PHYSICAL EXAMINATION

VS: Normal

PE: Paroxysmal cough, whoop, and post-tussive vomiting were noted during examination. Conjunctival hemorrhages and facial petechiae were also noted. There were no signs of lower respiratory illness.

LABORATORY STUDIES

Blood

WBC: 32,000/μL

Differential: 14% PMNs, 78% lymphs, 8% monos

Imaging

Chest x-ray did not reveal any pulmonary infiltrates.

Table 7-1 lists the likely causes of illness (differential diagnosis). Epidemiologic and clinical criteria of paroxysmal cough for 14 (CDC) or 21 (WHO) days are used for making the clinical diagnosis of pertussis because the presentation and duration of symptoms are so typical. However, laboratory tests may be useful in young infants and in atypical cases. Leukocytosis with absolute lymphocytosis occurs during the late catarrhal and paroxysmal phases and is a nonspecific finding. Investigational approach to delineating the etiology may include

• Direct fluorescence antibody (DFA) testing of nasopharyngeal specimens

• Culture of posterior nasopharyngeal secretions

• PCR testing of nasopharyngeal swabs or aspirates

TABLE 7-1 Differential Diagnosis and Rationale for Inclusion (consideration)

Adenoviruses

Bacterial causes of bronchitis

Non type b Haemophilus influenzae

Mycoplasma pneumoniae

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