SHM Converge Scientific Abstract ePoster Gallery-Gasping, Choking, and Spasms: Pertussis With a New Look

Pdf Summary

This case describes an 8-year-old unvaccinated girl with recurrent nocturnal choking and gasping episodes, body stiffening, and post-episode emesis. She was repeatedly evaluated for cough, choking, constipation, reflux, seizures, and other neurologic or gastrointestinal causes. Multiple tests were normal, including chest imaging, CT head, EEG, EKG, upper GI series, and modified barium swallow. During hospitalization, an expanded respiratory viral panel was positive for <strong>Bordetella pertussis</strong>, establishing the diagnosis.

The case highlights that pertussis can present atypically in older children, not just as classic “whooping cough.” Symptoms may include paroxysmal cough, gasping, dyspnea, post-tussive emesis, spasms, and even apnea or cyanosis in infants. Because pertussis incidence is increasing across age groups and vaccine protection wanes over time, clinicians should maintain a high index of suspicion, especially when symptoms are unexplained and recurrent.

Key points from the presentation:
- <strong>Diagnosis is primarily clinical</strong>, with <strong>PCR preferred over culture</strong>.
- <strong>Treatment should not be delayed</strong> if suspicion is high.
- <strong>Azithromycin is first-line therapy</strong>; trimethoprim-sulfamethoxazole or another macrolide is second-line.
- Prevention includes <strong>maternal and childhood vaccination</strong>, timely boosters, <strong>isolation until 5 days of treatment are completed</strong> (or 21 days if untreated), and <strong>post-exposure prophylaxis for close contacts regardless of immunization status</strong>.

In this case, family contacts had recent pertussis, but the patient had not received post-exposure prophylaxis. She was treated with azithromycin, but her delayed diagnosis led to prolonged symptoms and extensive contact tracing across healthcare systems. The case underscores that early recognition and prevention are crucial to reduce patient morbidity and limit spread.

Asset Subtitle

Andrew W. Halterman

Meta Tag

Author List Andrew W. Halterman, Lora Greene Sowunmi

Category Clinical Vignettes

Concept Pertussis

Concept Post-tussive Emesis

Concept Polymerase Chain Reaction

Concept Azithromycin

Concept Clinical Suspicion

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic

Presenting Author Andrew W. Halterman

Track Pediatric

Keywords

Bordetella pertussis

unvaccinated child

nocturnal choking

paroxysmal cough

post-tussive emesis

atypical pertussis

PCR diagnosis

azithromycin treatment

vaccination prevention

post-exposure prophylaxis

Pertussis

Post-tussive Emesis

Polymerase Chain Reaction

Azithromycin

Clinical Suspicion