This article will discuss the respiratory illness whooping cough that can occur in children, adolescents, and adults. Symptoms include fatigue and malaise, a low-grade fever, excessive tearing, red eyes, severe coughing, a “whooping” sound on inspiration, and vomiting after coughing.
What is whooping cough?
Whooping cough is caused by the bacteria Bordetella pertussis, which affects the respiratory systems of children, adolescents, and adults. Whooping cough has also been called the “100-day cough” because of its extended time course. The symptoms classically associated with whooping cough are a sudden, uncontrollable coughing spell (“paroxysmal cough”), a “whooping” sound on inspiration, and throwing up after a coughing fit. The course of the condition is generally divided up into three phases — catarrhal, paroxysmal, and convalescent phases. The symptoms of the condition generally change over the course of these phases. Whooping cough is highly contagious and generally spread through respiratory droplets. The DTaP or Tdap vaccines are used to prevent the spread of whooping cough.
You should visit your primary care physician within the next 24 hours. This disease is managed with prescription antibiotics, and it is important to get treated as soon as possible to avoid spreading the infection to others.
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Whooping cough symptoms
While whooping cough predominantly affects the respiratory system, the symptoms vary throughout the course of the illness. As previously discussed, the condition is generally divided into the catarrhal, paroxysmal, and convalescent stages. The catarrhal stage is the earliest and usually lasts one to two weeks. The paroxysmal stage is the longest portion, lasting about two months. The convalescent stage is when the condition is resolving and usually lasts one to two weeks. Symptoms of whooping cough are listed below.
- Fatigue and malaise: These begin within the first one to two weeks of the condition in the catarrhal phase.
- Low-grade fever: This often develops as the bacteria infect the individual and occurs during the catarrhal phase.
- Excessive tearing
- Red eyes
- Severe, uncontrollable coughing: This is the hallmark symptom of whooping cough. It begins during the paroxysmal phase.
- “Whooping” sound on inspiration: This sound, giving the condition its name, is generally heard after episodes of intense coughing fits as an individual forcefully breathes in. This sound is heard during the paroxysmal phase and is even more prominent in children with whooping cough due to the small size of their windpipes.
- Vomiting after coughing: Also known as post-tussive emesis, this can occur due to the forceful nature of the coughing fits. The intense contraction of the muscles of the thorax (the part of the body where the lungs are found) and the abdomen can cause you to vomit after a coughing fit.
Other symptoms seen in whooping cough are not directly caused by the pertussis bacteria but by the extended period of time you experience intense coughing fits:
- Subconjunctival hemorrhage: “Subconjunctival” describes the source of the bleeding, located beneath the conjunctiva, the thin membrane covering the surface of the eye. The increased force during coughing fits can lead to rupture of the very small, delicate blood vessels of the eye and cause this symptom.
- Development or worsening of an abdominal hernia: The contraction of abdominal muscles used in coughing increases the overall pressure within the abdomen. This increase in intra-abdominal pressure can force movement of organs through membranes within the abdomen. Hernias can be seen around the belly button, lower abdomen, or groin regions.
- Urinary incontinence: Involuntary leakage of urine may occur as the abdominal muscles are contracting during coughing fits. This contraction puts stress on the bladder which can cause the release of urine. This occurs when the force from coughing overcomes the force of the pelvic floor muscles and urinary sphincters working to keep urine from expelling.
It is important to make the diagnosis of whooping cough as early as possible to help you manage your symptoms as well as prevent the spread of infection. According to the CDC, whooping cough can be diagnosed clinically by the presence of a cough not explained by another condition that lasts at least two weeks along with the presence of one of the following: coughing fits, throwing up after coughing fits, or a “whooping” sound on inspiration. Other laboratory tests can also be used for the definitive diagnosis depending on what point of the illness you are experiencing:
- Respiratory culture: Respiratory secretions may be swabbed and cultured to look for the presence of the Bordetella bacteria during the first two weeks of the cough.
- Polymerase Chain Reaction: Also called PCR, this test is used alongside a culture from the respiratory system if the cough has been present for two to four weeks.
- Serology: Serology is a blood test used to detect antibodies, or the body’s natural defense mechanism, to the bacteria causing the infection. This test is used if the cough has been present for greater than four weeks.
Whooping cough causes
Whooping cough is caused by the bacteria Bordetella pertussis. The bacteria multiply in the respiratory tract over the course of seven to 10 days after the bug has lodged itself on the throat and nasal mucosa. This infection is highly contagious and is spread from person-to-person through the respiratory droplets expelled with the vigorous coughing spells that are characteristic of the condition. Prior to the introduction of vaccination in the 1940s, whooping cough often leads to death, especially among infants with the infection. The vaccine has significantly decreased the incidence and severity of pertussis in the U.S.
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Treatment options and prevention for whooping cough
Despite having the name “100-day cough,” studies show that most people with whooping cough experience a resolution of the infection in three to six weeks without any treatment. The CDC has provided recommendations with regards to administering antibiotics for people with whooping cough. These recommendations state that any person presenting with whooping cough within three weeks of the onset of the cough should receive treatment with antibiotics. The CDC also states that pregnant women, healthcare workers, and individuals with close contact to infants should receive antibiotic treatment if they present with cough suspicious for whooping cough. The preferred antibiotics for treatment are azithromycin or clarithromycin, both in the macrolide class of drugs.
The most significant intervention for the prevention of whooping cough is the vaccine. The modern-day form of the vaccine, called the “acellular” vaccine, was introduced in 1991. This form of the vaccine is given along with immunity for tetanus in diphtheria in the vaccine Tdap (tetanus, diphtheria, acellular pertussis). Most people do not have any side effects from this vaccine, however, 25 percent of children will experience redness where the shot was given or a short course of fever.
- Infants/children and vaccination: The vaccine schedule for Tdap starts at age 2 months and a total of 5 vaccines given in total and ending around age 6.
- Adolescents and vaccination: Adolescents 11 to 18 years of age should receive a booster vaccine for Tdap.
- Pregnant women and vaccination: Pregnant women should also receive the vaccination at 27 to 36 weeks as this immunity can be transferred to the developing baby.
Even if an individual has been vaccinated against whooping cough, he or she should receive prophylactic antibiotics after coming in direct contact with someone who has an active pertussis vaccine.
When to seek further consultation for whooping cough
An important aspect of preventing the spread of whooping cough is early detection. Any individual who is experiencing a persistent cough, fever, or a whooping sound on inspiration should consult his or her healthcare provider as soon as possible. Infants and elderly are particularly at risk of complications from the condition and should be under the careful care of a physician.
Questions your doctor may ask to determine whooping cough
- How severe is your fever?
- Has your cough gotten better or worse?
- Is your cough constant or come-and-go?
- How severe is your cough?
- How long has your cough been going on?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
- Pertussis (whooping cough). Centers for Disease Control and Prevention. Updated July 11, 2018. CDC Link
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- Centers for Disease Control and Prevention (CDC). Pertussis--United States, 1997-2000. MMWR Morb Mortal Wkly Rep. 2002;51(4):73-6. PubMed Link
- Kwantes W, Joynson DH, Williams WO. Bordetella pertussis isolation in general practice: 1977-79 whooping cough epidemic in West Glamorgan. J Hyg (Lond). 1983;90(2):149-158. PubMed Link
- Whooping cough (Pertussis). Centers for Disease Control and Prevention. Updated August 14, 2015. CDC Link