Pertussis in Childhood

John Snyder; Donna Fisher

doi:10.1542/pir.33-9-412

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John Snyder, MD*
Donna Fisher, MD^†

^*Assistant Professor of Pediatrics, Tufts University School of Medicine, Boston, MA; Associate Director, Pediatric Residency Program, Baystate Children’s Hospital, Springfield, MA.
^†Assistant Professor of Pediatrics, Tufts University School of Medicine, Boston, MA; Interim Chief, Division of Pediatric Infectious Diseases, Baystate Children’s Hospital, Springfield, MA.

Author Disclosure
Drs Snyder and Fisher have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

CDC:: Centers for Disease Control and Prevention
DTP:: diphtheria, tetanus, and whole cell pertussis vaccine
DTaP:: diphtheria, tetanus, and acellular pertussis vaccine
PCR:: polymerase chain reaction
PT:: pertussis toxin
RSV:: respiratory syncytial virus
Tdap:: diphtheria, tetanus, and acellular pertussis vaccine (reduced diphtheria component)

Educational Gap

The incidence in the United States of pertussis, a potentially fatal disease, has increased during the past decade and new recommendations for vaccination have been made in recent years.

Objectives

After reading this article, readers should be able to:

Understand the pathophysiology of pertussis.
Describe the clinical presentation, natural history, and potential complications of pertussis infection.
Appreciate the changing epidemiology of pertussis.
Master the laboratory diagnosis and medical management of pertussis infection.
Describe the vaccination strategies for the prevention of pertussis infection.

Introduction

Pertussis, commonly known as “whooping cough,” is a respiratory illness caused by the bacterium Bordetella pertussis. The classic clinical syndrome causes morbidity by affecting the upper respiratory tract in patients of all ages. The disease can be modified greatly and prevented by primary vaccination. An ongoing resurgence of clinical pertussis has been seen in the United States over the past decade, with increasing numbers of young infants affected despite the availability of effective vaccines. It is important to understand the biological properties of the bacterium, the clinical presentation, and the factors contributing to the continuing burden of this disease.

The Organism and Pathophysiology

B pertussis is a small Gram-negative coccobacillus that infects only humans. It is aerobic and grows best at 35°C to 37°C. Bordetella species, including B pertussis and B parapertussis, are fastidious and difficult to grow on media usually used in the laboratory to grow respiratory pathogens; B pertussis requires supplemental growth factors including charcoal, blood, and starch. Media such as Bordet-Gengou, which contains potato starch, and charcoal-based Regan-Lowe media typically are used in microbiology laboratories for culturing the organism.

B pertussis causes irritation and inflammation by infecting the ciliated …