PA Medical News about cough; pertussis; superimposed pneumonia; Mycoplasma pneumoniae

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Cough steadily increases in severity
JAAPA, 09/11/09

Jacobson MD et al. – An 18–year–old male developed nasal congestion, fatigue, malaise, and mild dry cough at boarding school. Over the next week, his cough got worse, occurring in severe spasms. The patient felt like he was choking and could not catch his breath. Several times, he came close to posttussive vomiting. He had no shortness of breath, exertional dyspnea, postnasal drip, reflux, fevers, chills, or sweats. Only a codeine–based cough syrup provided relief. A school physician prescribed amoxicillin, followed by amoxicillin/clavulanic acid, prednisone, and albuterol, all to no avail...The patient had acute pertussis and a superimposed pneumonia caused by Mycoplasma pneumoniae. Polymerase chain reaction of a nasopharyngeal swab detected Bordetella pertussis DNA. Radiographs revealed a right lower–lobe infiltrate in the retrocardiac space. IgG titers were positive for M pneumoniae. Even with a seemingly “normal” physical examination, chest radiographs are crucial in the evaluation of a persistent cough. Empiric antibiotics should include coverage for atypical pathogens.

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