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Be Aware of the Potential Risks of Pertussis Infection. Whooping cough, Knowing the Enemy. The 100-day Cough. Part II

David S. Klein, MD FACA FACPM

Pertussis, also known as whooping cough, now commonly called 'The 100-day cough," is a highly contagious bacterial infection that significantly impacts the respiratory system. Even with vaccines widely available, pertussis remains a serious public health issue. Outbreaks continue to occur in various parts of the globe, stressing the importance of awareness about this infection. In this post, we will explore the risks, symptoms, and preventive measures associated with pertussis.


What is Pertussis?


Pertussis is caused by the Bordetella pertussis bacterium, which leads to severe coughing fits lasting several weeks. The initial symptoms are mild and often resemble those of a common cold, making it tough to recognize at first. As the infection advances, the cough intensifies and is frequently accompanied by a characteristic “whooping” sound during inhalation.


The infection spreads primarily through respiratory droplets from coughing or sneezing. While pertussis can affect anyone, it poses particular risks to infants who may not yet be fully vaccinated.




Recognizing the Symptoms


Identifying the symptoms of pertussis early is essential for appropriate treatment. The infection typically evolves through three stages:


  1. Catarrhal Stage: Lasting one to two weeks, this stage causes symptoms similar to a cold, including a runny nose, mild cough, and sneezing.

  2. Paroxysmal Stage: Following the catarrhal stage, the cough escalates, becoming violent and lasting weeks or even months. The cough is often punctuated by the distinctive "whoop" sound upon inhalation.


  3. Convalescent Stage: This final stage indicates the beginning of recovery, with coughing gradually declining over weeks or months.


Recognizing these stages allows for timely medical attention, which can lessen the severity of the disease.


The Hidden Dangers of Pertussis


Although many individuals recover, pertussis can lead to severe complications, particularly for vulnerable groups.


Complications in Infants


Infants, especially those younger than one year, face a heightened risk of serious complications due to their still-developing immune systems. Hospitalization rates for infants can reach up to 50% in severe cases. Complications include:


  • Pneumonia: This is the most common serious complication, which may require hospitalization in severe instances.

  • Seizures: Intense coughing can lead to oxygen deprivation, triggering seizures.


  • Cerebral Hypoxia: Serious coughing fits can deprive the brain of oxygen, resulting in potential brain damage.


Complications in Older Children and Adults


Older children and adults may experience complications, though less frequently. Examples include:


  • Weight Loss: The severity of the cough can lead to difficulty in eating or drinking, potentially resulting in weight loss and dehydration.


  • Rib Fractures: Intense coughing spells can cause rib injuries, especially in older adults.


  • Urinary Incontinence: Severe coughing can inadvertently result in loss of bladder control in some individuals, particularly women.


These complications emphasize the critical need for vaccination and increased awareness to prevent the spread of this infection.


Rare Complications of Pertussis


Pertussis (whooping cough) can cause several rare but serious complications, especially in infants, young children, and individuals with underlying health conditions. These complications can arise from the intense coughing episodes or as a result of the systemic effects of the infection. Here are some rare complications:


Neurological Complications

  1. Seizures

    • Result from hypoxia due to prolonged coughing fits or fever.

  2. Encephalopathy (Pertussis Encephalopathy)

    • Rare but serious complication, possibly related to hypoxia or toxins, leading to altered mental status, developmental regression, or long-term cognitive impairment.

Respiratory Complications

  1. Pulmonary Hypertension

    • Secondary to hypoxia or infection-induced inflammation.

  2. Pneumothorax

    • Caused by the rupture of alveoli due to high intrathoracic pressures during forceful coughing.

  3. Subcutaneous Emphysema

    • Air leakage into subcutaneous tissues, particularly around the neck and chest, due to excessive coughing.

  4. Bronchiectasis

    • Chronic inflammation can lead to permanent structural damage to the airways, resulting in recurrent infections and impaired lung function.

Cardiovascular Complications

  1. Cardiac Arrest

    • Extremely rare, often secondary to severe hypoxia or acidosis in infants.

  2. Myocarditis

    • Rare inflammation of the heart muscle, possibly related to systemic effects of the infection.

Gastrointestinal Complications

  1. Rectal Prolapse

    • Caused by increased abdominal pressure during violent coughing spells.

Skeletal Complications

  1. Cough-induced Fractures

    • Rib fractures in adults and older children due to intense coughing fits.

Immunological and Systemic Complications

  1. Secondary Bacterial Infections

    • Such as pneumonia caused by opportunistic pathogens like Staphylococcus aureus or Streptococcus pneumoniae.

  2. Malnutrition and Dehydration

    • Prolonged illness and feeding difficulties in infants can lead to weight loss and electrolyte imbalances.

  3. Hemorrhages

    • Intracranial, subconjunctival, or nasal hemorrhages caused by increased vascular pressure during coughing.

Perinatal and Pregnancy Complications

  1. Preterm Labor

    • Severe coughing can induce uterine contractions in pregnant women.

  2. Intrauterine Growth Restriction (IUGR)

    • Rarely, severe maternal pertussis may affect fetal growth due to hypoxia.

These complications highlight the importance of early diagnosis, vaccination, and prompt treatment of pertussis to prevent severe outcomes.


The Importance of Vaccination


Vaccination is the most effective way to prevent pertussis. The DTaP vaccine is recommended for children, along with booster shots (Tdap) for adolescents and adults. Vaccination not only protects individuals but also helps reduce the risk of outbreaks in the community, thereby safeguarding everyone.


Despite the known benefits, vaccine hesitancy presents challenges. In a 2019 survey, approximately 18% of parents expressed concerns about vaccine safety, which can delay immunization efforts and prolong the cycle of infection. Education campaigns are vital in dispelling myths and promoting high vaccination rates, ultimately shielding vulnerable populations.


Final Thoughts


The hidden dangers of pertussis emphasize the need for awareness, prompt diagnosis, and vaccination. Understanding the symptoms, potential complications, and preventive measures empowers individuals and communities to effectively combat this preventable disease.


Ongoing public health initiatives, along with community education, are crucial for creating a safer environment, particularly for those most at risk, such as infants and individuals with weakened immune systems. By recognizing the risks associated with pertussis and committing to preventive strategies, we can take important steps toward safeguarding collective health and well-being.


Eye-level view of a vaccination clinic setup with syringes and medical supplies
Setting of a vaccination clinic promoting immunization against whooping cough.

Each person's contribution is vital in ensuring that we avoid the serious consequences of pertussis in our communities. Let us unite in the effort to keep ourselves and each other safe.


References:


  • Zatovkaňuková, P., & Slíva, J. (2024). The potential dangers of whooping cough: a case of rib fracture and pneumothorax. BMC Infectious Diseases, 24, Article number: 1293.

    • This case report discusses a 48-year-old woman who developed a cough-induced rib fracture and recurrent pneumothorax due to pertussis, highlighting severe complications in adults.

      BMC Infectious Diseases

  • Gopal, D. P., Barber, J., & Toeg, D. (2019). Pertussis (whooping cough). The BMJ, 364, l401.

    • This article reviews the management of pertussis, emphasizing its mimicry of viral upper respiratory infections and the importance of considering it in differential diagnoses.

      BMJ

  • Demirhan, S., & Ogle, M. (2024). Pertussis (Whooping Cough). Pediatric Care Online, American Academy of Pediatrics.

    • This reference outlines the clinical presentation of pertussis in infants, noting complications such as pneumonia, apnea, cyanosis, pulmonary hypertension, seizures, encephalopathy, and death.

      AAP Publications

  • Scarpino, S. V., & Dimitrov, N. B. (2015). Asymptomatic transmission and the resurgence of Bordetella pertussis. BMC Medicine, 13, 146.

    • This study explores the role of asymptomatic transmission in the resurgence of pertussis, discussing its implications for public health and infection control.

      BMC Medicine

  • Cherry, J. D. (2015). Pertussis: challenges today and for the future. Pediatric Annals, 44(9), e218-e222.

    • This article discusses the resurgence of pertussis, challenges in diagnosis, and the need for improved vaccines to address waning immunity.

  • Klein, N. P., Bartlett, J., Rowhani-Rahbar, A., Fireman, B., & Baxter, R. (2012). Waning protection after fifth dose of acellular pertussis vaccine in children. The New England Journal of Medicine, 367(11), 1012-1019.

    • This study examines the decline in vaccine-induced immunity over time, contributing to increased susceptibility to pertussis in later childhood.

  • Mooi, F. R., van Loo, I. H., & King, A. J. (2001). Adaptation of Bordetella pertussis to vaccination: a cause for its reemergence? Emerging Infectious Diseases, 7(3 Suppl), 526-528.

    • This research explores how genetic changes in B. pertussis may contribute to its resurgence despite vaccination efforts.

  • Winter, K., Glaser, C., Watt, J., & Harriman, K. (2014). Pertussis epidemic—California, 2014. Morbidity and Mortality Weekly Report, 63(48), 1129-1132.

    • This report provides data on a significant pertussis outbreak, discussing factors contributing to its spread and public health responses.

  • Clark, T. A. (2014). Changing pertussis epidemiology: everything old is new again. The Journal of Infectious Diseases, 209(7), 978-981.

    • This article reviews shifts in pertussis epidemiology, including increased incidence in certain age groups and potential reasons for these changes.

  • Wendelboe, A. M., Van Rie, A., Salmaso, S., & Englund, J. A. (2005). Duration of immunity against pertussis after natural infection or vaccination. The Pediatric Infectious Disease Journal, 24(5 Suppl), S58-S61.

    • This study compares the duration of immunity following natural infection versus vaccination, with implications for booster vaccination strategies.


 


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