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To detect and diagnose infection with Bordetella pertussis, which causes pertussis, also known as whooping cough
Pertussis, commonly called whooping cough, is a respiratory infection caused by the bacteria Bordetella pertussis. These bacteria are highly contagious and are passed from person to person through coughing and sneezing and close contact. Whooping cough tests are performed to detect and diagnose infection with B. pertussis.
The time between infection with the bacteria and developing signs and symptoms (incubation period) varies from a few days to up to three weeks. B. pertussis typically causes a prolonged, three-stage infection:
Whooping cough can sometimes lead to complications requiring hospitalization, particularly for infants, and may include apnea (61%) or pneumonia (23%), or much less frequently convulsions (1%), brain disease or damage (encephalopathy) (about 0.3%) or death (1%).
Whooping cough used to be very common in the United States, affecting about 200,000 people during outbreaks that would occur every few years. Since the introduction of a whooping cough vaccine and widespread vaccination of infants, this number has drastically decreased. For details on the whooping cough vaccine, see the Centers for Disease Control and Prevention (CDC)'s Pertussis: Summary of Vaccine Recommendations.
Importantly, prior infection or receipt of the complete vaccination series for whooping cough do not prevent you from becoming infected as they do not provide lifetime immunity or protection from re-infection. Fully vaccinated individuals who are infected with B. pertussis may develop a less severe infection, with persistent coughing but without the classic paroxysmal cough.
Periodic outbreaks of whooping cough in unvaccinated infants, in adolescents, and in adults still occur in the United States. According to the CDC, 10,000 to 40,000 cases of whooping cough are reported each year. Over 48,000 cases of whooping cough were reported in 2012, the most recent peak year, and many more likely went unreported.
Diagnostic tests for whooping cough
Because the initial symptoms of whooping cough, especially during the catarrhal stage, are frequently indistinguishable from those of a common cold or of other respiratory illnesses, such as bronchitis, influenza (flu), or in children, respiratory syncytial virus (RSV), diagnostic testing is necessary to help identify the infection.
There are a few test methods that may be used to detect whooping cough, and the type of testing your healthcare practitioner orders is largely dependent on how long you have had symptoms.
How is the sample collected for testing?
Proper collection of the appropriate samples is essential for accurate whooping cough test results.
For bacterial culture or testing by PCR, a nasopharyngeal (NP) swab or nasal aspirate is collected. For tests to detect antibodies to the bacteria, a blood sample is needed.
Whooping cough tests are used to detect and diagnose a B. pertussis infection. Importantly, early diagnosis and treatment may lessen the severity of symptoms and help limit spread of the disease.
Whooping cough tests may be ordered when you have signs and symptoms that suggest a pertussis infection. Your healthcare practitioner may have a strong suspicion that you have whooping cough if:
Testing should not be performed on close contacts who do not have symptoms.
Both culture and PCR tests are less likely to be positive as the illness progresses.
With blood testing, pertussis IgG antibodies will be present in those who have been vaccinated or have had a past infection. IgM and IgA antibodies may indicate recent vaccination or infection and will only be present for a short period of time (2-3 months). Blood testing is not typically recommended for the diagnosis of active whooping cough and is most useful after approximately 3-4 weeks of symptoms.
Whooping cough is treated with antibiotics, which will help to resolve the infection and help stop spread of the disease. Close contacts of people diagnosed with whooping cough may also be treated to prevent spread of the infection.
Three different formulations of the pertussis vaccine are available, typically in combination with the tetanus and diphtheria vaccines (DPT). The vaccination is given to infants as a series of shots. Children who have not completed the series of vaccinations are at a higher risk of becoming infected. Even some people who have been vaccinated may still be infected by B. pertussis, but they tend to have a less severe illness.
Pregnant women are advised to be re-vaccinated to prevent transmission of pertussis to their newborns. Grandparents and other caretakers who will be spending time with a newborn are also advised to be re-vaccinated.
International travelers should be aware that many resource-limited countries do not have widespread vaccination programs for whooping cough. Infants who have not completed their series of vaccinations and people who have not had a recent booster vaccine may be at an increased risk of contracting whooping cough.
A throat swab is not acceptable. During a pertussis infection, the bacteria are found in the back of the nose, not in the throat or the front portion of the nose.
No. There is no simple, rapid diagnostic test for whooping cough. It requires specialized equipment and is typically performed in clinical laboratories. Not every laboratory performs this testing and samples may need to be sent to a public health laboratory.
Healthcare practitioners are required to report whooping cough to state health departments. Outbreaks are tracked and interventions, such as vaccination and appropriate prophylactic antibiotic treatment, may be provided to help limit the outbreak.
B. parapertussis are bacteria that can infect humans in the same manner as B. pertussis, but the infection usually causes a milder respiratory illness. Culture methods and PCR tests can detect and distinguish B. parapertussis from B. pertussis, and both are commonly tested for since the signs and symptoms may be similar in people with either infection. Blood tests may not detect antibodies to B. parapertussis and there is no vaccine to prevent B. parapertussis infection.
Direct fluorescent antibody (DFA) is a testing method that is no longer recommended or routinely available in clinical laboratories to detect whooping cough. This method is less specific and less sensitive than either the culture or PCR methods.
Sources Used in Current Review
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