Pertussis without apparent cough in a disabled girl with a tracheostomy

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Pertussis (whooping cough) is a highly contagious respiratory infection caused by Bordetella pertussis.
• Classic symptoms include severe coughing fits followed by a characteristic 'whooping' sound.
• Clinical presentation and disease course in disabled children remain poorly understood.

Observation:

• A case involving a disabled girl with a history of tracheostomy and laryngotracheal separation was observed.
• The patient presented with increased tracheal secretions and required hospitalization.
• Notably, the patient did not exhibit the hallmark cough associated with pertussis.

Findings:

• Sputum Gram stain revealed numerous short, gram-negative rods, suggestive of an unusual bacterial infection.
• A nucleic acid amplification test confirmed the presence of Bordetella pertussis.
• The patient demonstrated clinical improvement following treatment with azithromycin.

Implications:

• Pertussis can manifest atypically in disabled children, lacking classic symptoms like prolonged coughing.
• Healthcare providers should consider pertussis in disabled children with respiratory symptoms, even without a cough.
• Early diagnosis and treatment are crucial for managing pertussis in this population.