B. pertussis continues to rear its ugly head in some parts of the country.
King County in Washington state has been battling outbreaks of this disease
for 3 or more years now. Remember vaccintated persons (adults and children)
can still get pertussis. The clinical definition for pertussis is: "A cough
illness lasting at least 2 weeks with one of the following: paroxysms of
coughing, inspiratory "whoop", or post-tussive vomiting and without other
apparent cause as reported by a health professional."
A clinical tip provided by Chas DeBolt, RN, MPH nurse epidemiologist at the Seattle King County Health Department is to ask female patients if the
cough causes the patient to "wet her pants". She included this question in
her thesis work on B. pertussis and found that this may be a sign of a
cough severe enough to indicate pertussis (unless the patient normally has
cough induced stress incontinence).
Pertussis can be confirmed with serum titers showing a 4-fold rise in IgG
or IgA, or a 4-fold rise or fall in IgM antibodies in paired serum
specimens. You need to get the first specimen within 2-3 weeks of the cough
developing and then the convalescent specimen is collected 3-4 weeks later.
If you only have one specimen, the presence of both high IgM and high IgA
antibody titers has been considered as evidence of B. pertussis infection.
Pertussis can also be confirmed with a nasopharyngeal culture that has to
be collected and transported on special media.
Treatment for pertussis is accomplished with erythromycin as the first drug
of choice followed by trimethaprim/sulfamethoxazole or ampicillin. Recent
studies have also found azithromycin to be effective and much better
tolerated by both adults and children.
Contact your health department for complete details on diagnosis and
treatment of B. pertussis.
