This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Seth W. Wright, MD; Kathryn M. Edwards, MD; Michael D. Decker, MD, MPH; Marie H. Zeldin, RN

JAMA. 1995;273(13):1044-1046.

Abstract
Objective.
—To determine the prevalence of Bordetella pertussis infection in adult patients with persistent cough.

Design.
—Prospective case series.

Setting.
—Urban university hospital emergency department.

Patients.
—Convenience sample of 75 patients aged 18 years or older with a cough lasting 2 weeks or longer. Serum specimens from 67 patients without respiratory complaints were used to develop reference values.

Interventions.
—In patients with cough, nasopharyngeal culture and direct fluorescent antibody testing for B pertussis were performed and serum samples were obtained at the first visit and 1 month later. Serum specimens were assayed for antibody to pertussis toxin (PT) and filamentous hemagglutinin (FHA).

Main Outcome Measures.
—A subject with one or more of the following was defined as having a pertussis infection: a positive B pertussis culture result, a fourfold change in PT or FHA titer, and/or a single PT or FHA titer at least 2 SDs greater than the geometric mean of the control group.

Results.
—No subject tested culture positive for B pertussis. Sixteen (21%) (95% confidence interval [CI], 13% to 32%) of 75 subjects met the serologic criteria for pertussis infection; for 13 (81%; 95% CI, 54% to 96%) of the 16, the criteria were met by the initial serum specimen. In contrast, the geometric mean levels of antibody to PT and FHA for the remaining 59 subjects with cough did not differ from those of the control group. Clinical symptoms and the lymphocyte count did not differentiate patients with pertussis from those without the disease.

Conclusion.
—Pertussis is a common cause of persistent cough in adults and should be considered in the differential diagnosis. Clinical symptoms, pertussis culture, direct fluorescent antibody testing, and lymphocytosis are of limited value in making the diagnosis.

(JAMA. 1995;273:1044-1046)

Author Affiliations
From the Department of Emergency Medicine (Dr Wright and Ms Zeldin), and the Departments of Pediatrics (Dr Edwards), Preventive Medicine (Dr Decker), and Medicine (Dr Decker), Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tenn.

Footnotes
Presented in part at the Society for Academic Emergency Medicine annual meeting, Washington, DC, May 26, 1994.

Reprint requests to Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232-4700 (Dr Wright).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Whooping cough
Harnden
BMJ 2009;338:b1772-b1772.
FULL TEXT  

Pertussis Vaccination for Health Care Workers
Sandora et al.
Clin. Microbiol. Rev. 2008;21:426-434.
ABSTRACT | FULL TEXT  

Pertussis requiring intensive care
Surridge et al.
Arch. Dis. Child. 2007;92:970-975.
ABSTRACT | FULL TEXT  

Pseudo-asthma: When Cough, Wheezing, and Dyspnea Are Not Asthma
Weinberger and Abu-Hasan
Pediatrics 2007;120:855-864.
ABSTRACT | FULL TEXT  

Whooping cough: the current scene.
Singh and Lingappan
Chest 2006;130:1547-1553.
ABSTRACT | FULL TEXT  

A Community-wide Pertussis Outbreak: An Argument for Universal Booster Vaccination.
Schafer et al.
Arch Intern Med 2006;166:1317-1321.
ABSTRACT | FULL TEXT  

Postinfectious Cough: ACCP Evidence-Based Clinical Practice Guidelines
Braman
Chest 2006;129:138S-146S.
ABSTRACT | FULL TEXT  

The Growing Paradigm of Preventing Disease: Vaccines To Prevent Herpes Zoster and Pertussis in Adults
Poland
ANN INTERN MED 2005;143:539-541.
FULL TEXT  

Pathogen adaptation under imperfect vaccination: implications for pertussis
van Boven et al.
Proc R Soc B 2005;272:1617-1624.
ABSTRACT | FULL TEXT  

Pertussis in Adolescents and Adults: Should We Vaccinate?
Lee et al.
Pediatrics 2005;115:1675-1684.
ABSTRACT | FULL TEXT  

Adults Are Whooping, but Are Internists Listening?
Dworkin
ANN INTERN MED 2005;142:832-835.
ABSTRACT | FULL TEXT  

The Epidemiology of Pertussis: A Comparison of the Epidemiology of the Disease Pertussis With the Epidemiology of Bordetella pertussis Infection
Cherry
Pediatrics 2005;115:1422-1427.
ABSTRACT | FULL TEXT  

Molecular Pathogenesis, Epidemiology, and Clinical Manifestations of Respiratory Infections Due to Bordetella pertussis and Other Bordetella Subspecies
Mattoo and Cherry
Clin. Microbiol. Rev. 2005;18:326-382.
ABSTRACT | FULL TEXT  

Pertussis -- Not Just for Kids
Hewlett and Edwards
NEJM 2005;352:1215-1222.
FULL TEXT  

Diagnosis and management of pertussis
Tozzi et al.
CMAJ 2005;172:509-515.
ABSTRACT | FULL TEXT  

Establishment of Diagnostic Cutoff Points for Levels of Serum Antibodies to Pertussis Toxin, Filamentous Hemagglutinin, and Fimbriae in Adolescents and Adults in the United States
Baughman et al.
CVI 2004;11:1045-1053.
ABSTRACT | FULL TEXT  

A 65-Year-Old Woman With Acute Cough Illness and an Important Engagement
Gonzales
JAMA 2003;289:2701-2708.
FULL TEXT  

Chlamydia pneumoniae infection in adult patients with persistent cough
Miyashita et al.
J Med Microbiol 2003;52:265-269.
ABSTRACT | FULL TEXT  

Diagnosis of Community-Acquired Pertussis Infection: Comparison of Both Culture and Fluorescent-Antibody Assays with PCR Detection Using Electrophoresis or Dot Blot Hybridization
Lingappa et al.
J. Clin. Microbiol. 2002;40:2908-2912.
ABSTRACT | FULL TEXT  

Sustained Efficacy During the First 6 Years of Life of 3-Component Acellular Pertussis Vaccines Administered in Infancy: The Italian Experience
Salmaso et al.
Pediatrics 2001;108:e81-81.
ABSTRACT | FULL TEXT  

Principles of Appropriate Antibiotic Use for Treatment of Uncomplicated Acute Bronchitis: Background
Gonzales et al.
ANN INTERN MED 2001;134:521-529.
ABSTRACT | FULL TEXT  

Uncomplicated Acute Bronchitis
Gonzales and Sande
ANN INTERN MED 2000;133:981-991.
ABSTRACT | FULL TEXT  

The Diagnosis and Treatment of Cough
Irwin and Madison
NEJM 2000;343:1715-1721.
FULL TEXT  

Costs of Illness Due to Bordetella pertussis in Families
Lee and Pichichero
Arch Fam Med 2000;9:989-996.
ABSTRACT | FULL TEXT  

Comparison of PCR, Culture, and Direct Fluorescent-Antibody Testing for Detection of Bordetella pertussis
Loeffelholz et al.
J. Clin. Microbiol. 1999;37:2872-2876.
ABSTRACT | FULL TEXT  

Clinical Manifestations of Bordetella pertussis Infection in Immunized Children and Young Adults
Yaari et al.
Chest 1999;115:1254-1258.
ABSTRACT | FULL TEXT  

An Application of Orem's Theory To the Nursing Management of Pertussis
Logue
The Journal of School Nursing 1997;13:20-25.
ABSTRACT  

Economic Impact of Pertussis
Pichichero and Treanor
Arch Pediatr Adolesc Med 1997;151:35-40.
ABSTRACT  

Prevalence and Incidence of Adult Pertussis in an Urban Population
Nennig et al.
JAMA 1996;275:1672-1674.
ABSTRACT