Whooping Cough: Symptoms, Types, Causes and Treatment

Whooping cough, medically known as pertussis, is a highly contagious respiratory disease that continues to pose a significant public health challenge worldwide—even in the era of widespread vaccination. This article provides a comprehensive overview of whooping cough, synthesizing the latest research to help you understand its symptoms, types, underlying causes, and the most effective treatment strategies.

Symptoms of Whooping Cough

Whooping cough is notorious for its intense, prolonged coughing fits. While often associated with infants and children, the disease can affect all age groups, sometimes presenting very differently in adults. Early recognition of symptoms is key to timely treatment and preventing complications.

Symptom	Description	Severity	Source(s)
Paroxysmal Cough	Sudden, uncontrollable coughs	Mild to Severe	1 6 3
Whoop Sound	Gasping "whoop" at end of cough	Classic in children	3 6
Vomiting	After coughing episodes	Common	3 6
Sinus Pain	Facial discomfort	Mild	1
Headache	Associated with coughing	Mild	1
Chest Pain	Due to intense coughing	Moderate	1
Hemoptysis	Coughing up blood	Moderate	1
Syncope	Fainting after coughing	Severe	1
Cardiac Arrhythmia	Heart rhythm disturbances	Severe	1

Table 1: Key Symptoms

Typical Presentation in Children

• Stage 1 – Catarrhal Stage: Begins like a common cold, with runny nose, mild cough, and low fever. After 1–2 weeks, the cough worsens.
• Stage 2 – Paroxysmal Stage: Characterized by intense coughing fits (paroxysms), often ending with a high-pitched "whoop" as the person gasps for air. Vomiting or exhaustion may follow each episode. This stage can last several weeks 3 6.
• Stage 3 – Convalescent Stage: Gradual recovery, but coughing may persist for weeks.

Atypical Presentation in Adults

• Adults may not experience the classic whoop sound.
• Symptoms can be mistaken for other respiratory infections.
• Severe cases may present with complications like chest pain, headaches, syncope (fainting), cardiac arrhythmia, and hemoptysis (coughing up blood), especially in those with underlying health conditions 1.

Complications

• Infants: Apnea (pauses in breathing), pneumonia, seizures, encephalopathy, and even death can occur if not treated promptly 6.
• Adults: Exacerbation of chronic illnesses, life-threatening complications, especially in immunocompromised individuals 1 6.

Types of Whooping Cough

While Bordetella pertussis is the classic cause of whooping cough, research has shown that other Bordetella species can also cause similar illnesses. Recognizing these types is important for diagnosis, treatment, and understanding vaccine effectiveness.

Type	Causative Bacteria	Host(s)	Note/Prevalence	Source(s)
Classic Pertussis	Bordetella pertussis	Humans	Most common	2 3 6
Parapertussis	B. parapertussis (hu)	Humans	Similar, milder	2
Zoonotic Bordetella	B. bronchiseptica	Animals, rarely humans	Rare human infection	2
Holmesii Pertussis	B. holmesii	Humans	Emerging, rising	5

Table 2: Whooping Cough Types and Causative Agents

Classic Whooping Cough (Pertussis)

• Primary cause: Bordetella pertussis.
• Responsible for the majority of human cases worldwide 2 3 6.
• Highly contagious and often severe in infants and young children.

Parapertussis

• Caused by: Bordetella parapertussis (hu).
• Leads to a pertussis-like illness, generally milder than classic pertussis.
• Not covered by standard pertussis vaccines 2.

Bordetella bronchiseptica

• Primarily infects animals, but can rarely infect humans, usually those with weakened immune systems.
• Human infections are zoonotic (transmitted from animals) and are less common 2.

Bordetella holmesii

• An emerging cause of pertussis-like illness, especially noted in recent outbreaks.
• Prevalence is rising, with some studies showing up to 8.8% of whooping cough cases linked to B. holmesii in certain regions 5.
• The emergence of B. holmesii raises concerns about vaccine coverage and diagnostic accuracy.

Why Types Matter

• Diagnosis: Different species may require different laboratory tests for confirmation.
• Treatment and Prevention: While antibiotics are generally effective against all, existing vaccines are primarily targeted at B. pertussis, and may be less effective against other species 5 2.
• Epidemiology: Understanding the types helps track outbreaks and improve public health interventions.

Causes of Whooping Cough

At its core, whooping cough is an infectious disease caused by specific types of bacteria. But what makes these bacteria so effective at causing illness, and why is whooping cough making a comeback even with high vaccination rates? Let's explore.

Cause	Agent/Factor	Key Features	Source(s)
Infectious Agent	Bordetella pertussis	Gram-negative coccobacillus	1 2 3 4
Transmission	Airborne droplets	Highly contagious	3 6
Virulence Factors	Pertussis toxin, etc.	Toxin production causes symptoms	1
Other Species	B. parapertussis, B. holmesii	Can cause similar illness	2 5
Host Factors	Waning immunity, chronic illness	Increases susceptibility	1 6

Table 3: Main Causes and Risk Factors

The Bacterial Culprits

• Bordetella pertussis: The principal cause of whooping cough. This gram-negative aerobic coccobacillus possesses several virulence factors—including pertussis toxin, filamentous hemagglutinin, and adenylate cyclase toxin—that damage the respiratory tract and trigger the characteristic cough 1 2 3 4.
• Other Bordetella species: B. parapertussis and B. holmesii can mimic pertussis, sometimes leading to diagnostic challenges 2 5.

Transmission

• How it spreads: Whooping cough is transmitted through airborne droplets when infected people cough or sneeze 3 6.
• Contagiousness: The disease is highly contagious, especially during the early, cold-like stage—before the classic cough develops. This makes early detection and containment difficult 3 6.

Pathogenesis: How Does It Cause Disease?

• The bacteria attach to the cilia lining the upper respiratory tract and release toxins that:
  • Paralyze the cilia, impairing the natural clearing of mucus.
  • Cause inflammation and damage to the respiratory tract.
  • Lead to the characteristic paroxysmal cough and whooping sound 1.

Why Is Whooping Cough Still a Problem?

• Waning Immunity: Immunity from childhood vaccination or natural infection decreases over time, leaving adolescents and adults susceptible to infection and capable of spreading the disease 1 6.
• Vaccine Coverage: Most vaccination programs target infants and young children, sometimes neglecting booster doses for older children, adults, and healthcare workers 1.
• Emergence of Other Bordetella species: B. holmesii and B. parapertussis are not prevented by standard vaccines, contributing to outbreaks 5.

Host Factors

• High risk groups: Infants, immunocompromised individuals, and people with chronic respiratory or cardiac conditions face higher risks of severe illness 1 6.
• Exacerbation of existing illness: Whooping cough can trigger worsening of chronic diseases, particularly in adults 1.

Treatment of Whooping Cough

While antibiotics are the mainstay of treatment, their ability to change the course of the illness is limited. Timely intervention, supportive care, and prevention remain critical.

Treatment	Purpose	Effectiveness/Limitations	Source(s)
Antibiotics	Eradicate bacteria	Reduce infectivity, little effect on symptoms	7 11 6
Macrolides (e.g., azithromycin, erythromycin)	First-line agents	Short- and long-term regimens equally effective	7 11
TMP/SMX	Alternative to macrolides	Effective in bacterial clearance	7 11
Supportive Care	Symptom management	Main approach for cough and complications	6 9 10
Immunoglobulin	Reduce toxin effects	Some benefit if given early; evidence limited	8 9 10
Symptomatic Medications	Manage cough	Corticosteroids, antihistamines, beta-agonists ineffective	9 10
Vaccination	Prevention	Reduces incidence, boosters needed	1 3 6

Table 4: Treatment and Prevention Options

Antibiotic Therapy

• Goal: Reduce the period of infectivity and prevent spread, especially to vulnerable contacts 7 6.
• Agents:
  • Macrolides (azithromycin, clarithromycin, erythromycin) are the first-line drugs 7. Shorter courses (e.g., azithromycin for 3–5 days) are as effective as longer erythromycin courses but cause fewer side effects.
  • Trimethoprim/sulfamethoxazole (TMP/SMX) can be used in those intolerant to macrolides 7 11.
• Limitations:
  • Antibiotics do not significantly alter the course or duration of symptoms, especially if started late in the illness 7.
  • Contact prophylaxis with antibiotics is generally not beneficial for individuals over six months of age 7.

Supportive and Symptomatic Treatment

• Supportive care: Ensures adequate hydration, nutrition, and monitoring for complications such as pneumonia or apnea in infants 6.
• Symptomatic treatments: Most interventions to reduce cough severity—including corticosteroids, beta-agonists, antihistamines, and leukotriene receptor antagonists—have not shown significant benefit in clinical trials 9 10.
• Immunoglobulin therapy: High-dose specific pertussis immunoglobulin may help reduce the severity and duration of symptoms if given early, but evidence is limited and more research is needed 8 9 10.

Hospitalization

• When needed: Hospital care is indicated for infants, those with severe paroxysms, complications (e.g., pneumonia, apnea), or inability to maintain hydration 6.

Prevention

• Vaccination: The cornerstone of pertussis control. Routine childhood immunization, adolescent boosters, and vaccination of close contacts (including pregnant women and healthcare workers) are essential to reduce disease burden 1 3 6.
• Booster doses: Recommended for adolescents and adults, as immunity wanes over time 1.

Conclusion

Whooping cough remains a serious, highly contagious respiratory illness with the potential for severe complications, especially in infants and vulnerable adults. Despite advances in vaccination and treatment, pertussis continues to cause significant morbidity worldwide due to its ability to mimic other illnesses, waning immunity, and emerging causative agents.

Key Takeaways:

• Symptoms: Classic presentation includes paroxysmal cough and whoop, but adults may have atypical, severe symptoms 1 3 6.
• Types: Primarily caused by Bordetella pertussis, but B. parapertussis and B. holmesii are emerging agents 2 5.
• Causes: Driven by highly infectious bacteria with potent toxins; transmission occurs via airborne droplets 1 3 6.
• Treatment: Antibiotics reduce infectivity but offer limited symptomatic relief; supportive care is crucial 7 9 10.
• Prevention: Vaccination (with boosters) remains the best defense; awareness of atypical cases and emerging species is vital 1 3 5 6.

Staying informed about whooping cough's evolving landscape is essential for individuals, families, and healthcare providers alike. Early recognition, appropriate treatment, and prevention can save lives and curb the spread of this ancient, yet persistent, disease.