Whooping Cough
Everything about the causes, symptoms, and treatments of this bacterial respiratory infection.
Symptoms and Causes
Whooping cough (pertussis) is a bacterial infection caused by Bordetella pertussis, which affects the upper respiratory tract—namely, the nose, mouth, paranasal sinuses, pharynx, and larynx. It manifests as sudden, violent fits of dry coughing.
Pertussis is transmitted from person to person through airborne droplets (Pflugge droplets), secretions expelled when speaking, breathing, coughing, or sneezing. The contagious period begins with the first symptoms, which resemble those of a common cold, and may last up to four weeks after the onset of coughing if no treatment is administered. This period is reduced to approximately five days when antibiotic therapy is started, although the infection may persist in the body for six to ten weeks.
In adults and children, the prognosis of whooping cough is generally good, and most patients recover without sequelae. However, it is a serious disease for newborns and infants.
Symptoms
The most common symptoms of whooping cough are:
- Cold-like signs for one or two weeks: nasal congestion, runny nose, sneezing, and low-grade fever.
- Intense, dry, and consecutive coughing fits.
- Seizures.
- Coughing spasms ending with a deep, prolonged inspiration caused by lack of air in the lungs, often accompanied by a characteristic high-pitched "whoop" sound that gives the disease its name.
- Cyanosis (bluish discoloration) during coughing fits.
- Fatigue.
- Anxiety.
Causes
Whooping cough is caused by infection with the bacterium Bordetella pertussis.
Risk Factors
The main risk factors for whooping cough are:
- Lack of vaccination.
- Close contact with an infected person or carrier.
- Being under one year of age.
- Pregnancy.
- Living in overcrowded conditions.
Complications
Complications of whooping cough in infants under one year of age can be severe. The most significant include:
- Pneumonia.
- Bronchitis.
- Otitis.
- Seizures.
- Apnea.
- Dehydration.
- Pertussis encephalopathy: brain damage caused by oxygen deprivation (hypoxia).
- Rectal prolapse: protrusion of rectal mucosa through the anus.
- Death.
In most other patients, the disease resolves without lasting effects. When complications occur, the most frequent are:
- Rib fractures.
- Abdominal hernia.
- Rupture of blood vessels in the skin or eyes.
- Nosebleeds.
Prevention
The best way to prevent whooping cough is through vaccination. In Spain, the immunization schedule recommends the following doses:
- Pregnant women: From week 27 of gestation, preferably at 27 or 28 weeks.
- Infants: At 2, 4, and 11 months.
- Booster: At 6 years of age.
- Adults: A booster at 65 years of age for those vaccinated in childhood.
- Unvaccinated adults should complete a five-dose immunization schedule.
Which Specialist Treats Whooping Cough?
Whooping cough is usually diagnosed in family and community medicine or pediatrics, as it is common in children. In some cases, specialists in otorhinolaryngology, internal medicine, or pulmonology may also be involved in treatment.
Diagnosis
Diagnosing whooping cough can be challenging, as it is often mistaken for the common cold during the early stages. When coughing fits begin, clinical evaluation of the symptoms is usually sufficient to determine the presence of the disease.
To confirm the diagnosis, the following tests may be performed:
- Nasopharyngeal culture: A sample is taken from the area where the throat and nose meet for laboratory analysis. After about five days, the culture is examined under a microscope to detect the presence of Bordetella pertussis.
- Blood Tests: Performed to assess the patient’s overall health status. An increased white blood cell count indicates infection.
- Chest X-ray: Used to obtain images of the lungs to identify possible complications such as pneumonia. The X-ray can also reveal inflammation or fluid accumulation.
Treatment
Treatment for whooping cough is primarily pharmacological, as antibiotics help combat the bacteria. The most commonly used are macrolides (azithromycin as first-line therapy, or clarithromycin and/or erythromycin).
Infants under one year of age or patients with complications are hospitalized for close monitoring, as they may require mechanical ventilation, intravenous parenteral nutrition, or suctioning of accumulated mucus.
Isolation is recommended until symptoms disappear to prevent transmission.
