James D. Tutor, MD

Since pertussis has been considered to be primarily apediatric disease, it is often overlooked as a cause of cough inadults. However, the incidence has been increasing in adolescentsand adults, and these persons are the major reservoir forthe disease. The first stage of illness is characterized by flu-likesymptoms; then patients typically have paroxysms of severecoughing-several short dry coughs, followed by a deep inspiratoryeffort and the characteristic "whoop." The most commoncomplication of pertussis is pneumonia, but other complicationsinclude bronchitis, laryngitis, atelectasis, pneumothorax,subconjunctival hemorrhage, subdural hematoma,and seizures. The diagnosis can be confirmed by isolation ofBordetella pertussis in culture; rapid diagnostic tests, such as thedirect fluorescent antibody method and polymerase chain reaction;and serological tests to detect antibodies to B pertussis.First-line therapy for pertussis includes a macrolide antibiotic.(J Respir Dis. 2008;29(4):172-178)