Table 4.

General Comments on Clinical Presentation of Pertussis

• Pertussis should be increasingly suspected in patients who are afebrile with increasing cough duration and severity

• Coryza is associated with illness onset and, in contrast with most viral respiratory infections, does not become purulent

• The key to identifying a paroxysmal cough is that the patient does not inhale until he has run out of breath (possibly resulting in an inspiratory “whoop”)

• Paroxysmal cough episodes are more disturbing to the patient at night

• Among young infants, apnea and seizures may not be noted to occur with recognized paroxysms

• Most infants with pertussis will have had a close exposure to an adolescent or adult (usually a family member) with a prolonged afebrile cough illness

• The cough in pertussis is not truly productive

• Sweating episodes occur in adolescents and adults in time periods when coughing is not occurring