Whooping cough: medical terminology and clinical overview

Whooping Cough, known medically as Pertussis, is a serious respiratory tract infection that attacks the lining of the breathing passages, especially the windpipe area (Whooping 2006).

Caused by Bordetella Pertussis bacteria, whooping cough is extremely contagious and can be fatal, however widespread vaccination has made the disease rare in the United States (Whooping 2006). Whooping cough gets its name from the patient's labored inhalation that causes the individual to make a high-pitched whooping sound when breathing (Whooping 2006).

Symptoms of whooping cough include prolonged, violent coughing spasms that usually cause thick mucus and difficult breathing. The disease is spread by infected respiratory droplets from the coughs and sneezes of infected individuals (Whooping 2006). The most susceptible population are infants younger than 1-year, and they often have the most severe symptoms, however adolescents and adults may have milder cases that are usually mistaken for bronchitis, thus they may spread the disease because they are unaware that they are infected with the bacteria (Whooping 2006).

Symptoms, which usually begin within 3-12 days after exposure to an infected person, include nasal congestion, runny nose, sneezing, mild fever, and watery eyes (Whooping 2006). These symptoms may last for up to two weeks, and may be mistaken for the common cold. After the two-week period, a dry, hacking cough begins that progresses to prolonged coughing spasms, during which the tongue may protrude, the eyes may bulge and the patient's complexion becomes discolored (Whooping 2006). Moreover, mucus is produced and vomiting may occur. The coughing spasms are usually followed by noisy "whooping" inhalations, however infants younger than 3 months and adults may not experience this characteristic when breathing (Whooping 2006). Although most contagious during the early stage, it is possible that the illness may be spread until the infection subsides completely (Whooping 2005).

Once the bacteria is inside the airways, it multiplies and produces toxins that interfere with the respiratory tract's ability to "sweep away" germs (Whooping 2005).

Uncontrollable coughing is caused by the thick mucus deep inside the airways. The bacteria causes inflammation that narrows the breathing tubes in the lungs, and it is this narrowing that leaves the individual gasping for air, "sucking in air with a high-pitched "whoop" after a fit of coughing" (Whooping 2005).

Most people believe that whooping cough has been eradicated, much like polio, due to vaccination campaigns, however it has not been completely eradicated (Whooping 2005). Actually, the number of reported cases in the United States has been increasing during recent years. The historic low was about 1,000 cases in 1974, yet in 2004, more than 25,000 cases were reported, marking the largest number of cases since the 1950's (Whooping 2005). Experts blame this rise on the fact that the vaccine children receive eventually wears off, thus leaving adolescents and adults susceptible to infection when there is an outbreak. Moreover, children are not completely immune until they receive at least three shots of vaccine, therefore children 6 months and younger are at the greatest risk of infection (Whooping 2005).

Medical attention is advised if prolonged coughing spells exist, particularly if the spells cause the patient to turn red or blue and are followed by vomiting, or occur with a whooping sound when inhaling (Whooping 2005). Moreover, parents should call their physician if their child has been exposed to an infected individual, even if the child has been vaccinated, because treatment with antibiotics or a booster of whooping cough vaccine may be needed to prevent infection (Whooping 2005).

In its early stages, whooping cough can be difficult to diagnose because the signs and symptoms are common to other respiratory illnesses, such as the flu, a cold or bronchitis (Whooping 2005). Often, physicians are able to diagnose the illness by listening to the cough, however medical tests may be required to confirm the diagnosis.

One such test is a nose and/or throat culture, in which a nose or throat swab or suction sample is taken and then sent to a laboratory where it is cultured and/or otherwise tested for whooping cough bacteria (Whooping 2005). A blood sample may be sent to a laboratory to check for high white blood cell count, because a high white cell count usually indicates an infection or inflammation is present, however this is a general test and not a specific test for whooping cough (Whooping 2005). Often, a chest x-ray is taken to check for the presence of fluid on the lungs, which occurs when pneumonia complicates whooping cough and other respiratory infections (Whooping 2005).

Because it is so highly contagious, once whooping cough is diagnosed, the patient will be advised to avoid contact with other people during his/her recovery, and must have doctor's approval before returning to work or school (Whooping 2005).

Moreover, physicians must report any cases of diagnosed whooping cough to health officials who record whooping cough outbreaks (Whooping 2005).

Adults and adolescents generally recover from whooping cough without serious complications, although excessive coughing may result in a bruised or broken rib or a hernia, (abnormal protrusion of a loop of intestine through a weak area of abdominal muscle), and it is not uncommon for children to injure the muscles in the chest wall or develop a hernia as well (Whooping 2005). However complications from whooping cough in infants, particularly those under the age of 2, are more severe and may include: ear infections, pneumonia, slowed or stopped breathing, dehydration, seizures, and brain damage (Whooping 2005). Therefore, because infants and toddlers are at greater risk of serious complications from whooping cough, they are more likely to require medical treatment in a hospital setting. For infants under 6 months of age, whooping cough life-threatening complications (Whooping 2005).

Treatment for whooping cough varies, according to the age of the infected individual and the severity of signs and symptoms. For older children, adolescents and adults, bed rest together with an antibiotic, such as azithromycin or erythromycin, is usually prescribed (Whooping 2005). Antibiotics will not cure whooping cough, however they can shorten the duration of the illness and the period of communicability. A slow response to antibiotic therapy may make it necessary to extend the antibiotic treatment for two weeks or longer (Whooping 2005). Antibiotics are not very effective if the illness has progressed to the stage of severe coughing spells, yet they usually are still used.

There is not much available for symptom relief, since over-the-counter cough medicines have little effect on whooping cough (Whooping 2005). A typical case of whooping cough generally lasts for about six weeks, but may last longer (Whooping 2005).

The majority of infants younger than 2 months, as well as many older babies, who are diagnosed with whooping cough are admitted to the hospital in an effort to decrease the risk of serious complications, and while most infants overcome the illness without lasting effects, the risks remain until the infection is cleared (Whooping 2005).

In a hospital setting, a child will typically receive intravenous antibiotics to treat the infection and perhaps corticosteroid drugs, which aid in reducing inflammation in the lungs (Whooping 2005). In addition, the airway may also be suctioned to remove mucus that is blocking it, and the child's breathing is carefully monitored for the need of extra oxygen (Whooping 2005). To prevent the infection from spreading, the child will be isolated from others, and intravenous fluids may be administered if he/she is unable to take liquids or food, and to ensure rest, prescription sedative may be given (Whooping 2005).