John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Whooping cough is caused by the bacteria Bordetella pertussis. Humans are the only known reservoir
for these bacteria. (That means it can only thrive and multiply in humans.)
Whooping cough is spread by contact with droplets coughed out by someone with the disease or by contact with recently contaminated hard surfaces upon which the droplets landed. The bacteria thrive in the respiratory passages where they produce toxins that damage the tiny hairs (cilia) that are needed to remove particulate matter and cellular debris that are normally introduced into the airways with each breath. This results in an increased inflammation of the respiratory passages and the typical
dry cough which is the hallmark of the infection. Whooping cough is contagious from
seven days after exposure to the bacteria and up to three weeks after the onset of coughing spasms. The most contagious time is during the first stage of the illness.
Initially thought to be a disease of childhood, studies have shown that adults are susceptible to whooping cough and account for up to 25% of cases. The disease tends to be milder in adults and adolescents -- a persistent cough much like an upper respiratory infection or cold. Because of this fine distinction, the diagnosis of whooping cough is frequently missed in that population and thus allows the bacteria to spread to more susceptible infants and children.
Whooping cough is highly contagious. Between 75%-100% of unimmunized household contacts of a person with pertussis will develop the disease. Even among fully immunized and naturally immunized people living in the same household, there have been reports of undetectable infection following extreme exposure.
The course of whooping cough is divided into three stages.
The first stage of whooping cough is the catarrhal (runny nose) stage. This phase typically lasts for
one to two weeks. Symptoms during this phase resemble that of an upper respiratory illness: runny nose, nasal congestion, sneezing, and occasional cough. A low-grade fever may be present in some cases. It is only during this stage that progression of whooping cough can be halted by antibiotics.
The second stage of whooping cough is the paroxysmal stage. The duration of this phase is highly variable, lasting between one to six weeks, or up to 10 weeks. It is characterized by intense and drawn out bouts of coughing. The attacks tend to be more frequent at night, with an average of 15 attacks in a 24-hour period. Often a "whoop" can be heard caused by the gasping person inhaling between coughs. (Barking coughs usually indicate a viral infection and are not indicative of whooping cough). Newborn babies and infants, in particular, may appear to stop breathing and perhaps turn blue during the coughing spasms. Vomiting
or choking is also common during this stage as well.
The third stage of whooping cough is the convalescent stage. This can last for weeks or months and is characterized by a chronic cough that becomes less paroxysmal (fewer sudden outbursts of coughing) in nature.
Reviewed by David Perlstein, MD, MBA, FAAP on 8/5/2013