CHEST Guidelines-Clinically-Diagnosing-Pertussis-associated-Cough-i

Clinically-Diagnosing-Pertussis-associated-Cough-i

Pdf Summary

The CHEST Guideline and Expert Panel Report focuses on the clinical diagnosis of pertussis-associated cough in adults and children, aiming to provide guidance without waiting for laboratory confirmation, which is often the basis for treatment initiation. Pertussis, or whooping cough, is a highly infectious respiratory disease caused by Bordetella pertussis, characterized by symptoms like a persistent acute cough, paroxysms of coughing, inspiratory whooping, and posttussive vomiting.<br /><br />The outlined approach utilizes clinical symptoms to distinguish pertussis from other causes of cough. In adults with acute or subacute cough, the presence of inspiratory whooping or posttussive vomiting can indicate possible pertussis, while the absence of paroxysmal cough or the presence of fever suggests otherwise. In children, posttussive vomiting is indicative but less reliable as a diagnostic factor for pertussis.<br /><br />The guidelines provide specific recommendations for clinicians. For adults, assessing four key features—paroxysmal cough, posttussive vomiting, inspiratory whooping, and absence of fever—is suggested to rule in or out pertussis, considering factors like the high sensitivity but low specificity for paroxysmal cough and absence of fever, and the opposite for inspiratory whooping and posttussive vomiting. For children, evaluating paroxysmal cough, posttussive vomiting, and inspiratory whooping is important, although these features are less conclusive as diagnostic tests compared to adults.<br /><br />The decision guideline emphasizes the need for clinical diagnosis since laboratory methods are used variably across different health organizations, and the onset of antibiotic treatment reduces disease spread but does not change the illness course. The report identifies gaps in current research and recommends further prospective studies, particularly in primary care and among infants, to improve the clinical diagnosis of pertussis.

Keywords

pertussis

whooping cough

clinical diagnosis

Bordetella pertussis

paroxysmal cough

posttussive vomiting

inspiratory whooping

guidelines

adults and children

antibiotic treatment