RT Journal Article
SR Electronic
T1 Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e662
OP e667
DO 10.3399/bjgp15X686917
VO 65
IS 639
A1 Jolien Teepe
A1 Berna DL Broekhuizen
A1 Margareta Ieven
A1 Katherine Loens
A1 Kris Huygen
A1 Mirjam Kretzschmar
A1 Hester de Melker
A1 Chris C Butler
A1 Paul Little
A1 Beth Stuart
A1 Samuel Coenen
A1 Herman Goossens
A1 Theo JM Verheij
YR 2015
UL http://bjgp.org/content/65/639/e662.abstract
AB 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.