Question of the Week #485

485. A 10-year-old female presents with a 3 week history of cough.  Initially she had a runny nose and was tired with a slight cough but as the runny nose resolved the cough seemed to get worse.  She states that the cough is dry sounding and occurs during the day and night.  She describes having coughing spasms that occasionally end in vomiting but between episodes of coughing she is fine.  Her mom reports that during a coughing spasm she will gasp for air and sometimes make a “whooping” noise.  A nasopharyngeal swab confirms a diagnosis of Bordatella pertussis.  Which of the following is true?

A. Her 3-month-old brother should be treated with azithromycin as prophylaxis

B. She should be started on azithromycin for more rapid resolution of cough.

C. Her classmates should be treated with clarithromycin as prophylaxis

D. She will have lifelong natural immunity against Bordatella pertussis.

E. Her classmates should receive a Tdap booster regardless of their vaccination status

11 Responses

  1. B. She should be started on Azithromycin before the ‘convalescent phase’ …

  2. E

  3. C

  4. Patient should be started on azithromycin but it has no effect on duration of cough in paroxysmal stage. There is also no evidence of any benefit of post exposure Tdap booster in prevention.

  5. Answer ?

  6. c

  7. According to CDC Recs, all contacts ages <12 months should receive prophylaxis, so I would answer A.

    C is wrong due to age

  8. D

  9. A is ans post exposure prophylaxis to close contacts

  10. A

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