West Virginia University School of Medicine, Eastern Division , Harpers Ferry, WV, USA.
Am Fam Physician. 2013 Oct 15;88(8):507-14.
Pertussis, also known as whooping cough, is an acute respiratory tract infection that has increased in incidence in recent years. The initial catarrhal stage presents with nonspecific symptoms of malaise, rhinorrhea, sneezing, lacrimation, and mild cough. During the paroxysmal stage, severe outbreaks of coughing often lead to the classic high-pitched whooping sound patients make when gasping for breath. The paroxysmal stage is followed by the convalescent stage and resolution of symptoms. Complications vary by age, with infants more likely to experience severe complications such as apnea, pneumonia, seizures, or death. In adolescents and adults, complications are the result of chronic cough. The diagnosis depends on clinical signs and laboratory testing. Both culture and polymerase chain reaction testing can be used to confirm the diagnosis; serologic testing is not standardized or routinely recommended. Although antibiotics have not shown clear effectiveness in the treatment of pertussis, they eradicate nasal bacterial carriage and may reduce transmission rates. Macrolide antibiotics such as azithromycin are first-line treatments to prevent transmission; trimethoprim/sulfamethoxazole is an alternative in cases of allergy or intolerance to macrolides. Immunization against pertussis is essential for disease prevention. Current recommendations in the United States consist of administering five doses of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine to children before seven years of age, and administering a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster between 11 and 18 years of age. Recent efforts have focused on the vaccination of adolescents and adults, with new recommendations for a single dose of the Tdap booster if it has not been previously administered.
百日咳，又称作“鸡咳”或“鸬鹚咳”，是一种近年来发病率有所上升的急性呼吸道传染病。初始卡他期表现为非特异性的不适、流涕、喷嚏、流泪和轻度咳嗽。在阵咳期，剧烈的咳嗽发作常常导致典型的鸡鸣样吸气吼声。阵咳期后是恢复期，症状缓解。并发症因年龄而异，婴儿更可能出现严重并发症，如呼吸暂停、肺炎、癫痫发作或死亡。在青少年和成年人中，并发症是慢性咳嗽的结果。诊断取决于临床症状和实验室检测。培养和聚合酶链反应检测均可用于确诊；血清学检测尚未标准化或常规推荐。虽然抗生素在治疗百日咳方面没有明显效果，但它们可以消除鼻内细菌携带，可能降低传播率。大环内酯类抗生素如阿奇霉素是预防传播的一线治疗药物；对于对大环内酯类药物过敏或不耐受的患者，可选择复方磺胺甲噁唑。接种百日咳疫苗对于预防疾病至关重要。目前美国的建议是在 7 岁之前为儿童接种 5 剂白喉和破伤风类毒素无细胞百日咳（DTaP）疫苗，在 11 至 18 岁之间接种一剂破伤风类毒素、减毒白喉类毒素和无细胞百日咳（Tdap）加强针。最近的工作重点是青少年和成年人的疫苗接种，对于以前未接种过的人，新建议是接种一剂 Tdap 加强针。
