Pertussis

Nocturnal

Step 1: View clinicals

A 12 year old boy presents with a persistent non-productive cough for 5 weeks, associated with nocturnal paroxysms, inspiratory whoops, and intermittent post-tussive vomiting. He also experienced on and off wheezing. He was anorectic, and lost around 2 kg of weight during the same period. His symptoms did not respond to a course of Amoxicillin. He was completely healthy earlier, with unremarkable medical and surgical histories. All immunizations are up to date.


Step 2: Order all relevant investigations

FBC + CRP

Hb: 13.4 g/dL (11.5-15.5) WBC: 17,200/mm3 (4,000-11,000) Neutrophils: 40% Lymphocytes: 55% Platelets: 289,000/mm³ (150,000-350,000) C-reactive Protein: 2 mg/dL (< 6)

Chest X-Ray

The X-ray of the chest appears normal.

Flexible Bronchoscopy

Flexible bronchoscopy will be performed tomorrow.

Sputum Induction and Cultures

Nebulization is used to induce samples of sputum. Cultures show no growth, but PCR is positive for Bordetella pertussis.


Step 3: Select appropriate management

Oxygen
Prophylaxis of Close Contacts
Clarithromycin
Immunization


Score: ★★☆