Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis
- Paul Cornia, MD
Paul Cornia, MD
- Associate Professor of Medicine
- University of Washington
- Benjamin A Lipsky, MD, FACP, FIDSA, FRCP
Benjamin A Lipsky, MD, FACP, FIDSA, FRCP
- Emeritus Professor of Medicine
- University of Washington
- Visiting Professor of Medicine
- Teaching Associate, Green Templeton College
- University of Oxford
Pertussis, also known as "whooping cough," is a highly contagious, acute respiratory illness caused by Bordetella pertussis. In the prevaccine era, the disease predominantly affected children <10 years of age and usually manifested as a prolonged cough illness with one or more of the classical symptoms: inspiratory whoop, paroxysmal cough, and posttussive emesis .
Since the introduction of pertussis vaccines, the epidemiology of reported pertussis infections has changed; in the United States in the 1990s, more than one-half of cases occurred in adolescents and adults . Infected adolescents and adults serve as a reservoir for infection of infants and children in whom serious morbidity and mortality may occur. Symptoms and signs in adolescents and adults are often nonspecific, and the diagnosis may not be considered.
Clinical manifestations and diagnosis of pertussis will be reviewed here. Issues related to the pathogenesis, epidemiology, treatment, and prevention of pertussis are discussed separately. (See "Pertussis infection: Epidemiology, microbiology, and pathogenesis" and "Pertussis infection in adolescents and adults: Treatment and prevention" and "Pertussis infection in infants and children: Clinical features and diagnosis" and "Pertussis infection in infants and children: Treatment and prevention".)
The incubation period following exposure is typically 7 to 10 days but may be three weeks or longer . This incubation period is considerably longer than that of common upper respiratory infections, such as the common cold (one to three days). Infection with B. pertussis in individuals without preexisting immunity is characterized by three phases: the catarrhal phase, the paroxysmal phase, and the convalescent phase. In infected adolescents or adults with a history of prior infection or vaccine-induced immunity, classic symptoms may or may not occur.
Catarrhal phase — The catarrhal phase is the earliest phase of illness, lasting one to two weeks, and is characterized by nonspecific symptoms including generalized malaise, rhinorrhea, and mild cough. Slight temperature elevations may be present, but high fever is uncommon . Two early clinical findings suggestive of pertussis are excessive lacrimation and conjunctival injection. Diagnostic tests are most accurate during this phase; however, the nonspecific clinical manifestations rarely lead to suspicion of pertussis. (See 'Approach to diagnosis' below.)
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