A Patient's Perspective
The Cough that Would Not Quit
Am Fam Physician. 2019 Feb 1;99(3):185.
The cough started just before Christmas. I am used to contracting every germ my students bring to school, but thought I was immune to most by now. Everyone seemed to have a virus at the time, so I expected it to pass. Despite my best efforts, things got steadily worse and I was eventually treated with antibiotics. After a brief improvement, the symptoms returned worse than ever. The coughing and exhaustion just would not end, despite multiple rounds of antibiotics, inhalers, and other remedies. I thought the clinic staff must be tired of seeing me, but my family doctor was always helpful and remained determined to find out what was wrong. After multiple x-rays, two CT scans, and more blood work, I was finally diagnosed with whooping cough.
I was really surprised. I thought I was immunized, and my symptoms were nothing like my idea of whooping cough. The illness started like a typical cold but was longer, nastier, and much more exhausting than anything I had previously experienced. I still have a cough but have been reassured that no permanent damage has been done.
I do not recall being offered a booster immunization—the advertisements seem to be all about grandparents, without an emphasis on teachers and others who are around young children on a daily basis. I trusted that all of my students had been immunized and was shocked by how many parents had opted out. I worried about infecting students or others, including residents of my mother's nursing home, but as far as I know, no one else has been diagnosed. I wish I had realized earlier that this was not just a stubborn virus. I am thankful my family physician stuck with me to make the diagnosis.—R.E.
Thankfully, R.E. has recovered. As her symptoms dragged on, we both began to worry about more sinister diagnoses. Pertussis is notoriously difficult to diagnose in adults, but her story has made me much more likely to think of it in adults with prolonged cough. R.E.'s experience has also made me more motivated to talk with parents who are hesitant about vaccinations regarding the real dangers of pertussis in our community, and to think about immunization for all adults who are around young children.
Resourcesshow all references
Centers for Disease Control and Prevention. Pertussis (whooping cough): https://www.cdc.gov/pertussis/index.html...
Centers for Disease Control and Prevention. Recommended immunization schedule for adults aged 19 years or older, United States 2018. https://www.cdc.gov/vaccines/schedules/hcp/adult.html
Kline JM, Lewis WE, Smith EA, Tracy LR, Moerschel SK. Pertussis: a reemerging infection [published correction appears in Am Fam Physician. 2014;89(5):317]. Am Fam Physician. 2013;88(8):507–514
Ebell MH, Marchello C, Callahan M. Clinical diagnosis of Bordetella pertussis infection: a systematic review. J Am Board Fam Med. 2017;30(3):308–319.
Cornia PB, Hersh AL, Lipsky, Newman TB, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010;304(8):890–896.
This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Majd, MD.
A collection of Close-ups published in AFP is available at https://www.aafp.org/afp/closeups.
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