Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care.
BACKGROUND
Most cases of adult pertussis probably remain undiagnosed.


AIM
To explore the prevalence, diagnosis, and disease course of acute pertussis infection in adult patients presenting with acute cough.


DESIGN AND SETTING
Prospective observational study between 2007 and 2010 in primary care in 12 European countries.


METHOD
Adults presenting with acute cough (duration of ≤28 days) were included. Bordetella pertussis infection was determined by polymerase chain reaction (from nasopharyngeal flocked swabs and sputa) and by measurement of immunoglobulin G antibodies to pertussis toxin (PT) in venous blood at day 28. An antibody titre to PT of ≥125 IU/ml or PCR positive result in a respiratory sample defined recent infection. Patients completed a symptom diary for 28 days.


RESULTS
Serum and/or respiratory samples were obtained in 3074 patients. Three per cent (93/3074) had recent B. pertussis infection. Prior cough duration >2 weeks discriminated to some extent between those with and without pertussis (adjusted odds ratio 1.89, 95% confidence interval = 1.17 to 3.07; P = 0.010). Median cough duration after presentation was 17 and 12 days in patients with and without pertussis, respectively (P = 0.008). Patients with pertussis had longer duration of phlegm production (P = 0.010), shortness of breath (P = 0.037), disturbed sleep (P = 0.013) and interference with normal activities or work (P = 0.033) after presentation.


CONCLUSION
Pertussis infection plays a limited role among adults presenting with acute cough in primary care, but GPs should acknowledge the possibility of pertussis in uncomplicated lower respiratory tract infection. As in children, pertussis also causes prolonged symptoms in adults. However, pertussis is difficult to discern from other acute cough syndromes in adults at first presentation.
['Teepe|Jolien|J|', 'Broekhuizen|Berna D L|BD|', 'Ieven|Margareta|M|', 'Loens|Katherine|K|', 'Huygen|Kris|K|', 'Kretzschmar|Mirjam|M|', 'de Melker|Hester|H|', 'Butler|Chris C|CC|', 'Little|Paul|P|', 'Stuart|Beth|B|', 'Coenen|Samuel|S|', 'Goossens|Herman|H|', 'Verheij|Theo J M|TJ|', '|||']
D000328:Adult D000907:Antibodies, Bacterial D001886:Bordetella pertussis D003371:Cough D005060:Europe D006801:Humans D007074:Immunoglobulin G D037342:Pertussis Toxin D016133:Polymerase Chain Reaction D015995:Prevalence D011320:Primary Health Care D011446:Prospective Studies D014917:Whooping Cough
prevalence diagnosis primary care Bordetella pertussis prognosis whooping cough