Infant Pertussis Diagnosis and Management

Clinical Presentation

Pertussis begins with an insidious onset of catarrhal symptoms including nasal congestion, runny nose, mild sore throat, mild dry cough, and minimal or no fever, lasting approximately 1-2 weeks, according to the Centers for Disease Control and Prevention (CDC) 1, 2
Infants may present with atypical disease, initially showing apneic spells and minimal cough or other respiratory symptoms, as reported by the CDC 1, 3
The initially intermittent cough becomes paroxysmal, characterized by a succession of coughs without inspiration, as described by the CDC 2
Paroxysms of cough typically increase in frequency and severity as the illness progresses, usually persisting for 2-6 weeks, according to the CDC 2
Coughing episodes occur more frequently at night, as noted by the CDC 2
Post-tussive vomiting is a common symptom in infants with pertussis, as reported by the CDC 2

Primary or secondary bacterial pneumonia is a potential complication of pertussis, as reported by the CDC 2
Pneumothorax from severe coughing is a possible complication, according to the CDC 2
Seizures and hypoxic encephalopathy are potential neurologic complications of pertussis, as noted by the CDC 2
Substantial weight loss and sleep disturbance are common complications of pertussis, as reported by the CDC 2
Epistaxis, subconjunctival hemorrhage, and subdural hematoma from pressure generated by severe coughing are potential complications, according to the CDC 2

Age less than 6 months, with highest risk in those under 2 months, is a significant risk factor for severe disease, as reported by the CDC 4, 5
Unvaccinated or incompletely vaccinated status increases the risk of severe disease, according to the CDC 2
Prematurity (gestational age <37 weeks) is a risk factor for severe disease, as noted by the CDC 5
Hispanic ethnicity (observed in mortality studies) is a potential risk factor for severe disease, as reported by the CDC 5

Macrolide antibiotics are the treatment of choice for pertussis, as recommended by the CDC and the American Academy of Pediatrics 6, 7
Azithromycin is the preferred first-line agent for infants, according to the CDC and the American Academy of Pediatrics 7
Early administration of antibiotics can reduce the duration and severity of symptoms and decrease the period of communicability, as reported by the CDC 6

Vaccination is the most effective preventive strategy against pertussis, as recommended by the CDC and the American Academy of Pediatrics 6, 7
DTaP vaccine is recommended at ages 2, 4, 6, 15-18 months, and 4-6 years, according to the CDC 6
Macrolide antibiotics should be administered to close contacts of pertussis patients, as recommended by the CDC and the American Academy of Pediatrics 7

Infants under 6 weeks of age with pertussis typically require hospital admission for 2-6 weeks, with duration depending on severity of symptoms and complications, according to the Centers for Disease Control and Prevention (CDC) 8
Young infants have the highest risk for severe disease and death from pertussis, with a case-fatality ratio of 1.8% among infants aged <2 months, as reported by the CDC 9
Prematurity (gestational age <37 weeks) and Hispanic ethnicity are risk factors for severe disease requiring prolonged hospitalization, as noted by the CDC 9

Pneumonia occurs in approximately 13% of infants with pertussis and significantly extends hospital stay, according to the CDC 9
Substantial weight loss and feeding difficulties are complications that may require longer hospitalization, as reported by the CDC 8

Supportive care is the mainstay of management during hospitalization, including monitoring for apneic episodes, particularly at night when paroxysms may increase, as recommended by the CDC 8