What symptoms rule out whooping cough in adults?

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Takeaway

  • In adult patients the presence of whooping or post-tussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out.

Why this matters

  • Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality.

Study design

  • 53 studies involving 23796 participants (4149 had a diagnosis of pertussis) met eligibility criteria after a search on CINAHL, EMBASE, Medline and SCI-EXPANDED/CPCI-S up to June 2016.
  • Funding: None disclosed.

Key results

  • Of 53 included studies, 37 had a prospective design, 12 were retrospective and 4 were case-control studies.
  • Paroxysmal cough and absence of fever had a high sensitivity (93.2%; 95% CI 83.2-97.4 and 81.8%; 95% CI, 72.2-88.7 respectively) and low specificity (20.6%; 95% CI, 14.7-28.1, and 18.8%; 95% CI, 8.1-37.9 respectively) in adult patients.
  • In adult patients post-tussive vomiting and whooping had low sensitivity (32.5%; 95% CI, 24.5-41.6 and 29.8%; 95% CI, 8.0-45.2 respectively) and high specificity (77.7%; 95% CI, 73.1-81.7 and 79.5%; 95% CI, 69.4-86.9 respectively).
  • In children, post-tussive vomiting had moderate sensitivity (60.0%, 95% CI, 40.3-77.0) and specificity 66.0%, 95% CI, 52.5-77.3).

Limitations

  • Heterogeneity among included studies.