Is it pertussis or RSV? Here’s how to tell

The differentiation between an early pertussis infection and respiratory syncytial virus (RSV) can be very difficult, says Nancy Eckle, RN, MSN, CEN, program manager for emergency services at Children’s Hospital in Columbus, OH.

"In areas experiencing a pertussis outbreak, the possibility of pertussis should be considered in all infants and children with respiratory illnesses that are not fully immunized," she adds.

Follow these tips

Here are some things to consider when differentiating between RSV and pertussis:

• Don’t assume that wheezing means RSV.

Not all wheezing in infants is RSV. It may be pertussis. "Although wheezing is not commonly described as a symptom of pertussis we see it fairly routinely," notes Eckle. "The impact is that we have to isolate infants with wheezing that have not been fully immunized differently than those who have had the full initial series of vaccines."

Take appropriate isolation precautions.

Pertussis is spread by droplet transmission when the patient coughs, sneezes, or is talking, says Eckle. "Patients with suspected pertussis are placed in droplet precautions," she explains. Droplet precautions include the following, she says:

— placing the patient in a private room;

— wearing a mask if within 3 feet of the patient;

— hand washing.

RSV is spread through direct contact. Patients with suspected RSV are placed on contact precautions, notes Eckle. These include:

— placing the patient in a private room;

— wearing gloves at all times when in the room;

— wearing a gown at all times;

— hand washing with an antimicrobial agent.

Use isolation precautions

When pertussis and RSV are suspected, combined droplet and contact isolation precautions are needed, recommends Eckle. "To prevent transmission of RSV and/or pertussis, isolation precautions should ideally be initiated upon the patient’s arrival in the ED."

Know which patients are at risk for contracting pertussis.

Pertussis can occur at any age, but is most common in young children and adults, notes Eckle. "Infants and children who are not fully immunized [those who have not received at least three DPT vaccine doses] are at greatest risk for contracting pertussis. Older children and adults are also at risk for the disease, because immunity from vaccines diminishes over time."

Three stages of infection

Be familiar with the signs and symptoms of pertussis.

Pertussis begins with mild upper respiratory symptoms that progress to severe paroxysms of cough, Eckle notes. Patients may have other respiratory illnesses at the same time, she adds. For example, it is possible for the patient to have an RSV infection/bronchiolitis and pertussis concurrently. The three stages of a pertussis infection are as follows:

Stage 1 (Catarrhal stage). Duration: One to two weeks. Communicability is most likely in this stage. Begins to diminish with the onset of paroxysmal coughing, but might last as long as three weeks. Symptoms/history are:

• mild upper respiratory tract symptoms;

• cough;

• conjunctivitis;

• nasal discharge;

• inflammation of nasal mucous membranes.

Stage 2 (Paroxysmal stage). Duration: Two to four weeks. Symptoms/history are:

• increasingly severe cough;

• prolonged spasm of coughing (paroxysms). Parent may describe as not being able to catch breath between coughs;

• vomiting following coughing episodes;

• inspiratory "whoop" sound following a coughing episode (caused by a sudden inflow of air). The "whoop" may be absent in infants younger than 6 months and in older children and adults;

• apnea may occur in infants less than 6 months of age;

• fever is absent or minimal;

• wheezing and signs of respiratory distress exclusive of coughing episodes might be present with concurrent viral respiratory infection.

Stage 3 (Convalescent stage). Duration: Four to six weeks. Symptom: Intensity of cough gradually decreases.

For more information on differentiating between respiratory syncytial virus and pertussis, contact:

Nancy Eckle, RN, MSN, CEN, Program Manager for Emergency Services, Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. Telephone: (614) 722-4353. Fax: (614) 722-6890. E-mail: EckleN@chi.osu.edu.