Pertussis is a disease reported since the 1500s. Pertussis, meaning intense or violent cough, is a highly communicable, bacterial infection of the respiratory system. The gasping inspiratory sounds, heard mostly in young children, give it its common name, whooping cough. Patients are contagious for three weeks, with an incubation period of one to two weeks. Before a vaccine for pertussis was developed in 1948, it was the leading cause of death from communicable disease for children under age 14 in the United States. Worldwide reduction in the use of the vaccine in recent years has caused an increase in incidence of pertussis.

Bordetella pertussis and B. parapertussis, small gram-negative coccobacilli, are the infectious organisms that produce pertussis in humans. Aerosol droplets are usually spread from the cough of infected patients. The bordetella organism adheres to the cilia of the epithelial cells lining the mucosa of the respiratory tract, producing the pertussis toxin, causing local tissue reaction, and eventually systemic illness.

• Lack of immunization to pertussis
• Exposure to infected person(s)

After an incubation period of 5 to 20 days, there are three phases (catarrhal, paroxysmal, and convalescent) each with its own signs and symptoms.

Catarrhal phase (one to two weeks):

• Upper respiratory tract infection; often indistinguishable from the common cold but increasingly severe
• Low-grade fever
• Rhinitis
• Anorexia

Paroxysmal phase (one to four weeks):

• Cough increases (2 to 50 episodes a day) and fever subsides
• Sudden, forceful inspirations (whooping sound)
• Paroxysms of cough include bulging eyes, tongue protrusion, lacrimation, cyanosis.
• Vomiting (thick secretions), choking, and/or apnea follow paroxysms.
• Patient may not appear ill between paroxysms; infants often exhausted and may lose consciousness

Convalescent phase (two weeks to several months):

• Residual cough
• Older children and adults with previous vaccine or illness have nonspecific bronchitis-like symptoms, usually without the characteristic whooping sound.

• Acute upper respiratory infections
• Pneumonias
• Bronchiolitis
• Cystic fibrosis
• Tuberculosis
• Foreign bodies in respiratory tract
• Chronic obstructive pulmonary disease
• Leukemia

The patient initially presents with cold-like symptoms. Paroxysms may occur following a slight startle. Often a child who appears well begins to flail and gasp as the face reddens, eyes water, and the inspiratory whoop may be heard. Adults describe feelings of strangulation and bursting headache before air again enters the lungs.

• Pertussis organisms are cultured from respiratory tract secretions (highly specific, but not sensitive) or nasopharyngeal secretions (more sensitive); negative cultures occur with patients taking antibiotics or with previous vaccination.
• Direct fluorescein-conjugated antibody (DFA) staining of nasopharyngeal secretions effectively identifies B. pertussis; may give false negatives and positives; only reliable in experienced laboratories.
• Serologic tests (now commercially available) show that IgM and IgA are elevated with infection.

• Lymphocytosis is stimulated by pertussis toxin.
• White blood count is elevated (15,000 to 60,000).
• Pertussis toxin causes leukocyte dysfunction, insulin secretion, and histamine sensitivity.
• Local epithelial damage results from tracheal cytotoxin, dermonecrotic factor, and adenylate cyclase.

Chest X ray may be clear or show mild infiltrates.

Available laboratory tests are generally used for research and patients with severe complications. Pertussis should be suspected for severe cough (longer than two weeks) with post-tussive vomiting, leukolymphocytosis, inspiratory whoop, and known exposure. A lack of immunization is not a good indicator of possible pertussis, as a large percentage of immunized people contract pertussis.

Treatment is largely to control symptoms and prevent spread. Quarantine for four weeks. Parenteral fluid and nutrition, oxygen supplementation, and mechanical ventilation may be required.

• Antibiotics—usually erythromycin (40 to 50 mg/kg/day, with a maximum dose of 2 kg, in four divided doses for 14 days) reduces transmission and is effective even for infants. Unless given in the catarrhal phase, antibiotics do not reduce the severity or length of illness.
• Corticosteroids (e.g., betamethasone, 0.075 mg/kg/day) may reduce severity and length of paroxysms, especially for infants.
• Albuterol (0.3 to 0.5 mg/kg/day) reduces the severity of cough paroxysms.
• Immediate resuscitation from loss of consciousness is essential to avoid anoxic brain damage and death.
• Suctioning of secretions, oxygen administration, parenteral fluids and electrolytes are used for infants and protracted illness.
• Mist by tent may benefit infants.
• Do not use cough suppressants.

Pertussis is more serious in children under the age of 2 and in the elderly. For those people with healthy immune systems, pertussis can be treated with nutrition, herbs, and homeopathy with excellent results. Alternative therapies require intensive nursing on the part of the caretaker.

Note: Doses given are for children. Adults should double the amounts.

• Eliminate mucus-forming foods such as dairy, bananas, wheat, and meat products.
• Encourage small, frequent meals of vegetable broths, steamed vegetables, and fresh fruit (especially pineapple and grapes) and vegetable juices. Add therapeutic foods to broths, including onions, garlic, ginger, leeks, turnips, carrots, and leafy greens.
• Vitamin C (200 to 500 mg tid), zinc (10 to 15 mg/day), and beta-carotene (10,000 to 25,000 IU/day) support the immune system.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

Respiratory and immune-stimulating herbs are used in a variety of modalities. For best results use both internal and external treatment.

Catarrhal stage: Use immune-stimulants, expectorants, and antiseptics to facilitate expectoration, enhance immunity, and reduce severity of infection. Choose two herbs from each of the first three categories. Combine in equal parts in a tea (1/2 cup every three to four hours), a tincture or glycerite (30 drops every three to four hours).

Paroxysmal stage: In addition to the above formula, add antispasmodic herbs to ease cough. Combine 2 parts of catnip with two to four of the other antispasmodic herbs in a tincture or glycerite (20 drops every one to two hours).

Immune-stimulating herbs:

• Coneflower (Echinacea purpurea)
• Usnea lichen (Usnea spp.)
• Garlic (Allium sativum)
• Astragalus (Astragalus membranaceus)

Expectorants:

• Licorice root (Glycyrrhiza glabra)
• Elecampane (Inula helenium)
• Mullein (Verbascum densiflorum)

Antiseptics:

• Thyme (Thymus vulgaris)
• Hyssop (Hyssopus officinalis)
• Anise seed (Pimpinella anisum)

Antispasmodics:

• Indian tobacco (Lobelia inflata)—should not be more than 1/4 of a combination.
• Catnip (Nepeta cateria)
• Chamomile (Matricaria recutita)
• Cramp bark (Viburnum opulus)
• Valerian (Valeriana officinalis)

Garlic (Allium sativum) and ginger root (Zingiber officinale) can be made into a syrup and given throughout the course of illness. Combine 10 to 12 cloves of sliced garlic with 10 to 12 slices of fresh ginger root. Using 2 cups of raw sugar, layer ginger, garlic, and sugar in a glass jar. Let sit in cool place for two days. Strain and store in amber jar. Give. 1/2 to 1 tsp. tid. Garlic and ginger can also be combined in a tea. Using 2 to 3 cloves of garlic and 2 to 3 slices of ginger, simmer in 1 cup of water for 10 to 15 minutes. Drink 1/2 cup tid to qid. May add honey and lemon for flavor.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

• Aconite for sudden onset of cough and great thirst for cold drinks
• Belladonna for sudden onset, high fever with flushed face and irritability
• Drosera for cough that is aggravated by tickle in the throat or on lying down. Paroxysms of coughing may be so severe that the patient cannot catch his or her breath
• Bryonia alba for cough that is dry and painful and is aggravated by eating and any motion
• Arnica montana for painful cough with nosebleed. Child may cry in anticipation of cough.
• Antimonium tartaricum for rattling cough and weakness that prevents expectoration
• Ipecacuanha for persistent nausea with paroxysmal cough leading to or ending in gagging or vomiting

• Chest rubs. Use 3 to 6 drops of essential oil (camphor, thyme, eucalyptus, rosemary) with 1 tbsp. food grade oil (almond, flaxseed, or olive). Rub on chest to increase circulation and ease spasm.
• Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory and may help prevent consolidation in pertussis. Apply oil directly to chest, cover with a clean soft cloth (e.g., flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results use three consecutive days in one week. Use daily during acute infection. Can add three to six drops of essential oil (see chest rub) to enhance the benefit.
• Herbal steams. Place 3 to 6 drops of essential oil (see chest rub) in a humidifier or a warm bath. This will help thin mucus and open respiratory passages.
• Contrast hydrotherapy. Alternating hot and cold applications to the chest and/or back increases circulation to the chest, brings nutrients to the lungs, and diffuses metabolic waste from inflammation. The overall effect is decreased inflammation, pain relief, and enhanced healing. Alternate three minutes hot with one minute cold. Repeat three times. This is one set. Do two to three sets/day.
• Warming sock treatment. Before bed, place cold, damp socks on warmed feet and cover with dry wool socks. Let child sleep with the wet socks on overnight. This will stimulate immune function, decrease congestion, and may allow more restful sleep.
• Tapotement and postural drainage may also help prevent consolidation and decrease duration of illness.

Both acupuncture and acupressure are used for children. May enhance immunity and decrease duration and severity of infection.

See chest rubs under physical medicine. Foot massage has an overall relaxing effect and can help induce relaxation and sleep in an anxious child.

Patients who have serious complications, severe paroxysms, or are under one year of age should be hospitalized.

Vaccination (0.5 mL, intramuscularly)

• 80% to 90% effective but lasts only up to 12 years (disease is less severe and often undiagnosed in older child and adult); studies show observer bias in efficacy of vaccine
• Typically given with diphtheria and tetanus

The following whole-cell (DTP) side effects have led to reduction in use.

• Inoculation site soreness
• Fever
• Persistent (more than three hours) crying
• Seizures
• Encephalopathy

Acellular (DTaP)—rare, infrequent side effects similar to DTP

• Patient should be isolated for seven days.
• Antibiotic (erythromycin) prescribed to nonimmunized, exposed person may prevent pertussis.

• Death in infants (more common in infants under 6 months of age)
• Pneumonia—low-grade fever after the catarrhal phase is indicative of secondary infection (10% of infants)
• Otitis media
• Seizures
• Coma
• Encephalopathy (1%)

Interathoracic and intraabdominal pressure during paroxysms can cause the following.

• Umbilical and inguinal hernias
• Subconjuctival, scleral, and cerebral hemorrhages
• Hemoptysis
• Rectal prolapse
• Periorbital edema
• Subcutaneous emphysema
• Pneumothorax or pneumomediastinum

Without complications, complete recovery can be expected.

Pertussis is generally uncomplicated in healthy adults. Nutritional support and homeopathics are safe in pregnancy. Herbal treatment should be under the supervision of a qualified practitioner.

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Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:432.

Bove M. An Encyclopedia of Natural Healing for Children and Infants. New Canaan, Conn: Keats Publishing; 1996:205-208.

Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Co; 1998.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1996.

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