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Clinical Consultation: Pertussis in adults
Although pertussis is generally considered to be a pediatric illness, it is important to note that approximately 60% of cases of pertussis in the United States occur in adolescents and adults.1 The incidence of pertussis in adults in the United States increased 400% from 1990 to 2001.2-4
Should you considerpertussis when evaluatingcough in an adult?When should I consider the diagnosisof pertussis in an adult? Is the treatmentthe same as it is in children?
Although pertussis is generally considered to be a pediatric illness, it is important to note that approximately 60% of cases of pertussis in the United States occur in adolescents and adults.1 The incidence of pertussis in adults in the United States increased 400% from 1990 to 2001.2-4
Generally, a cough that lasts for more than 2 weeks should lead to the suspicion of pertussis. Pertussis should also be suspected in any adult with catarrhal symptoms, such as a runny nose, who is a close contact of a person with either suspected or confirmed pertussis because that person may be in the initial stage of infection.
The clinical case definition for pertussis is a cough lasting at least 2 weeks with one of the follow- ing: paroxysms of coughing, inspiratory whoop, or posttussive vomiting without other apparent cause. When a patient's symptoms are consistent with the case definition of pertussis, it should be reported to a local health department. In an outbreak of pertussis, to interrupt transmission in the community more quickly, public health professionals use a more sensitive and less specific definition that requires the case patient only to have a cough lasting at least 2 weeks.
In December 2005, the CDC published updated recommendations for the use of antimicrobial agents in the treatment of pertussis.1 The macrolide agents are preferred for the treatment of pertussis in persons aged 1 month and older. Azithromycin is preferred for infants younger than 1 month. Trimethoprim/sulfamethoxazole is an alternative to macrolides for persons older than 2 months.
References:
REFERENCES
1. Centers for Disease Control and Prevention. Recommended antimicrobial agents for treatment and postexposure prophylaxis of pertussis. 2005 CDC guidelines.
MMWR.
2005;54(RR14):1-16.
2. Guris D, Strebel PM, Bardenheier B, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults. 1990-1996.
Clin Infect Dis.
1999;28:1230-1237.
3. Centers for Disease Control and Prevention. Pertussis outbreak among adults at an oil refinery--Illinois, August-October 2002.
MMWR.
2003;52:1-4.
4.Dworkin MS. Adults are whooping, but are internists listening?
Ann Intern Med.
2005;142:832-835.
