Whooping Cough in Adults: A Series of Severe Cases
Bordetella pertussis is a gram-negative aerobic coccobacillus causing contagious respiratory tract disease called whooping cough. The virulence factors consist of pertussis toxin, filamentous hemagglutinin, fimbriae, lipooligosaccharide, and adenylate cyclase toxin. The disease causes a worldwide threat to public health despite a high vaccination coverage. The course of whooping cough in adults is frequently atypical, causing difficulty in diagnosis. In this report we present five patients hospitalized with Bordetella pertussis infection manifesting atypical and severe symptoms. The diagnosis was based on serological tests: serum concentration of specific antibodies against pertussis toxin and sputum cultures. We observed a wide spectrum of symptoms, from benign (sinus pain – 80 %, headaches – 20 %), through moderate (hemoptysis – 40 %; chest pain 60 %) to severe symptoms (cardiac arrhythmia – 40 %; syncope – 60 %). Bordetella pertussis infection can cause life-threatening complications and exacerbation of concomitant chronic diseases. Most vaccination programs cover only the first few months of life. Booster doses should be considered in adults, especially those immunocompromised or with pulmonary complications, but also in healthcare workers who are exposed to the contagion and also may spread the infection.
KeywordsBordetella pertussis Cardiac arrhythmia Chronic cough Syncope Vaccination booster Whooping cough
Conflicts of Interest
The authors have no conflicts of interest to declare in relation to this article.
- Bhatti MM, Rucinski SL Schwab JJ, Cole NC, Gebrehiwot SA, Patel R (2015) Eight-year review of Bordetella pertussis testing reveals seasonal pattern in the United States. J Pediatric Infect Dis Soc pii:piv079Google Scholar
- Centers for Disease Control and Prevention (2012) Pertussis epidemiology and prevention of caccine-preventable diseases, (12 ed). Atkinson W, Wolfe S, Hamborsky J, eds. Washington, DC: Public Health Foundation, pp 215–230Google Scholar
- Centers for Disease Control and Prevention (2015) The pink book: course textbook. Epidemiology and prevention of vaccine-preventable diseases (13 ed) U.S. Department of Health and Human Services, pp 261–278Google Scholar
- ECDC (2014) European Centre for Disease Prevention and Control. Annual epidemiological report. Vaccine-preventable diseases, ECDC Surveillance Report. Available from: http://www.ecdc.europa.eu; Accessed on 1 Sept 2015
- Sanz Moreno JC, De Ory Manchón F, González Alonso J, de La Torre JL, Salmerón F, Limia A, Tello O, Pachón I, Amela C, Vázquez J, de Ory F, Sanz JC; Grupo de Trabajo sobre Tos Ferina (2002) Laboratory diagnosis of pertussis. Role of serology. Enferm Infecc Microbiol Clin 20:212–218 (Article in Spanish)Google Scholar
- Scheller EV, Cotter PA (2015) Bordetella filamentous hemagglutinin and fimbriae: critical adhesins with unrealized vaccine potential. Pathog Dis 73(8):ftv079; doi: 10.1093/femspd/ftv079
- WHO (2015) Pertussis vaccines: WHO position paper. The Weekly Epidemiological Record (WER) No. 35 2015, 90(35):433–460 Available from: http://www.who.int/wer; Accessed on 15 Aug 2015