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Clinical Findings and Management of Pertussis
Ilaria Polinori1, Susanna Esposito2
1Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy.
Insights
Pertussis, a vaccine-preventable illness, is re-emerging due to waning immunity and vaccine limitations. Early diagnosis and treatment are crucial, especially for children, but broad vaccination coverage is key to control Bordetella pertussis circulation.
Area of Science:
- Infectious Diseases
- Vaccinology
- Pediatrics
Background:
- Pertussis (whooping cough) is a highly contagious, endemic disease causing significant childhood illness and death.
- Recent years have seen a resurgence of pertussis, prompting investigations into its causes.
- Suboptimal vaccine efficacy and waning immunity are suspected contributors to this re-emergence.
Purpose of the Study:
- To review the current understanding of pertussis epidemiology and clinical presentation.
- To highlight the challenges in diagnosing pertussis, particularly atypical forms.
- To emphasize the importance of prompt diagnosis, treatment, and vaccination for disease control.
Main Methods:
- Literature review of pertussis resurgence, clinical features, diagnosis, and treatment.
- Analysis of factors influencing clinical presentation, including vaccination history and patient demographics.
- Discussion of diagnostic challenges and therapeutic strategies, focusing on macrolide antibiotics.
Main Results:
- Pertussis presents with diverse clinical forms, influenced by age, immunization status, and treatment.
- Early diagnosis is critical for managing complications, especially in children, but remains clinically challenging.
- Macrolides are the primary treatment, reducing cough duration and severity.
Conclusions:
- Effective control of Bordetella pertussis relies on prompt diagnosis, appropriate antibiotic therapy, and high vaccination coverage.
- Addressing suboptimal vaccine efficacy and duration of protection is essential to curb the pertussis resurgence.
- Continued research and public health efforts are needed to combat this persistent infectious threat.
Abstract:
Pertussis is an endemic highly infectious vaccine-preventable disease. The disease is a major cause of childhood morbidity and mortality. In the most recent years, the re-emergence of pertussis occurred, and many efforts were done to identify the possible causes. Certainly, more effective laboratory methods have a role in making the diagnosis easier. However, sub-optimal efficacy of available vaccines as well as their limited duration of protection could explain the resurgence of the disease. Many forms and clinical features of the disease, ranging from the most classical to atypical and very nuanced forms, have been reported. There are many aspects that influence the clinical features of the pathology, such as a previous immunization or infection, patient's age, gender and antibiotic treatment. A prompt suspect and a rapid diagnosis of pertussis is fundamental for an appropriate clinical management and for preventing pertussis complications, especially in children. However, under a clinical point of view, pertussis is often difficult to be diagnosed. A prompt treatment may decrease the duration and severity of cough; the cornerstone drugs are the macrolides. Although prompt diagnosis and effective therapy are important for pertussis control, only with a broad vaccination coverage will be possible to reduce circulation of Bordetella pertussis.
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