What is the etiology of pertussis. How does pertussis typically present. What are the treatment and management options for pertussis. What strategies can the interprofessional team use to improve care coordination and communication for patients with pertussis.

The Etiology of Pertussis

Pertussis, also known as whooping cough, is caused by the bacteria Bordetella pertussis and Bordetella parapertussis. These bacteria are highly contagious and spread through airborne droplets produced during coughing. Bordetella is the sole reservoir for the disease, and it can affect up to 100% of non-immune household contacts. Immunity from vaccination or prior infection wanes over time, with only 50% protection remaining 12 years after completing a vaccination series. Immunocompromised individuals can also contract Bordetella bronchiseptica, which typically affects animals and is known as “kennel cough.”

The Typical Presentation of Pertussis

Pertussis infection typically progresses through three distinct stages: the catarrhal phase, the paroxysmal phase, and the convalescent phase. The catarrhal phase, which lasts 1-2 weeks, is the most infectious stage and presents with symptoms similar to other upper respiratory tract infections, such as fever, fatigue, rhinorrhea, and conjunctival injection.

The paroxysmal phase follows the catarrhal phase and is characterized by paroxysms of a staccato cough, which can be triggered by cold or noise and are more common at night. During these paroxysms, patients may exhibit cyanosis, diaphoresis, or apnea, and they may develop post-tussive emesis, syncope, or apnea immediately following the paroxysm.

Finally, the convalescent phase is marked by a residual cough that can persist for weeks to months.

Treatment and Management Options for Pertussis

What are the treatment and management options available for pertussis? Pertussis is typically treated with antibiotics, such as macrolides (e.g., azithromycin, clarithromycin, or erythromycin), which can help reduce the duration and severity of symptoms if given early in the course of the disease. However, antibiotics do not prevent the characteristic paroxysmal cough. Supportive care, including maintaining hydration, managing fever, and providing oxygen if needed, is also essential in the management of pertussis.

Improving Care Coordination and Communication for Patients with Pertussis

How can the interprofessional team improve care coordination and communication for patients with pertussis? Effective coordination and communication within the interprofessional team, including physicians, nurses, pharmacists, and public health officials, are crucial for enhancing the care of patients with pertussis and improving patient outcomes. This may involve timely diagnosis, appropriate antibiotic treatment, effective patient and family education, and coordination of isolation and contact tracing efforts to prevent further transmission of the disease.

The Epidemiology of Pertussis

What is the epidemiology of pertussis? Reported pertussis cases have been increasing in the United States and worldwide. While pertussis was once a leading cause of infant morbidity and mortality, the introduction of the pertussis vaccine in the 1940s led to a sharp decline in cases, from 150,000-250,000 per year in the prevaccination era to just 1,010 cases reported in 1976. However, pertussis has since been on the rise, which is partially attributed to waning adolescent and adult immunity. Although pertussis remains primarily a pediatric disease, with the majority of cases occurring in infants and young children, adolescents and adults can also contract the disease and contribute to the increasing number of cases seen in recent decades.

The Pathophysiology of Pertussis

How does the pathophysiology of pertussis work? Bordetella pertussis is a gram-negative coccobacillus that adheres to ciliated respiratory epithelial cells, causing local inflammatory changes in the mucosal lining of the respiratory tract. The released toxins, such as pertussis toxin, dermonecrotic toxin, adenylate cyclase toxin, and tracheal cytotoxin, act locally and systemically, although the organism itself does not fully penetrate the respiratory tract and is rarely found in blood cultures.

The Importance of Vaccination

Why is vaccination against pertussis so important? Before the pertussis vaccine was developed, the disease was a major cause of infant morbidity and mortality. Although the introduction of the vaccine led to a significant decline in cases, pertussis has been on the rise in recent decades due to waning immunity. Maintaining high vaccination rates, both in children and adults, is crucial for preventing the spread of this highly contagious and potentially severe illness.