Chief Complaint: Cough
Determining the Cause
a. History: Household contact with a prolonged cough
Differential Diagnosis
Pertussis*,
| Next Pivotal Assessment | Findings | ||
|---|---|---|---|
| History | Cough no improving | ||
*There should be a low threshold to suspect pertussis in young infants, given the risk of serious complications. Clinical suspicion of pertussis in infants, especially those younger than four months, should trigger immediate treatment. Laboratory confirmation should not delay the initiation of treatment. Early diagnosis and prompt treatment, as well as other precautionary measures, are essential to prevention of transmission. (See 'Complications' above and "Pertussis infection in infants and children: Treatment and prevention".)
Hospitalization may be warranted because pertussis can progress rapidly in young infants. Intensive care may be required, especially if apnea, cyanosis, or leukocytosis >30,000 cells/microL (which is associated with significant morbidity) is present, given the potential for rapid, unpredictable deterioration [43,87]. If the admitting hospital cannot provide intensive care, transfer to a hospital with an intensive care unit may be warranted [86].