Complications of pertussis in adults Pertussis, also known as whooping cough, is a highly contagious disease that is seen in both adults and children. In modern medicine, pertussis can be treated completely and is also preventable with the help of a widely available vaccine.

Pertussis has a wide range of symptoms; one should keep a keen eye to identify and get it diagnosed and treated immediately. Read on as the article discusses the signs and symptoms, treatment plan, and complications of the much-hated ‘whooping cough’.

Introduction

Pertussis is also known as whooping cough or 100-day cough. It is a condition where the patient has recurrent episodes of intense cough which may last up to 10 weeks, hence the name 100-day cough. It is caused by the bacterium Bordetella pertussis. and it affects the respiratory tract. It is an airborne disease and is highly contagious. It spreads from one person to another when the infected person sneezes or coughs. A vaccine-Diphtheria, Pertussis, Tetanus(DPT) has been developed and is widely used for pertussis which is given along with the vaccines for other diseases like diphtheria and tetanus. Pertussis is more likely to affect infants below the age of 12 months. Let us read further to understand the symptoms of the disease.

Signs and symptoms

Symptoms don’t appear as soon as you get infected. It takes around - 7-10 days for the symptoms to show. This period is called the Incubation period. Pertussis's initial signs and symptoms are very similar to the common cold and can be mistaken as the latter. Symptoms are of two types.

• Typical symptoms
• Atypical symptoms

The typical symptoms include

• Fever
• Cough
• Runny nose
• Nasal congestion
• Red, watery eyes

These signs may last for two weeks or more and sometimes worsen.

The atypical symptoms are different or unusual from what is considered normal.

• Persistent cough
• Post-tussive emesis- this can be considered one of the diagnostic features of Pertussis. This condition is where the affected person vomits after a rigorous episode of coughing
• Gasping or characteristic ‘whooping sound’ with the intake of breath

Let’s read further to understand the complications of pertussis in adults.

Complications 

Pertussis causes major complications generally in infants as they can't be vaccinated unless they're at least 2 months old. They are susceptible to infection from adults and caregivers. There could be severe complications like breathlessness also known as apnea. In adults, the complications are generally mild as they’ve been vaccinated already. The complications may worsen once the effect of the vaccine wears off or if they fall short of taking a booster dose.

The possible complications include

1. Pneumonia
2. Rib fracture
3. Syncope
4. Subconjunctival haemorrhage
5. Urinary incontinence

Pneumonia

Pneumonia is an infection of the lungs that could be viral, bacterial or fungal. The bacterial pneumonia is considered to be more fatal. Pneumonia is a common complication of pertussis. It can be caused by bacterial superinfection wherein a different bacteria acts on the already existing bacteria causing a secondary infection.

Rib fracture¹

A rib fracture is another complication where vigorous and persistent coughing can cause a fracture in the ribs. Studies show that it affects 4% of the patients. It usually occurs in the 5-10^th ribs. The chances of rib fractures are higher in the case of elderly people due to deteriorating bone strength.

Syncope

It is also called ‘tussive syncope’, where the person loses consciousness after an episode of severe and rigorous cough. It may last only a few seconds after which the person regains consciousness. It commonly occurs in a sitting or standing position and rarely occurs during a supine position. With prolonged coughing, the intra-thoracic pressure reduces resulting in reduced blood flow, causing syncope.

Subconjunctival haemorrhage

Subconjunctival haemorrhage is caused by a broken blood vessel in the eye causing the eye to turn red. The eyes may turn completely or partially red depending on the severity of damage to the blood vessel. Increased pressure in the ocular spaces due to severe coughing leads to this condition. It usually heals by itself. Depending on the severity of the damage, it may take a few days to a few weeks for the lesion to heal completely.

Urinary incontinence

Urinary incontinence is loss of control over one’s urinary bladder. Coughing causes an increase in the intraabdominal pressure which may cause the patient to lose control over the bladder. This could be embarrassing to the patient and may affect the quality of his life negatively.

Diagnosis

Diagnosis of whooping cough in the earlier stages can be difficult as it does not have any classic symptoms. Symptoms usually mimic other respiratory infections like the common cold and influenza. The characteristic feature is the whooping sound which only appears in the later stages. Certain tests are required to confirm the diagnosis.

• Serological tests- a swab/sample is taken from the nose or throat and is sent to culture to identify the disease-causing organism
• Polymerase chain reaction (PCR)- It is one of the important diagnostic tools. It is more precise than the serological test. PCR identifies the DNA segment of the causative bacteria, in this case,  Bordetella pertussis. In this technique also, a swab is collected from the nose or throat for investigative purposes

Treatment

Treatment of pertussis should be done at the early stages to prevent escalation of the disease which later on leads to complications². Antibiotics are used as the primary treatment. The commonly used antibiotics are azithromycin, erythromycin, and clarithromycin. If the condition doesn’t subside even after consumption of antibiotics, a hospital visit will be required. In severe cases, the breathing has to be monitored and the airway has to be kept clear. Supportive care like taking plenty of rest and consumption of liquids to prevent dehydration has to be done. Frequently having small meals will also help prevent vomiting.

Prevention

As the famous saying goes, prevention is always better than cure. The best way to prevent pertussis is by getting a vaccine. The vaccine for this condition is known as the DPT vaccine³, which is a combination vaccine for diseases like diphtheria, pertussis, and tetanus. This vaccine has multiple doses.

• First dose: 2 months old
• Second dose: 4 months old
• Third dose: 6 months old
• Fourth dose: Between 15 and 18 months old
• Fifth dose: Between 4 and 6 years old

Adults between the age of 19-64 are also advised to take a booster dose as the efficacy of the vaccine wears off as age advances. Since adults are the major source of infection for kids, it is advisable to get a booster dose.

• Since pertussis is an infectious disease, it is always better if the infected person isolates himself/herself to limit the spread to people around them
• There should be general awareness among the people to identify the disease and get it treated in the early stages. The public should be educated about the symptoms and complications of the disease and should be encouraged to take a vaccine at the earliest

Summary

Pertussis or whooping cough is an infectious disease affecting the respiratory tract. It is caused by the organism, Bordetella pertussis. It affects both young and adult people although newborns are more susceptible to the disease. Signs and symptoms of pertussis in the earlier stages are very similar to common cold and flu and can be easily mistaken for the latter. There are several complications of pertussis in adults such as pneumonia, rib fracture, urinary incontinence, subconjunctival haemorrhage, and syncope. Therefore, it is important to identify the disease and get it treated at the earliest. The public has to be educated and encouraged to take up the DPT vaccine to reduce the intensity of the disease. Even though contagious, pertussis can be treated completely and the patient will recover completely after a few weeks.