Haemorrhage, hyponatraemia and more than just a hack

Area of Science:

• Infectious Diseases
• Respiratory Medicine
• Microbiology

Background:

• Pertussis, or whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis.
• While often considered a childhood illness, pertussis can affect individuals of all ages, including adults.

Observation:

• A previously healthy 43-year-old solicitor presented with a 9-day history of severe, paroxysmal cough productive of yellow sputum.
• Symptoms included sore throat, myalgia, bilateral subconjunctival hemorrhages, multiple daily cough syncopes, and one episode of hematemesis.
• Initial presentation and treatment were for a presumed atypical chest infection, with hyponatremia also noted.

Findings:

• Blood cultures and atypical respiratory screens were performed.
• Bordetella pertussis was eventually confirmed, despite Legionella being a primary differential diagnosis.
• This diagnosis was unexpected given the patient's age and initial presentation.

Implications:

• This case underscores the importance of considering Bordetella pertussis in the differential diagnosis of severe cough illness in adults.
• It highlights the potential for severe clinical manifestations of pertussis in immunocompetent adults.
• Increased awareness and diagnostic vigilance for adult pertussis are crucial for effective public health management.