Case series of pertussis in pregnancy: A deadly, re-emerging disease

Abstract

Background: Pertussis is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It can cause serious complications and can be deadly in infants. Maternal pertussis vaccination is effective in preventing disease in infants who are too young to be vaccinated. Case Description: Case 1: A 32 y old, G3P2 at 18 w of pregnancy, with underlying bronchial asthma presented with cough for 2 w and worsening breathlessness. She had prior contact with her sick child. Her chest radiograph was normal. She was initially treated for acute asthmatic exacerbation with bronchodilator and steroid. Pertussis was considered in view of multiple episodes of post-tussive vomiting and she was administered with oral azithromycin for 5 d. Her symptoms resolved upon discharge. Nasopharyngeal aspirate for pertussis PCR was positive. As she was in early pregnancy, she was given a booster dose of pertussis vaccine. Case 2: A 27 y old, pregnant at 38 w, presented with cough for 3 w and post-tussive vomiting. She was afebrile, respiratory examination and chest radiograph were normal. Pertussis was suspected and she was given 5 d of azithromycin. She delivered a healthy baby via emergency LSCS due to acute fetal distress. Pertussis was confirmed by positive pertussis PCR from nasopharyngeal aspirate. Case 3: A 30 y old woman, 36 w pregnant, presented with sore throat and productive cough for 2 w, associated with post-tussive vomiting for 3 d and dehydration. Her chest radiograph was normal. She was rehydrated and treated with azithromycin as pertussis was suspected. She was discharged well. PCR for Bordetella pertussis was detected in nasopharyngeal sample. Discussion: Diagnosis of pertussis in pregnancy or adults is challenging due to milder symptoms and the usual absence of classical inspiratory whoop. It should be considered in patients coughing longer than 2 w with post-tussive vomiting. Natural infection with pertussis and childhood vaccination does not provide lifelong immunity, thus booster Tdap is highly recommended in all pregnant women to reduce the risk of pertussis in young infants. Conclusion: Pertussis is often under-diagnosed due to lack of awareness among clinicians. Despite all, vaccination is still the most important and cost-effective measure to reduce pertussis transmission, its morbidity and mortality.