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Open Access Highly Accessed Research article

Diagnostic value of symptoms and laboratory data for pertussis in adolescent and adult patients

Naoyuki Miyashita1*, Hiroto Akaike2, Hideto Teranishi2, Yasuhiro Kawai2, Kazunobu Ouchi2, Tadashi Kato1, Toshikiyo Hayashi1 and Niro Okimoto1

Author Affiliations

1 Department of Internal Medicine I, Kawasaki Medical School, 2-1-80 Nakasange, Kita-ku, Okayama, 700-8505, Japan

2 Department of Pediatrics, Kawasaki Medical School, 2-1-80 Nakasange, Kita-ku, Okayama, 700-8505, Japan

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BMC Infectious Diseases 2013, 13:129  doi:10.1186/1471-2334-13-129

Published: 11 March 2013

Abstract

Background

Several symptoms are classically thought to be suggestive of pertussis in children, but the diagnostic value of these symptoms in adolescent and adult patients is unclear. We evaluated the accuracy of the clinical findings for the early presumptive diagnosis of pertussis in adolescent and adult patients. Furthermore, we measured fractional exhaled nitric oxide (FeNO) with regard to whether we could distinguish eosinophilic inflammation of the airway and pertussis. FeNO is not expected to be associated with pertussis.

Methods

We compared 183 cases with laboratory-confirmed pertussis using serology and polymerase chain reaction and 1,132 cases without laboratory-confirmed pertussis.

Results

Among pertussis patients, paroxysmal cough was common with 90% sensitivity, but the specificity was low (25%). Posttussive vomiting and whoop were less common (sensitivity 25% and 19%, respectively), but both showed greater specificity for pertussis (80% and 86%, respectively). Posttussive gagging was observed with intermediate frequency and provided greater specificity (49% and 77%, respectively). Pertussis cases were most frequent between May and August with a peak in June. The mean FeNO value for the pertussis patients was 18.2 ± 9.2 ppb, which was significantly lower than that in asthma patients (56.9 ± 20.3 ppb, p <0.001). The most useful definition was posttussive vomiting and/or gagging, and a plus normal FeNO value, which had a sensitivity of 72% and a specificity of 70%.

Conclusions

Clinical symptoms and laboratory data are of limited value in making the diagnosis of pertussis, and it was clinically difficult to differentiate adolescent and adult patients with or without pertussis. However, pertussis should be considered if patients have posttussive vomiting and/or gagging and a normal FeNO concentration.

Keywords:
Bordetella pertussis; Adult; Adolescent; Seasonality; Fractional exhaled nitric oxide