Pertussis is commonly known as “Whooping Cough” which is a highly contagious respiratory infection caused by a type of bacteria called Bordetella pertussis. This bacteria attach to ciliated epithelial cells and release toxins that impair the upper respiratory system. One of the toxins secreted by this bacteria is called pertussis toxin which increases sensitivity to histamine leading to swelling and difficulty breathing. This toxin also impairs the cilia’s ability to clear mucus from the respiratory tract, leading to coughing fits. Coughing is an involuntary reflex controlled by the ANS that helps protect your lungs and airways. It's a natural response that happens automatically when something irritates your throat or lungs, like dust, mucus or smoke. While you can sometimes suppress a cough for a short period of time by holding your breath or swallowing, the urge to cough returns quickly because the body prioritizes clearing irritants from the airways. This is why you cough a lot when you’re sick.
The infection progresses through three stages; the Catarrhal stage, Paroxysmal stage and the Convalescent stage.
The Catarrhal Stage
This is the earliest and most contagious stage of pertussis where symptoms are very similar to an upper respiratory tract infection. Symptoms include:
Runny nose
Mild cough
Sneezing
Low-grade fever
The Paroxysmal Stage
This is the most severe stage of the infection where an individual experiences uncontrollable coughing fits that can last severe minutes. These coughing fits leave the person gasping for air which sounds like a “whooping” sound hence why this infection is also known as "Whooping Cough". These episodes can cause vomiting, exhaustion, and even temporary pauses in breathing (apnea) in infants.
The Convalescent phase
This is the last stage where the body begins to recover from the infection. Coughing fits decrease in severity and frequency, but a mild, lingering cough can persist for weeks or months as the airways heal. Fatigue may remain during this time, but the body steadily recovers.
While whooping cough can be a challenging illness to manage, early treatment with antibiotics and supportive care can significantly reduce its severity and prevent complications. Staying hydrated, getting plenty of rest, and avoiding irritants are key to easing symptoms. Vaccination (DTaP and Tdap) remains the best way to prevent whooping cough, protecting both individuals and communities from this contagious disease.
As future doctors, you’ll encounter symptomatic patients. Here’s what to do when you face a patient with pertussis.
Lauria, A. M., & Zabbo, C. P. (2022). Pertussis (whooping cough). National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519008/
CDC. (2024, July 2). Whooping Cough Vaccination. Whooping Cough (Pertussis). https://www.cdc.gov/pertussis/vaccines/index.html
This is a really good short and sweet overview of pertussis! I appreciate how clearly you’ve broken down the stages of the infection and explained the physiological mechanisms behind the symptoms. Highlighting the role of Bordetella pertussis toxins, particularly how they impair cilia function and increase histamine sensitivity, adds an important layer of understanding to why the coughing fits are so severe and persistent. The connection you made between the autonomic nervous system and the involuntary nature of coughing was also a great touch. Your emphasis on prevention through vaccination is critical. It’s important to remind the population that vaccines like DTaP and Tdap not only protect individuals but also reduce community spread, which is especially important for protecting infants who are at higher risk for complications.
ReplyDeleteHave you considered adding a brief note about how pertussis can impact different age groups, especially the risks for infants or the waning immunity in older adults, to further contextualize the importance of vaccination?
Wilkinson, K., Righolt, C. H., Elliott, L. J., Fanella, S., & Mahmud, S. M. (2021). Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine, 39(23), 3120–3130. https://doi-org.dml.regis.edu/10.1016/j.vaccine.2021.04.032