This infection is most common in infants, but people of all ages can contract it. Whooping cough symptoms tend to be less severe in adults than in children. Unvaccinated infants have the highest risk of developing severe symptoms and complications from whooping cough.
In this article, we discuss the symptoms and complications of whooping cough in adults and the treatment options. Adults tend to experience less severe symptoms of whooping cough compared with children. The reason for this is that adults have built up immunity from previous infections and vaccinations.
Bacteria called Bordetella pertussis cause whooping cough. These bacteria spread through the air when someone who is infected coughs or sneezes. Symptoms usually develop 5 to 10 days after exposure, but some people might not develop symptoms for several weeks. Stage 1 : People are highly contagious in the early stages of the disease. At first, whooping cough causes mild cold-like symptoms that last for 1 to 2 weeks, such as:. Stage 2 : After some time, people can develop a severe, persistent cough that leaves them gasping for air.
People are still contagious at this point, and stage 2 symptoms may last anywhere from 1 to 6 weeks. Stage 3 : In the final phase, the cough gradually improves, and coughing fits occur less often. At this point, people are no longer contagious, but they run the risk of developing other infections, which can slow down the recovery process.
Doctors might sometimes misdiagnose whooping cough as a common cold or another respiratory infection because whooping cough in adults does not typically cause severe symptoms. If an adult is experiencing a persistent cough, the doctor may recommend further medical tests to diagnose the problem.
These tests might include a nasopharyngeal swab, which involves a doctor collecting a sample of mucus through the nose to analyze for B. Pertussis and other Bordatella infections. In: Harrison's Principles of Internal Medicine. New York, N.
Cornia P, et al. Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis. Yeh S. Pertussis infection in infants and children: Clinical features and diagnosis.
Pertussis infection in infants and children: Treatment and prevention. Tdap Tetanus, Diphtheria, Pertussis vaccine information statements.
Postexposure antimicrobial prophylaxis. Steckelberg JM expert opinion. Mayo Clinic, Rochester, Minn. Related Whooping cough. Associated Procedures Chest X-rays. It's best to call the GP before you go in. They might suggest talking over the phone. Whooping cough is less severe in older children and adults but coughing may cause problems including:. If your whooping cough is severe, or your baby is under 6 months old and has whooping cough, you'll usually need treatment in hospital.
If diagnosed within 3 weeks of the infection, you'll be given antibiotics to help stop it spreading to others. After looking back at her personal medical record, we discovered that the patient had undergone a pertussis infection, at the age of ten. The original diagnosis had been confirmed by a positive result for Bordetella pertussis nasopharyngeal aspirate specimen culture and the disease had been treated with erythromycin.
Further laboratory work-up revealed negative urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila , negative immune serologic tests for Mycoplasma pneumoniae , Chlamydophila pneumoniae , and Coxiella burnetii , and negative urine and blood cultures. Nasopharyngeal samples for culture and PCR for pertussis were not taken early in the course of infection, due to lack of suspicion of pertussis. One month after recovery, she started a full vaccination course with tetanus-diphtheria-pertussis Tdap combination vaccine.
In her follow-up visits she remained free of symptoms and in good physical condition, while her chest X-ray returned to normal. The classical description of the clinical course of pertussis includes three stages: catarrhal, paroxysmal, and convalescent.
These stages are met in the majority of the cases. Still, in older or immunized patients, some attenuation of symptoms especially of paroxysmal stage can be observed [ 8 ].
This atypical clinical course often results in the underdiagnosis or misdiagnosis of the disease in adults, as postviral cough, asthma, or chronic sinusitis [ 9 , 10 ]. The gold standard method for the establishment of the diagnosis is the isolation of the pathogen from cultured tissues or fluids, mainly nasopharyngeal swabs, aspirates, or washes. Yet, several confounding factors can influence the reliability of the method, such as treatment with antibiotics, the stage of the disease, and previous vaccination history [ 12 ].
Serology may also be useful, particularly in cases where nasopharyngeal samples for culture and PCR are not taken early in the course of infection, due to lack of suspicion of pertussis. A 4-fold increase in anti-PT IgG with 4—6-week intervals is probably the most reliable serologic test [ 6 ]. Notably, as happened in the presented case, leukocytosis is generally uncommon in adolescents, adults, and partially immunized children and even in the absence of it, the diagnosis of pertussis should not be excluded [ 16 ].
Antibiotic agents of choice for pertussis treatment are macrolides, such as erythromycin, clarithromycin, and azithromycin. Appropriate antibiotic treatment can eliminate Bordetella pertussis from the respiratory tract and, consequently, prevent transmission to susceptible contacts. Furthermore, it has been proved that antibiotics decrease the probability of secondary bacterial infections and reduce duration and severity of symptoms, when given early in the course of the disease [ 17 ].
Unfortunately, we were not able to document the exact timing of antibiotic treatment. Still, it has been suggested in the literature that macrolides administration can weaken the subsequent immune response to infections, if given early during the course of the disease [ 18 ]. Newborns are vulnerable to infection during the first weeks of their life, given that the quantity of maternal antibodies transferred is, in most cases, insufficient to provide protection [ 11 ].
Tdap boost vaccination for subjects older than 11 years is an effective prevention strategy and, therefore, should not be omitted. Similar symptoms can be caused by other pathogens, as well, including adenoviruses, respiratory syncytial viruses RSV , human parainfluenza viruses, influenza viruses, Mycoplasma pneumonia , and rhinoviruses [ 9 ].
Coinfections, particularly with Bordetella pertussis and RSV, are commonly seen among infants [ 13 ]. In adult patients, it is essential that the differential diagnosis of persistent cough should include primary and secondary pulmonary malignancies, and imaging with X-ray or Computed Tomography CT of the chest must be accordingly performed in these cases [ 21 ]. This report aims to highlight the fact that pertussis is not only a disease of the childhood, but it should be also suspected in adults, presenting with chronic cough, even if they do have a previous history of natural infection or vaccination.
The authors declare that there are no conflicts of interest regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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