SESSION TITLE: Infectious Diseases Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Tuesday, October 27, 2015 at 07:30 AM - 08:30 AM
INTRODUCTION: Whooping cough, also known as pertussis, is a contagious respiratory illness caused by the bacteria Bordetella pertussis. The nasopharyngeal (NP) FilmArray Respiratory Pathogen (FARP) panel is able to detect B. pertussis with high sensitivity and specificity. Macrolide antibiotics are considered first-line treatment. We present a case of pertussis tracheitis diagnosed by bronchoscopy despite having 2 negative NP FARP swabs and a 5 day course of azithromycin.
CASE PRESENTATION: A 24 year-old male with a history of 2 heart transplantations in 2009 and 2013 for a congenital heart defect was admitted for a severe nonproductive cough and posttussive emesis. Six weeks prior, he presented to the emergency department (ED) for an intractable cough. NP FARP swabs and a chest x-ray (CXR) at that time were normal. He was discharged from the ED with 5 days of azithromycin. He represented to the ED 4 weeks later for persistent symptoms. A chest CT scan was normal and he was discharged again. He then developed new fevers and dyspnea. On admission, a repeat CXR and NP FARP swabs were normal. A diagnostic bronchoscopy revealed a severely inflamed trachea with purulent exudate overlying the mucosa (Figure). The tracheal washings were positive for B. pertussis by both culture and the FARP panel. He was prescribed a 14-day course of clarithromycin and is currently doing well.
DISCUSSION: B. pertussis is a gram-negative rod that causes pertussis. Pertussis is a highly contagious infection of the respiratory tract transmitted by respiratory droplets, which are effectively aerosolized by coughing. Its classic manifestation includes coughing paroxysms associated with posttussive emesis. The diagnosis of pertussis rarely requires bronchoscopy. The NP FARP detects 20 common pathogens implicated in respiratory tract infections. The reported sensitivity of NP FARP to detect B. pertussis is estimated to be >90%. Our patient had 2 negative NP FARP prior to his diagnosis. Once the diagnosis is made, the mainstay of treatment is macrolide antibiotics. Macrolide resistance is felt to be uncommon.
CONCLUSIONS: We present an exceedingly rare case of pertussis tracheitis diagnosed via bronchoscopy after having 2 negative NP FARP swabs, and a course of azithromycin.
Reference #1: FilmArray Respiratory Panel Instruction Booklet. BioFire Diagnostics, Inc. Salt Lake City, Utah, USA
Reference #2: Singh M, Lingappan K. Whooping cough: the current scene. Chest. 2006; 130(5):1547.
DISCLOSURE: The following authors have nothing to disclose: Kenneth Sakata, Richard Bottner, Kashif Yaqub, Thomas Grys, Karen Lambert, Roberto Patron, Karen Swanson
No Product/Research Disclosure Information