Clinical history of whooping cough
Table 1: Typical phases of whooping cough and associated clinical features
Good Practice TipDoctors must notify the public health unit once the diagnosis of whooping cough is suspected. This is required under the NSW Public Health Act 1991. Ring your public health unit
(range 5-21 days)
(transmission is via inhalation of aerosolised droplets from an infectious case)
Intermittent, dry, irritating cough
symptoms often worse at night
|Infectious for first 3 weeks after onset or until after 5 days of antibiotic treatment (usually macrolides)|
||Paroxysms of coughing.|
||1-6 weeks, sometimes longer.
||Cough gradually improves.
||A few years
||No symptoms but immunity wanes after natural infection. Subsequent episodes may be milder.
Table 2: Clinical features of whooping cough vary with the patient's age
|Neonates and infants
- Parents may complain their infant gags, gasps, chokes, turns blue or stops breathing.
- Feeding difficulties are common.
- Coughing paroxysms, post-tussive whoop or post-tussive vomiting are often absent.
- Convalescent phase is often prolonged.
|The youngest infants have the greatest incidence of complications from whooping cough which include: |
- feeding problems & weight loss
- sudden death
|Toddlers and older children
- Prolonged paroxysms of coughing on a single breath.
- Post-tussive whoop or post-tussive vomiting are common.
- Prior to coughing paroxysms, the child may be relatively well.
- During paroxysms, the child is extremely distressed and then is exhausted afterwards.
|Complications are less frequent in older patients. |
- weight loss
- rib fractures or strained chest wall muscles from severe coughing
|Teenagers and adults
- A nonspecific protracted cough is common.
- Only few have post-tussive whoop or post-tussive vomiting.
Good Practice Tip
Don't dismiss whooping cough just because your patient is fully immunised. Vaccination is only 85% effective and immunity wanes after vaccination. Most cases in NSW are in people who have been vaccinated
- Mild fever is sometimes present.
- There may be petechial haemorrhages on the upper body and subconjunctival haemorrhages.
- Chest auscultation is often normal.
Good Practice Tip
If you suspect whooping cough on clinical grounds, ask the patient not to go near babies or pregnant women. Don't wait for results of tests!
Differential diagnosisOther infective causes of prolonged coughing illness include:
- Bordetella parapertussis
- Bordetella bronchiseptica
- Mycoplasma pneumonia
- Chlamydia trachomatis
- Chlamydophila pneumonia
- Respiratory syncytial virus