CHEST Guidelines-Clinically Diagnosing Pertussis-associated Cough in Adults and Children

Clinically Diagnosing Pertussis-associated Cough in Adults and Children

Pdf Summary

The CHEST Guideline and Expert Panel Report on diagnosing pertussis-associated cough focuses on the clinical diagnosis of pertussis in adults and children, emphasizing decisions usually based on clinical symptoms rather than waiting for laboratory confirmation. This guideline is especially relevant due to pertussis, or whooping cough, being a highly contagious respiratory infection with significant potential for morbidity and mortality, especially in infants.

The guideline's methodology followed the CHEST guidelines framework, using systematic reviews, meta-analysis, and the Delphi consensus methodology. A high-quality systematic review identified key clinical features that might distinguish pertussis-associated cough from other cough causes. Key findings include:

1. <strong>Adults</strong>: For adults, the clinical features assessed included paroxysmal cough, posttussive vomiting, inspiratory whooping, and absence of fever. Paroxysmal cough and absence of fever showed high sensitivity but low specificity. Inspiratory whooping and posttussive vomiting demonstrated high specificity, making them useful in diagnosing pertussis when present.

2. <strong>Children</strong>: In children, posttussive vomiting was the only feature evaluated, with moderate sensitivity and specificity, indicating it is less reliable as a standalone diagnostic tool.

Recommendations stress that clinicians should assess these symptoms when diagnosing pertussis in patients with acute or subacute cough. For adults, the absence of paroxysmal cough or presence of fever excludes pertussis. Inspiratory whooping and posttussive vomiting can diagnose pertussis. In children, these features are suggestive but not definitive.

The guideline highlights the utility of clinical judgment in diagnosing pertussis-associated cough, acknowledging the limitations of relying solely on laboratory tests. While several effective antibiotics exist to treat pertussis, they do not change the clinical course and should be administered based on clinical diagnosis to prevent disease spread. This report outlines areas for further research and is integral in global health directives for pertussis management.

Keywords

pertussis

whooping cough

clinical diagnosis

adults

children

paroxysmal cough

posttussive vomiting

inspiratory whooping

CHEST guideline

respiratory infection