Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0043167 (pertussis)
 19,595 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate Bordetella pertussis as a cause of persistent cough in adults, we examined 201 patients who had a cough for 2-12 weeks and no pulmonary disease. We obtained the following at presentation: medical history, chest radiograph, respiratory function measurement, nasopharyngeal aspirate for polymerase chain reaction (PCR), nasopharyngeal swab specimen for culture, and a blood sample (acute serum). Four weeks later a second blood sample (convalescent serum) was obtained. Control sera were obtained from 164 age-matched healthy blood donors with no history of cough during the previous 12 weeks. Four patients were B. pertussis culture-positive; 11 (including the culture-positive patients) were B. pertussis PCR-positive; and 33, including 10 of the 11 PCR-positive patients, had serological evidence of recent B. pertussis infection. Pertussis-positive and -negative patients could not be discriminated by a history of cough. We conclude that B. pertussis infection is a common cause of persistent cough in adults. This is of concern, because these patients may be B. pertussis reservoirs from which transmission may occur to infants, in whom the disease can be devastating.
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PMID:Bordetella pertussis and chronic cough in adults. 1052 69

In late 1999, an outbreak of Bordetella pertussis occurred in a small town in North-West Western Australia. We undertook an investigation to describe the outbreak and to identify strategies to minimise the impact of future pertussis outbreaks in Australia. In November, people with respiratory symptoms were reviewed in an emergency pertussis clinic, which provided antibiotic treatment or prophylaxis. We conducted a school survey to enhance case ascertainment and followed up those attending the clinic by telephone. Fifty-nine cases of confirmed or probable B. pertussis infection were identified from 124 households (482 persons). Ages ranged from 5 months to 67 years, with children aged 9 to 11 years comprising 24 cases (41%). Early missed diagnoses and a school camp in September attended by 2 symptomatic children appeared to facilitate spread of infection, with the outbreak peak occurring in November. From immunisation records, childhood vaccine coverage in this sample was estimated at 96 per cent. All 21 cases of pertussis among the group under 10 years of age were at least partially vaccinated. There was only one laboratory confirmed case in the high-risk, under one-year of age category. Even in highly immunised populations periodic pertussis outbreaks are inevitable reflecting a vaccine efficacy of about 80 per cent and waning immunity with increasing age. Prevention of pertussis outbreaks depends not only on high vaccination coverage among young children but also early diagnosis and management of cases and their contacts. Clinicians should consider pertussis in the differential diagnosis of persistent cough illness in people of all ages--even those previously immunised.
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PMID:The outbreak that had to happen: Bordetella pertussis in north-west Western Australia in 1999. 1122 80

Cough is one of the most common complaints causing patients to seek medical attention, and chronic cough, defined as a cough period of at least three weeks, accounts for more than a third of referrals to a chest physician. Cough is an important factor in the spread and survival of microorganisms, but until recently little attention has been given to Bordetella pertussis (B. pertussis) in patients with chronic cough. This review summarizes the B. pertussis diagnostic methods--culture--polymerase chain reaction (PCR), and serology--and surveys the literature on B. pertussis and chronic cough in adults. There is growing evidence that B. pertussis is an important cause of persistent cough in adults; thus prevalence of pertusssis of 12.4-26% has been reported in studies from US, Australia and Germany. Recently we found evidence of pertussis as the cause of chronic cough in 16% of otherwise healthy adults in Denmark. Therefore, patients with chronic cough should be examined for B. pertussis infection. The demonstration of B. pertussis in an adult patient with chronic cough has two advantages: 1) the patient can be reassured that symptoms will disappear spontaneously, why more or less invasive examinations and empirical therapeutic trials can be omitted, 2) the source of infection can be eradicated, and contact persons, particularly non vaccinated infants in whom pertussis might be very severe, can be treated in order to avoid or attenuate clinical symptoms.
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PMID:Bordetella pertussis in the aetiology of chronic cough in adults. Diagnostic methods and clinic. 1141 22

In non-smokers the underlying causes for chronic persistent cough (CPC) e.g. chronic cough without diagnostic chest X-ray or pulmonary function test--are usually as follows: several common upper airways diseases, bronchial (cough type) asthma, gastrooesophageal reflux or treatment with an ACE (angiotensin converting enzyme)--inhibitor. In 10% of CPC however the cause remains uncertain. We report a 30 year old non-smoker with severe coughing and repeated vomiting for two months. No laboratory or technical data could be collected suggestive of a common cause of CPC: Upper airways disease, bronchial flow limitation or hyperresponsiveness, ACE inhibitor medication, B. pertussis infection, gastrooesophageal reflux disease (by 24 hours pH-probe) were ruled out. Fiberbronchoscopic findings remained unremarkable, except for the bronchial biopsy specimen, which showed moderate eosinophilic inflammation of the mucosa and marked thickening of the subepithelial layer. Since the cough was non-productive, sputum induction with 3 ml nebulised 3% NaCl solution was performed. 28% of the granulocytes were eosinophil stained. A low quality morning sputum (< 1 ml) showed 21% eosinophilia. Thus, the diagnosis of eosinophilic bronchitis was established. 400 micrograms budesonide dry powder inhalations b.i.d. for one week resolved the cough, treatment was stopped after three weeks. No recurrence was seen two months later. Both the cough type asthma and the eosinophilic bronchitis could represent a form fruste of classical bronchial asthma beyond wheezing or dyspnoea, but with the common main symptom: cough. Since hyperresponsiveness and cough are phenotypic hallmarks of cough variant asthma, in eosinophilic bronchitis--beside cough--another two features of asthma are present: eosinophilic inflammation of the mucosa along with sputum eosinophilia and subepithelial layer thickening. Not surprisingly, eosinophilic bronchial inflammation could be shown in patients with cough variant asthma as well, who--up to 56% during a four year-period--develop classic asthma. The long-term outcome of eosinophilic bronchitis is not known, however. Thus, asthma, cough variant asthma and cough due to eosinophilic bronchitis can mirror different phenotypes or phases of the same entity. CPC due to either the cough type asthma or the eosinophilic bronchitis is like asthma fast responding to inhalative steroids. (Induced) sputum staining should be added to the diagnostic armamentarium of CPC.
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PMID:[Eosinophilic bronchitis without asthma--an additional rare cause for chronic persistent cough (CPC)? A 30-year old patient with severe CPC due to eosinophilic bronchitis without asthma or hyperreactivity]. 1144 11

In June 2000, many cases with persistent cough were observed among inpatients and the staff of a ward for severely retarded. Some of them had symptoms suggestive of pertussis, such as whooping, post-tussive apnea. We performed a retrospective investigation to assess symptoms and serological findings suspicious of pertussis. There were a total of 14 cases of persistent cough over 3 weeks (4 to 9 weeks). 6 cases were inpatients and 8 were hospital staff. Of those, serological test for pertussis infection was performed in 10 cases and 6 cases were diagnosed as serologically confirmed pertussis. The other cases with persistent cough were also considered to be probable pertussis as they have had intensive contact with serologically confirmed cases. 12 cases were treated by antibiotics, but they all failed to respond. It was suggested that Bordetella pertussis must be considered as a causal organism of persistent cough even in adults. To prevent nosocomial transmission of pertussis, droplet precautions and macrolide treatment should be provided for patients with symptoms highly suggestive of pertussis.
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PMID:[A pertussis outbreak in a ward for severely retarded]. 1176 74

Although France has had a vaccination program for 40 years, since 1990, an increase in whooping cough cases with parent-infant transmission has been observed. This study prospectively assessed the frequency of Bordetella pertussis infection in adults who consulted general practitioners for a persistent cough without an evident diagnosis. Among 217 patients, 70 (32%) confirmed whooping cough cases were identified. One case was culture positive, 36 were polymerase chain reaction positive, and 40 had increases or decreases of > or =2-fold in anti-pertussis toxin IgG titer between serum samples collected during the acute and convalescent phases. The median duration of cough in confirmed cases was 49 days (range, 13-123 days). Of the patients, 60% reported vaccination, and 33% reported whooping cough in infancy. Pertussis should be considered for diagnosis of acute and chronic cough in adults. Future studies should evaluate the public health interest of booster doses of pertussis vaccine in adults.
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PMID:Evidence of Bordetella pertussis infection in adults presenting with persistent cough in a french area with very high whole-cell vaccine coverage. 1213 39

Diagnosis of Bordetella pertussis infection has been difficult due to the low sensitivity of culture. PCR tests have been shown to be more sensitive than culture, but the reported sensitivity of PCR is variable. We evaluated PCR product detection by using either agarose gel electrophoresis (PCR-gel) or dot blot hybridization with (32)P-labeled oligonucleotide probes, and we compared these methods to both culture and direct fluorescent-antibody (DFA) assays with microscopy for the detection of pertussis. This was done with 225 nasopharyngeal swab specimens collected in community clinic settings. The multiplexed PCR amplified the multiply repeated IS481 B. pertussis sequence and a sequence from the human globin gene as a positive control for specimen adequacy. Of 225 specimens, 179 were judged to be adequate for PCR analysis. Among the adequate specimens, 9, 4, and 10 were culture, DFA, and PCR-gel positive, respectively. The sensitivity of PCR-gel versus culture was 89% while the sensitivity of culture versus PCR-gel was 80%. DFA had the lowest sensitivity. Thirty specimens were positive by PCR with dot blot hybridization; no negative control specimens showed a signal above the background. Among the 79 (44%) adequate specimens with clinical data available, the rates of reported cough or persistent cough were similar for persons who were pertussis positive by each assay. The IS481 PCR, with either electrophoresis or dot blot hybridization, is a sensitive assay; however, at this time it cannot completely replace culture without an overall loss in sensitivity for the detection of pertussis. Further study is required to understand the clinical significance of B. pertussis PCR products detected by dot blot hybridization alone.
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PMID:Diagnosis of community-acquired pertussis infection: comparison of both culture and fluorescent-antibody assays with PCR detection using electrophoresis or dot blot hybridization. 1214 50

A study was conducted to determine the 1124 French Sentinel network general practitioners ability to consider pertussis as a cause of persistent cough among adults. Pertussis was rarely considered in the differential diagnosis of cough (6%). Factors associated with pertussis being considered included younger age, shorter cough duration, world health organization clinical definition for pertussis, and muscular chest pain.
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PMID:Is pertussis being considered as a cause of persistent cough among adults? 1459 33

Pertussis is increasing in frequency among children too young to be vaccinated and among adolescents and adults. This increase is due mainly to waning immunity among vaccinated individuals, who become susceptible during adolescence and adulthood and maintain the circulation of Bordetella pertussis. Infants are at highest risk of severe illness requiring hospital admission, complications and death. The clinical presentation in adolescents, adults and vaccinated individuals may be atypical, with paroxysmal cough of short duration or simply a persistent cough. Culture and polymerase chain reaction may be used to identify B. pertussis infection, but their sensitivity is high only in the early phase of the disease. Serologic tests are not standardized for the diagnosis of pertussis, and their clinical application is limited. Erythromycin is still considered in some countries to be the "gold standard" for therapy and prophylaxis; however, azithromycin and clarithromycin seem equally efficacious and are associated with fewer side effects.
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PMID:Diagnosis and management of pertussis. 1571 Sep 44

Since 2004, more than 25,000 cases of pertussis have been reported in the United States each year. Symptoms in adults range from mild cough to severe persistent cough with posttussive emesis. The characteristic paroxysmal cough (whoop) may be absent, and the diagnosis is often missed, especially when the cough is mild. The most useful diagnostic test to confirm pertussis is a polymerase chain reaction assay of a nasopharyngeal swab sample. Patients are infectious for three weeks from the cough onset. Antibiotic treatment, preferably with macrolide antibiotics, is indicated during this time for pertussis treatment and prophylaxis. In 2005, two new acellular pertussis vaccines were licensed: one (Boostrix) for patients aged 10 to 18 years and another (Adacel) for patients aged 11 to 64 years.
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PMID:The prevention and treatment of pertussis. 1740 82


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