Child

  • Bordetella pertussis is the causative organism.  It is highly contagious and spread by contaminated droplets
  • Infection typically occurs in nonimmunized or partially immunized children and adolescents.  It is also known to occur in adults since the immunization series does not guarantee life-time protection.
  • Clinical presentation is divided into 3 stages
    • Catarrhal (up to 2 weeks) – mild fever, rhinorrhea, conjunctivitis
    • Paroxysmal (2 to 4 weeks) – unremitting paroxysmal coughing followed by a “whoop” (listen here).  May occur 40x per day.  Post-tussive emesis is common.  Listen to a more severe case. Apnea and choling spells are not uncommon.
    • Convalescent (weeks to months) – residual cough
  • Older children commonly misdiagnosed with “chronic bronchitis”
  • Treatment
    • Erythromycin-based antibiotic (azithromycin, clarithromycin)
    • Hospital admission (with isolation) for patients < 1-yr-old or any patient in respiratory distress
    • Monitor for valsalva-induced-bradycardia and hypoxia
  • Highest mortality in children less than 1-year of age (highest in first month of life)

TWITTER notes (This Week In The ER) is an educational resource that presents high-yield, case-based information from actual patient presentations in the ED.

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