Usefulness of symptoms in the diagnosis of whooping cough
Reference of this article: Lalaguna Mallada P, García Romero R, Bajo Delgado A, Galbe Sánchez-Ventura J, Fernández Espuelas C, López Calleja AI, et al. Usefulness of symptoms in the diagnosis of whooping cough. Rev Pediatr Aten Primaria. 2003;5:215-224.
Published in Internet: 30-06-2003 - Visits: 9075
Objectives: To study the usefulness for the diagnosis of whooping cough of clinical
symptoms. The Gold standard test was the deep nasopharyngeal swab and specific culture
for bordetella pertussis, parapertussis or bronchiseptica.
Desing: Case-control retrospective not random a not blinded study.
Setting: An urban health centre.
Definition of case: children who were diagnosed of whooping cough with positive culture
or who had contact with infected persons and who presented one or more of the following
criteria: cough of more than 14 days, cough in accesses, post-tussive vomiting or final
sputum or apnoeas. All the cases took place in the year 2000 and in children who consult in
a health centre.
Definition of controls: children who in the same period of time presented one or more
of the following criteria: cough of more than 14 days, cough in accesses, post-tussive vomiting
or final sputum or associated to apneas. All the controls took place in the year 2000
between children who consult in a health centre.
In all the children nasopharyngeal specimens were taken and the sample was seeded
immediately in specific culture for Bordetella pertussis, Bordetella parapertussis o Bordetella
The data were taken from clinical histories of the children who fulfilled the criteria of
definition of case or control. The data were analysed by means of a leaf of Excel to calculate
sensitivity, specificity, predictive positive and negative values as well as positive and negative
quotients of probability for each one of the clinical symptoms alone or in combination.
It was considered as test of standard reference or ?gold? the specific culture for Bordetella
pertussis, parapertussis or bronchiseptica.
Main Results: Eleven children were diagnosed of whooping cough by bacteriologic culture
or secondary household contacs of cases with positive bacteriologic culture. In this population
the percentage of whooping cough was de 24%. The respective Positive likehood
ratio for Estridor: 2, Esputum: 1,25, Emeting cough 1,69, tussive acces 1,15. The pretest probability: 0,24.The posttests probability of three symptoms as Esputum+Emeting cough+
Tussive access: 54% and Estridor+Emeting cough+Esputum: 62%.
Conclussions: For the diagnosis of whooping coug is necessary the confirmatory bacteriologic
test. In many cases its takes a long time and medical staff needs objective data in
order to take decisions. So the results of this sutdy can be evaluated for each phyisician for
an individual management of each case.
Keywords● Bordetella ● Pertussis ● Pertussis