title: Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care.
abstract: BACKGROUND
  Most cases of adult pertussis probably remain undiagnosed.
  
  
  OBJECTIVE
  To explore the prevalence, diagnosis, and disease course of acute pertussis infection in adult patients presenting with acute cough.
  
  
  METHODS
  Prospective observational study between 2007 and 2010 in primary care in 12 European countries.
  
  
  METHODS
  Adults presenting with acute cough (duration of ≤28 days) were included. Bordetella pertussis infection was determined by polymerase chain reaction (from nasopharyngeal flocked swabs and sputa) and by measurement of immunoglobulin G antibodies to pertussis toxin (PT) in venous blood at day 28. An antibody titre to PT of ≥125 IU/ml or PCR positive result in a respiratory sample defined recent infection. Patients completed a symptom diary for 28 days.
  
  
  RESULTS
  Serum and/or respiratory samples were obtained in 3074 patients. Three per cent (93/3074) had recent B. pertussis infection. Prior cough duration >2 weeks discriminated to some extent between those with and without pertussis (adjusted odds ratio 1.89, 95% confidence interval = 1.17 to 3.07; P = 0.010). Median cough duration after presentation was 17 and 12 days in patients with and without pertussis, respectively (P = 0.008). Patients with pertussis had longer duration of phlegm production (P = 0.010), shortness of breath (P = 0.037), disturbed sleep (P = 0.013) and interference with normal activities or work (P = 0.033) after presentation.
  
  
  CONCLUSIONS
  Pertussis infection plays a limited role among adults presenting with acute cough in primary care, but GPs should acknowledge the possibility of pertussis in uncomplicated lower respiratory tract infection. As in children, pertussis also causes prolonged symptoms in adults. However, pertussis is difficult to discern from other acute cough syndromes in adults at first presentation.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jolien
authors.initials: J
authors.lastname: Teepe
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Berna D L
authors.initials: BD
authors.lastname: Broekhuizen
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Margareta
authors.initials: M
authors.lastname: Ieven
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Katherine
authors.initials: K
authors.lastname: Loens
authors.affiliation: Scientific Institute of Public Health (WIV-ISP), Scientific Service Immunology, National Reference Centre Bordetella, Brussels, Belgium.
authors.forename: Kris
authors.initials: K
authors.lastname: Huygen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Kretzschmar
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Hester
authors.initials: H
authors.lastname: de Melker
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: University of Southampton Medical School, Primary Care Medical Group, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: University of Southampton Medical School, Primary Care Medical Group, Southampton, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute (VAXINFECTIO), and Centre for General Practice, Primary and Interdisciplinary Care (ELIZA) Antwerp, University of Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D001886:Bordetella pertussis / Q000302:isolation & purification*; D003371:Cough / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000276:immunology; D037342:Pertussis Toxin / Q000097:blood* / Q000276:immunology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D014917:Whooping Cough / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D037342:Pertussis Toxin
keywords: Bordetella pertussis; diagnosis; prevalence; primary care; prognosis; whooping cough