CMAJ • February 15, 2005; 172 (4). doi:10.1503/cmaj.1040766.
© 2005 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Review
Synthèse

Diagnosis and management of pertussis

Alberto E. Tozzi, Lucia Pastore Celentano, Marta Luisa Ciofi degli Atti and Stefania Salmaso

From the Epidemiology Unit, Bambino Gesù Hospital (Tozzi), and the National Epidemiology Centre, Istituto Superiore di Sanità (Celentano, Ciofi degli Atti, Salmaso), Rome, Italy

Correspondence to: Dr. Alberto E. Tozzi, Epidemiology Unit, Bambino Gesù Hospital, Piazza S. Onofrio, 4, 00165 Rome, Italy; fax 39 06-68592583; alberto.tozzi{at}opbg.net

Abstract

PERTUSSIS IS INCREASING IN FREQUENCY among children too young to be vaccinated and among adolescents and adults. This increase is due mainly to waning immunity among vaccinated individuals, who become susceptible during adolescence and adulthood and maintain the circulation of Bordetella pertussis. Infants are at highest risk of severe illness requiring hospital admission, complications and death. The clinical presentation in adolescents, adults and vaccinated individuals may be atypical, with paroxysmal cough of short duration or simply a persistent cough. Culture and polymerase chain reaction may be used to identify B. pertussis infection, but their sensitivity is high only in the early phase of the disease. Serologic tests are not standardized for the diagnosis of pertussis, and their clinical application is limited. Erythromycin is still considered in some countries to be the "gold standard" for therapy and prophylaxis; however, azithromycin and clarithromycin seem equally efficacious and are associated with fewer side effects.




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