100-day cough

Scenario number one: A one-month-old baby was transferred from another institution in the hopes that further intervention would provide a cure. History revealed that the patient had been suffering from cough and cold a week prior to the first admission. There was no associated fever or any other symptoms. Earlier on, an initial consult was done and the patient was given nasal drops. The mother noted that in the days that followed, the cough increased in intensity and the baby would get “red in the face.” With the onset of difficulty in breathing, they decided to seek another consult. The mother volunteered that she had respiratory symptoms a week prior to the baby getting ill. While the admitting impression was spot on, appropriate diagnostics requested and therapeutic management administered, the condition steadily progressed and the patient unfortunately succumbed.

Scenario number two: “I had a minor accident and was so embarrassed. I had to shop for a change of unmentionables. This cough has been bothering me for weeks and try as I might to contain it, it is next to impossible. I have been a recipient of ‘that look,’ a cross between stark fear and tempered disgust lately. Been feeling so tired from lack of sleep and anxious about what I have. Do you think I have tuberculosis? ”

For the doctors, your diagnosis, please?

For those who are not in the medical profession, have you had a similar experience?

Pertussis, more commonly known as “the cough of 100 days” can affect anyone. A respiratory illness caused by Bordetella pertussis which is bacterial in nature, it is highly transmissible through coughing, sneezing, or being in close contact with infected individuals. Those most vulnerable to experiencing severe disease would be infants less than a year old, individuals aged 65 and older, and people suffering from asthma, chronic lung disease, or with an immunocompromising condition.

Course of the disease. Once infected and symptomatic, an individual goes through three stages, each lasting for weeks. The first stage usually starts with nonspecific upper respiratory symptoms followed by paroxysms of coughing better known as “whooping cough” which can result in post-tussive emesis, then a period of convalescence which can take weeks or months and is marked by a gradual waning of symptoms. While this is the classic course, some may be atypical in presentation making it a challenge to diagnose clinically. Complications seen in infants include apnea, pneumonia, seizures, encephalopathy with mortality as the most feared outcome. For adolescents and adults, due to prior infection or immunization, both of which do not confer lifelong immunity, the illness may be less severe and usually manifests as prolonged cough, save for those with underlying conditions, wherein pertussis infection may lead to exacerbation of their condition.

Diagnosis. Both the Centers for Disease Control and Prevention and the World Health Organization have provided clinical case definitions that are helpful most especially in outbreak situations and in cases wherein there has been close contact with a confirmed case. Diagnostic confirmation should be pursued ideally but should not be a barrier to the institution of empiric treatment once highly suspected. Locally, tests are available but there is a considerable turnaround time not to mention a high cost involved.

Treatment. Antimicrobial treatment is best given within the first three weeks from the onset of the cough. This is the period when one is considered the most contagious. Though institutions may not alter the course of the illness, the goal of therapy is to eradicate the organism and prevent the spread of disease. A five-day course of an appropriate drug is recommended and during that period, one should avoid contact with highly vulnerable populations.

Prevention. In general, preventive measures would include isolation of patients with suspected or confirmed pertussis, vaccination, and postexposure prophylaxis. Immunity wanes after infection and around five to 10 years from completion of childhood immunization necessitating booster doses. Pregnant women are also advised to get vaccinated starting on the 27th week of pregnancy so as to provide partial protection to their infants through the transfer of maternal antibodies.

Public health concern. According to the latest Department of Health report, from January to July 15 of this year, 160 cases of pertussis have been documented, a jump from the 16 reported in the same period last year. From personal communication, most have been reported from geographically isolated and disadvantaged barangays. That piece of information did not come as a surprise for one has a ready answer. Poverty will always be a major player in the how and the why. As long as we are stuck in this situation, the aim to reduce the numbers not only for pertussis, but dengue, tuberculosis, measles, and diphtheria would be a monumental challenge.

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