Clinical Manifestations

An incubation period of 7 to 10 days is followed by an initial catarrhal stage, lasting 1 to 2 weeks. During this phase the disease is highly communicable, but the symptoms are nonspecific and resemble those of many other infectious diseases, and of minor respira tory ailments. An increasingly persistent cough develops, which in the third stage becomes more severe and spasmodic, terminating in the characteristic whoop. In acute cases, paroxysms may occur 40 or 50 times in 24 hours. The whoop is frequently followed by vomiting. In young infants, who are unable to produce the whoop and resume effective breathing quickly, episodes of cyanosis follow the paroxysm. The acute stage lasts up to 4 weeks, but paroxysms may continue for 3 months or longer. The patient is considered convalescent when vomiting ceases, and the severity of the paroxysms diminishes. Complications include collapsed lungs, anoxic convulsions, and exhaustion; secondary bacterial infections may cause otitis media or pneumonia. Bronchiectasis has become rare since the introduction of antimicrobial agents.

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