Bordetella Pertussis

Question 1

BORDETELLA PERTUSSIS

Answer 1

3 stages / 7-17 days symptom onset / 6-week symptom duration

Question 2

A 16-month-old infant presents to clinic with c/o sneezing, decreased appetite, and hacking cough that began at night but is now
occurring during the day. What is high on your diagnosis differential of this patient?
A: RSV
B: Legionnaires disease
C: Pertussis
D: Epiglottitis

Answer 2

C: Pertussis

Question 3

What is the typical incubation period for pertussis?

Answer 3

Answer: 7-17 days

Question 4

T or F: infants are reservoirs of pertussis whereas adults / adolescents are most affected

Answer 4

Answer: False, infants are most affected whereas adults/adolescents are reservoirs

Question 5

How is pertussis transmitted between humans?

Answer 5

Answer: droplet transmission

Question 6

Approximately how long do symptoms last and what is unique about symptom progression?

Answer 6

Answer: last about 6 weeks, occur in 3 consecutive stages; cough that is intermittent and turns paroxysmal

Question 7

Stage 1 of pertussis is called what?

Answer 7

Answer: Catarrhal

Copious discharge of mucus associated with inflammation of mucous membranes, especially of the nose and throat.

Question 8

Stage 2 of pertussis is called what?

Answer 8

Answer: Paroxysmal

Question 9

Stage 3 of pertussis is called what?

Answer 9

Answer: Convalescent

Question 10

What is the typical symptom presentation in stage 1 (Catarrhal)?

Answer 10

Answer: insidious onset of lacrimation, sneezing, coryza, anorexia, malaise, hacking night cough that becomes day cough

Question 11

What is the typical symptom presentation in stage 2 (Paroxysmal)?

Answer 11

Answer: bursts of rapid, consecutive coughs followed by deep, high-pitched inspiration (inspiratory whoop)

Question 12

What is the typical symptom presentation in stage 3 (Convalescent)?

Answer 12

Answer: begins 4 weeks after onset with decrease in frequency / severity of paroxysms of cough

Question 13

In adult patients, what must be part of your differential when a cough has been present for more than 2 weeks?

Answer 13

Answer: pertussis

Question 14

What is the typical lab / diagnostic findings suggestive of pertussis?
A: PO2 <90%
B: WBC >15,000-20,000
C: Patchy opacities and lobar consolidation (CXR)
D: gram + bacteria (blood cultures)

Answer 14

B: WBC >15,000-20,000

Answer: B (patchy opacities/lobar consolidation is pneumonia; pertussis is a gram-negative bacteria)

Question 15

The FNP knows the gold standard to diagnosing a patient pertussis is?

Answer 15

Answer: nasopharyngeal culture (Bordet-Gengou agar)

Question 16

What is the best prevention for pertussis

Answer 16

Answer: DTaP vaccine (11-18 yr. old whose received DTP/DTaP should receive a SINGLE dose of either Tdap product; >64 yr needs a single dose of Tdap; during EACH PREGNANCY, receive a single dose of Tdap regardless of previous vaccine hx)

Question 17

What is the appropriate treatment for pertussis?

Answer 17

Answer: antibiotics – MYCINS (erythromycin, azithromycin, clarithromycin, or Bactrim)