Pertussis (whooping cough)BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l401 (Published 22 February 2019) Cite this as: BMJ 2019;364:l401
All rapid responses
This excellent review article inadvertently perpetuates the belief that pertussis is a childhood illness. In the UK most laboratory confirmed cases now are in teens and adults but the symptoms are the same. I have studied this disease in general practice for over 40 years and would like to make three points. Firstly, in spite of much greater awareness amongst GPs of its occurrence in adults it is still difficult to get it diagnosed unless the patient suggests it or provides a self-recorded smartphone recording of a typical paroxysm, which if regularly occurring is virtually pathognomonic of pertussis. Secondly is the important but so far little appreciated characteristic of the disease which makes clinical diagnosis much more specific; that is, long intervals with no coughing. The patient, usually adult, needs to be asked, "do you get frightening attacks of a choking and exhausting coughing followed by hours of no coughing at all?". If the answer is "yes" then serological testing is indicated. ThirdIy I would add that serology is only for Bordetella pertussis, so if negative in the presence of typical disease, it could quite likely be caused by B. parapertussis or other rarer types that possibly account for up to 10% of Bordetella infections.
Competing interests: I have a website www.whoopingcough.net providing information about whooping cough at my own expense.