Pneumothorax in Infants with Suspected Pertussis

Clinical Presentation and Diagnosis

The American Academy of Pediatrics recognizes pneumothorax as a complication of severe pertussis in infants, resulting from intense pressure generated during paroxysmal coughing episodes 1
Infants with pertussis typically present with atypical disease features before pneumothorax develops, including apneic spells, paroxysmal coughing, post-tussive vomiting, and worsening symptoms at night 1
Key symptoms to recognize include sudden deterioration in respiratory status, unilateral decreased chest expansion, dullness to percussion, reduced or absent breath sounds, cyanosis, and increased work of breathing with tachypnea and retractions 1, 2
Oxygen saturation below 92% indicates severe disease requiring urgent intervention 2

Chest radiograph (anteroposterior view) is used to identify air in the pleural space 2
Ultrasound must be used to confirm the presence of pleural air and guide any intervention 2
Oxygen saturation monitoring is crucial, with levels below 92% indicating severe disease 2

Azithromycin is the preferred first-line antibiotic for infants with pertussis, regardless of disease stage, according to the American Academy of Pediatrics 1, 3
Macrolide antibiotics reduce duration and severity of symptoms when given early 1
Supportive care, including monitoring for apneic episodes, is the mainstay of management 1
Hospital admission is mandatory for infants under 6 weeks with pertussis, typically requiring 2-6 weeks of hospitalization depending on complications 1

Respiratory droplet precautions are required until 5 days of appropriate antibiotic treatment are completed, as recommended by the Centers for Disease Control and Prevention 4, 3
All household and close contacts must receive macrolide antibiotic prophylaxis for 14 days, regardless of age and vaccination status, according to the American Academy of Pediatrics 5
Erythromycin, azithromycin, and clarithromycin are recommended for prophylaxis, with specific dosing regimens 5