Pertussis: Symptoms and Diagnosis (Pediatric Nursing)

00:01 So, before the signs and symptoms develop, there is typically about 5-10 day incubation period, and sometimes up to 3 weeks before the symptoms show.

00:10 Once the symptoms show, they'll show up in 3 phases.

00:13 The first phase is the catarrhal phase.

00:16 This phase may mimic a cold.

00:18 These patients have very mild symptoms.

00:20 They may have a low-grade fever, a normal cough, a runny nose, inflamed red eyes, and excessive tearing.

00:28 This is the really wet phase.

00:30 They go through a lot of Kleenex in this phase.

00:33 The cough in this phase is just intermittent and mild.

00:37 Next, the patient will start the second phase, and this is the paroxysmal phase.

00:41 This is where the cough becomes way more intense, and there can be an inspiratory whoop sound, followed by post-tussive vomiting, meaning the patient will cough to the point of vomiting.

00:52 The coughing fits, or paroxysms, increase in frequency and occur more at night.

00:57 And sometimes, the patients will say the cough just takes their breath away.

01:00 The duration of this phase is highly variable, and typically lasts for 1-10 weeks.

01:07 Next, is the third phase, or the convalescent phase, and this is the end.

01:10 This is when it's wrapping up.

01:11 It lasts 1 to 2 weeks, and here, your patient will gradually improve and have a reduction in their symptoms.

01:19 Here, you can see the typical clinical course timeline.

01:23 Although there is significant variation among patients, this is the standard course.

01:27 Their paroxysmal stage can last anywhere between 1 and 6 weeks.

01:31 So, let's start over on the left.

01:33 First, is the incubation period.

01:35 This is where the patient has been exposed to somebody who has pertussis, but they don't have any symptoms yet.

01:41 This is typically 5-10 days, but can be up to 21 days.

01:46 Then the patient will start with symptoms, and they start in phase 1 which is the catarrhal stage.

01:51 This typically lasts 1-2 weeks.

01:53 And remember, this looks like a cold.

01:55 The patient has a runny nose, maybe a low-grade fever, just a mild, normal cough.

02:00 And the problem with this is this is when the patient is very contagious.

02:04 They may be going to work and may be going to school thinking they only have a cold, and they are spreading the pertussis droplets in a 6-foot distance around them and on to surfaces.

02:15 Next, they will progress to the paroxysmal stage, and this is where their cough worsens significantly.

02:20 They will be up at night with coughing fits, they may cough to the point of vomiting, and they will feel like their breath is being taken away by their cough.

02:28 Now, the third stage, again, is the convalescence stage, and this is when the patient begins to improve.

02:35 So, in patients with uncomplicated pertussis, the physical exam findings contribute little to the diagnosis.

02:41 And most patients with pertussis don't have a fever.

02:45 They may have a low-grade fever in that phase 1 stage, but the rest of the illness, they should be afebrile.

02:51 Now, in very young patients, the patient may present with apnea only.

02:55 They may not have a cough.

02:57 They may not make the whooping sound, and they may not have the classic catarrhal stage that you're looking for with the runny nose and the cold-like symptoms.

03:04 These patients may just have periods of apnea, where they aren't able to breath, and this is because of the spasms happening in their airway and with their diaphragm because of pertussis.

03:15 The lung sounds are usually clear on exam.

03:18 The patient may have a whooping sound with their cough.

03:20 However, it depends on the size of the airway diameter.

03:23 Adults do not usually make the inspiratory whoop.

03:26 It's typically something with pediatric patients.

03:29 The patient may have cyanosis present due to their intense coughing fits because they are actually getting hypoxic while they're having these massive coughing fits.

03:38 And they may cough to the point of throwing up.

03:40 This is that post-tussive vomiting.

03:43 Now, the coughing is intense with pertussis.

03:46 Patients will pull muscles in their back, they will have sore abdominal muscles, and they can even have sub-conjunctival hemorrhages in their eyes from coughing.

03:56 How do we diagnose pertussis? Well, clinicians commonly use several types of lab tests to diagnose Bordetella pertussis.

04:03 It's very useful because there's a lot of respiratory pathogens that have similar clinical symptoms, and it's really important to diagnose pertussis from a public health perspective.

04:14 So, the Gold Standard is a culture.

04:17 This is the most specific method for identification, but other methods, such as the PCR or a blood test, are other options.

04:25 A culture is most useful in the first 2 weeks after the onset of the cough.

04:30 So, a PCR test is useful because it gives rapid results, and it has excellent sensitivity.

04:36 However, it varies in specificity.

04:38 So, you should obtain a culture confirmation in a pertussis patient or a suspected patient with pertussis during an outbreak.

04:46 A PCR test is useful from 0-3 weeks after the onset of cough, and sometimes, up to 4 weeks.

04:52 But after the fourth week of the cough, the bacterial DNA wanes in the nasopharynx, and you might not be able to detect it with a swab.

04:59 This will give you a false negative.

05:02 So cultures and PCRs are obtained by inserting a swab into the nasopharynx.

05:07 This is an unpleasant procedure for the patient, and it's also an unpleasant procedure for the clinician.

05:12 Children will need to be restrained during this procedure.

05:15 If able, they will blow their nose, and then the clinician will advance the swab into the postural nasopharynx, which is pretty far.

05:22 And sometimes, both nares need to be tested depending on the test.