In the Journals

Wheezing may delay pertussis diagnosis

In a highly vaccinated pediatric population, wheezing in children with pertussis may delay diagnosis of pertussis, according to recent study findings published in The Pediatric Infectious Disease Journal.

The study included 501 children aged 0 to 18 years (mean age, 8.4 years) with positive pertussis PCR from July to December 2010.

Researchers found that 93% of eligible patients received the complete diphtheria and tetanus toxoids and acellular pertussis vaccine and 38% of eligible patients received tetanus-diphtheria-acellular pertussis vaccine. Thirty-four percent of patients had paroxysms on physical examination followed by 30% post-tussive emesis and 8% wheezing. Wheezing at presentation was associated with a delay of a pertussis diagnosis (P<.0001). Exposures that were documented were associated with a more timely pertussis diagnosis (P<.001).

“It appears that wheezing confounds the diagnosis of pertussis, with clinicians sometimes attributing a prolonged cough to reactive airways or asthma rather than pertussis if mild wheezing in present, thereby delaying appropriate treatment and prolonging the period of communicability,” the researchers wrote. “Although a typical acute asthma exacerbation in an asthmatic patient should not prompt consideration of pertussis, mild wheezing that is noticed on examination in a patient with prolonged cough, or in one who has exposure to such a person, should not be used to exclude the diagnosis of pertussis, especially in the setting of an ongoing epidemic.”

Disclosure: The researchers report no relevant financial disclosures.