Overview
Infections caused by Bordetella pertussis (whooping cough) and Bordetella parapertussis primarily affect the respiratory tract, leading to characteristic paroxysmal cough, often severe in unvaccinated individuals and young children 1.Diagnosis
Clinical Presentation: Paroxysmal cough lasting >2 weeks, post-tussive vomiting, inspiratory "whoop" sound 1.
Nasopharyngeal Swab: PCR testing is highly sensitive and specific for confirming Bordetella infection 1.
Culture: Useful but slower, requiring specialized media and incubation conditions 1.
Serology: Less commonly used due to cross-reactivity and timing issues post-infection 1.Management
First-Line Treatment:
- Azithromycin: 10 mg/kg/day orally for 3-5 days (Evidence: Moderate) 1
- Erythromycin: 125 mg orally four times daily for 14 days (Evidence: Moderate) 1
Adjunctive Measures:
- Supportive Care: Hydration, oxygen if hypoxemic, and monitoring for complications like secondary infections 1
- Antitussives: Generally not recommended in pertussis due to potential to suppress cough reflex 1Special Populations
Pregnancy: Treatment with macrolides like azithromycin is preferred due to safety profile (Evidence: Moderate) 1
Pediatrics: Early treatment crucial to reduce severity and transmission; azithromycin dosing adjusted by weight (Evidence: Moderate) 1
Elderly: Similar management principles apply; close monitoring for complications like pneumonia (Evidence: Moderate) 1
Comorbidities: Patients with underlying respiratory conditions require vigilant monitoring and supportive care (Evidence: Moderate) 1Key Recommendations
Confirm Bordetella infection using PCR testing of nasopharyngeal swabs (Evidence: Strong) 1
Initiate macrolide antibiotics such as azithromycin for treatment, tailored to patient weight (Evidence: Moderate) 1
Provide supportive care including hydration and monitor for secondary infections, especially in high-risk groups (Evidence: Moderate) 1References
1 Ellis H. Jules Bordet: immunologist, bacteriologist and Nobel Prize winner. British journal of hospital medicine (London, England : 2005) 2020. link