Labcorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
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
Couturier, M. et. al. (2019 June, Updated). Bordetella pertussis – Whooping Cough. ARUP Consult. Available online at https://arupconsult.com/content/bordetella-pertussis. Accessed December 2019.
Bocka, J. et. al. (2019 May 2, Updated). Pertussis. Medscape Pediatrics: General Medicine. Available online at https://emedicine.medscape.com/article/967268-overview. Accessed December 2019.
Kaneshiro, N. et. al. (2017 September 5, Updated). Pertussis. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/001561.htm. Accessed December 2019.
(© 1995-2019). Bordetella pertussis and Bordetella parapertussis, Molecular Detection, PCR. Mayo Clinic Laboratories. Available online at https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/80910. Accessed December 2019.
(2018 October 1). Most Pertussis Cases in Infants Tied to Unvaccinated Mother. Medscape Medical News. Available online at https://www.medscape.com/viewarticle/902739. Accessed December 2019.
(2019 March 13). Genetic Shifts in Bordetella May Explain Surge in Pertussis. Medscape Medical News. Available online at https://www.medscape.com/viewarticle/910355. Accessed December 2019.
(2017 August 7, Reviewed). Pertussis (Whooping Cough), Laboratory Information. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/pertussis/lab.html. Accessed December 2019.
(2017 August 7, Reviewed). Pertussis (Whooping Cough) Diagnosis Confirmation. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html. Accessed December 2019.
Sources Used in Previous Reviews
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1536-1537.
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 1454-1455.
Forbes, B. et. al. (© 2007). Bailey & Scott's Diagnostic Microbiology, Twelfth Edition: Mosby Elsevier Press, St. Louis, Missouri. Pp 435-439.
Raguckas, S. et. al. (2007 March 14). Pertussis Resurgence: Diagnosis, Treatment, Prevention, and Beyond. Medscape from Pharmacotherapy 27(1): 41-52. [On-line information]. Available online at http://www.medscape.com/viewarticle/552159. Accessed on 10/11/08.
(2008 February 1, Updated). Pertussis (Whooping Cough). Minnesota Department of Health [On-line information]. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/pfacts.html. Accessed on 10/12/08.
Cornish, N. (2005 January). Identifying, testing for, and treating Bordetella pertussis. CAP Today [On-line information]. Available online at http://www.cap.org. Accessed on 10/12/08.
(2007 June 12). Pertussis. CDC Travelers' Health Yellow Book. Chapter 4, Prevention of Specific Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/travel/yellowBookCh4-Pertussis.aspx. Accessed on 10/12/08.
Mayo Clinic Staff (2007 December 19). Whooping Cough. Mayoclinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/whooping-cough/DS00445. Accessed on 10/12/08.
Weinberg, G. (2006 June, Revision). Pertussis. Merck Manual Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec23/ch272/ch272g.html#sec23-ch272-ch272g-800. Accessed on 10/12/08.
(2005 Revised). Pertussis (Whooping Cough). The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch173/ch173l.html#sec14-ch173-ch173l-774. Accessed on 10/12/08.
(2006 June). Pertussis. Guide to Surveillance, Reporting and Control. Massachusetts Department of Public Health, Bureau of Communicable Disease Control [On-line information]. PDF available for download at http://www.mass.gov/Eeohhs2/docs/dph/disease_reporting/guide/pertussis.pdf. Accessed on 10/12/08.
Carney, H. et. al. (2008 September, Updated). Bordetella pertussis. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Bacteria/Bordetellapertussis.html#. Accessed on 10/12/08.
(2004 September). Pertussis – Laboratory Testing. Minnesota Department of Health [On-line information]. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/hcp/labfacts.html. Accessed on 10/12/08/.
Gregory, D. (2006 August 1). Pertussis: A Disease Affecting All Ages. American Family Physician [On-line information]. Available online at http://www.aafp.org/afp/20060801/420.html. Accessed on 10/12/08.
Centers for Disease Control and Prevention: Guide for the Control of Pertussis Outbreaks (2000; amended in 2005, 2006). Available online at http://www.cdc.gov/vaccines/pubs/pertussis-guide/guide.htm. Accessed November 2008.
Forbes BA, Sahm DF, Weissfeld AS, Bailey & Scott's Diagnostic Microbiology 12th Edition: Mosby Elsevier, St. Louis, MO; 2007, Pp 435-438.
(August 26, 2010) Centers for Disease Control and Prevention. Pertussis. Available online at http://www.cdc.gov/pertussis/. Accessed November 2011.
(February 14, 2011) CDC. Pertussis, Diagnosis Confirmation Testing. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html. Accessed November 2011.
(February 14, 2011) CDC. Best Practices for Health Care Professionals on the use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html. Accessed November 2011.
(September 12, 2011) Minnesota State Department of Health. Pertussis Laboratory Testing. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/hcp/labfacts.html. Accessed November 2011.
(May 26, 2009) Bocka J. Pertussis in Emergency Medicine. Medscape Reference article. Available online at http://emedicine.medscape.com/article/803186-overview. Accessed November 2011.
Frisman D, et al. Pertussis Resurgence in Toronto, Canada. BMC Public Health. 2011; 11: 694. Published online 2011 September 7. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189138/?tool=pubmed. Accessed November 2011.
(August 31, 2015) Centers for Disease Control and Prevention. Pertussis. Available online at http://www.cdc.gov/pertussis/. Accessed October 2015.
(August 31, 2015) Centers for Disease Control and Prevention. Pertussis, Diagnosis Confirmation. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html. Accessed October 2015.
(May 19, 2015) Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases, Chp 10, Pertussis. Available online at http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.html. Accessed October 2015.
(February 2015) Mayo Medical Laboratories. Hot Topic: Bordetella pertussis and Bordetella parapertussis. Available online at http://www.mayomedicallaboratories.com/articles/hot-topic/2015/02-15-pertussis/. Accessed October 2015.
(August 31, 2015) Centers for Disease Control and Prevention. Pertussis, Laboratory Information. Available online at http://www.cdc.gov/pertussis/lab.html. Accessed October 2015.