PEDIATRICS- Catarrhal stage (7–10 days)—similar to URI
■ Coryza
■ Cough
■ Conjunctivitis - Paroxysmal stage (1–4 weeks)
■ Spasmodic fits of coughing, with inspiratory whoop
■ Physical exam may be normal between paroxysms
■ Fever uncommon - Convalescent stage (several months)
■ Decreasing frequency and severity of paroxysms
DIFFERENTIAL
■ Pneumonia
■ Cough-variant asthma
■ Aspirated foreign body
DIAGNOSIS
■ Nasopharyngeal aspirate may be sent for testing to confirm clinical suspi-
cion of pertussis.
■ WBC may be elevated (20,000–50,000/mm^2 ), with a lymphocytosis.
■ CXR to rule out other etiologies
TREATMENT
■ Erythromycin estolate, clarithromycin, or azithromycin
■ Prevention through immunization (DTaP = diphtheria, tetanus, acellular
pertussis)
COMPLICATIONS
■ Pneumonia
■ Seizures, encephalitis
■ Children <6 months are at highest risk for complications.
PNEUMONIA
Pneumonia is a lower respiratory tract infection caused by viruses, bacteria, or
atypical agents. The etiology varies with the age of the child, with viruses
more common than bacteria for all ages. Viruses causing pneumonia include
RSV, parainfluenza, influenza, adenoviruses, rhinoviruses, enteroviruses, vari-
cella, measles, CMV, HSV, EBV, and rubella. Bacterial pneumonia in new-
borns is most commonly caused by group B streptococcus, with older infants
and children affected by Streptococcus pneumoniaemore than any other bac-
terial agent. Rarely, S. aureusorH. influenzaemay cause bacterial pneumo-
nia in children. Atypical agents, such as Mycoplasma pneumoniaeorChlamy-
dia pneumoniae, are associated with pneumonia in older children and
teenagers.
SYMPTOMS/EXAM
Symptoms are variable and depend upon the age of the child and severity of
illness. Young infants may have no respiratory symptoms, but may present
only with fever and dehydration. The classical presentation of pneumonia
describes a patient infected with S. pneumoniae, and includes the sudden
onset of fever, chills, dyspnea with tachypnea, and a productive cough.
Antibiotic treatment for
pertussis begun after
paroxysmal stage has begun
does not ameliorate course of
disease, but does help
decrease bacterial shedding
and spread of disease