At a Glance
Why Get Tested?
To detect and diagnose a Bordetella pertussis infection
When to Get Tested?
When you have persistent, sharp spasms or fits of coughing (paroxysms) that the doctor suspects is due to pertussis (whooping cough); when you have symptoms of a cold and have been exposed to someone with pertussis
A nasopharyngeal (NP) swab or a nasal aspirate; occasionally, a blood sample drawn from a vein in your arm
Test Preparation Needed?
The Test Sample
What is being tested?
Bordetella pertussis is a bacterium that targets the lungs, typically causing a three-stage respiratory infection that is known as pertussis or whooping cough. It is highly contagious and causes a prolonged infection that is passed from person to person through respiratory droplets and close contact. Pertussis tests are performed to detect and diagnose a B. pertussis infection.
The incubation period for pertussis varies from a few days to up to three weeks. The first stage of the disease, called the catarrhal stage, usually lasts about two weeks and symptoms may resemble a mild cold. It is followed by the paroxysmal stage, which may last for one or two weeks or persist for a couple of months and is characterized by severe bouts of coughing. Eventually, the frequency of the coughing starts to decrease and the infected person enters the convalescent stage, with coughing decreasing over the next several weeks. Pertussis infection, however, can sometimes lead to complications such as pneumonia, encephalitis, and seizures, and it can be deadly. Infants tend to be the most severely affected and may require hospitalization.
Pertussis infections used to be very common in the United States, affecting about 200,000 people in epidemics that would occur every few years. Since the introduction of a pertussis vaccine and widespread vaccination of infants, this number has drastically decreased. However, since neither the vaccine nor the pertussis infection confers lifetime immunity, health professionals are still seeing periodic outbreaks of pertussis in young, unvaccinated infants, in adolescents, and in adults. According to the Centers for Disease Control and Prevention (CDC), there were over 27,000 cases of whooping cough reported in 2010, and many more that went unreported. In 2011, the Advisory Committee on Immunization Practices updated their recommendations for pertussis booster shots.
- For children and teens ages 11 through 18 years old, a single booster shot is advised for those who have completed the recommended childhood diphtheria, tetanus and pertussis (DTP/DTaP) series of vaccinations.
- For adults aged 19 through 64 years, a one-time vaccination is recommended.
- Adults 65 years and older who are or expect to be in close contact with infants, such as grandparents and child- and health-care providers, should receive a dose to boost their immunity if they had not previously done so.
Pertussis testing is used to diagnose these infections and to help minimize their spread to others. Several different types of tests are available to detect pertussis infection. Some of these include:
- Detection of pertussis genetic material (Polymerase Chain Reaction, PCR)
- Direct fluorescent antibody (DFA)
- Blood tests for pertussis antibodies (serology), IgA, IgG, IgM
Pertussis can be challenging to diagnose at times because the symptoms that present during the catarrhal stage are frequently indistinguishable from those of a common cold or of another respiratory illness such as bronchitis, influenza (flu), and, in children, respiratory syncytial virus (RSV). In the paroxysmal stage, many adults and vaccinated people who have pertussis will present with only persistent coughing. Suspicion of pertussis infection is increased in people who have the classic "whoop," in people who have cold symptoms and have been in close contact with someone who has been diagnosed with pertussis, and when there is a known pertussis outbreak in the community. A pertussis culture and/or PCR test will usually be ordered on these people but should not be performed on close contacts who do not have symptoms.
How is the sample collected for testing?
Sample collection technique is critical in pertussis testing. For a culture or for a test for genetic material (PCR) or for DFA, a nasopharyngeal (NP) swab or nasal aspirate is used. The nasopharyngeal swab is collected by having you tip your head back and then a Dacron swab (like a long Q-tip with a small head) is gently inserted into one of your nostrils until resistance is met. It is left in place for several seconds, then rotated several times to collect cells, and withdrawn. This is not painful, but it may tickle a bit, cause your eyes to tear, and provoke a coughing paroxysm. For a nasal aspirate, a syringe is used to push a small amount of sterile saline into your nose, and then gentle suction is applied to collect the resulting fluid. For antibody testing, a blood sample is obtained by inserting a needle into a vein in the arm.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation is needed.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Forbes BA, Sahm DF, Weissfeld AS, Bailey & Scott's Diagnostic Microbiology 12th Edition: Mosby Elsevier, St. Louis, MO; 2007, Pp 435-438.
(August 26, 2010) Centers for Disease Control and Prevention. Pertussis. Available online at http://www.cdc.gov/pertussis/ through http://www.cdc.gov. Accessed November 2011.
(February 14, 2011) CDC. Pertussis, Diagnosis Confirmation Testing. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html through http://www.cdc.gov. Accessed November 2011.
(February 14, 2011) CDC. Best Practices for Health Care Professionals on the use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html through http://www.cdc.gov. Accessed November 2011.
(September 12, 2011) Minnesota State Department of Health. Pertussis Laboratory Testing. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/hcp/labfacts.html through http://www.health.state.mn.us. Accessed November 2011.
(May 26, 2009) Bocka J. Pertussis in Emergency Medicine. Medscape Reference article. Available online at http://emedicine.medscape.com/article/803186-overview through http://emedicine.medscape.com. Accessed November 2011.
Frisman D, et al. Pertussis Resurgence in Toronto, Canada. BMC Public Health. 2011; 11: 694. Published online 2011 September 7. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189138/?tool=pubmed through http://www.ncbi.nlm.nih.gov. Accessed November 2011.
Sources Used in Previous Reviews
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1536-1537.
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 1454-1455.
Forbes, B. et. al. (© 2007). Bailey & Scott’s Diagnostic Microbiology, Twelfth Edition: Mosby Elsevier Press, St. Louis, Missouri. Pp 435-439.
Raguckas, S. et. al. (2007 March 14). Pertussis Resurgence: Diagnosis, Treatment, Prevention, and Beyond. Medscape from Pharmacotherapy 27(1): 41-52. [On-line information]. Available online at http://www.medscape.com/viewarticle/552159 through http://www.medscape.com. Accessed on 10/11/08.
(2008 February 1, Updated). Pertussis (Whooping Cough). Minnesota Department of Health [On-line information]. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/pfacts.html through http://www.health.state.mn.us. Accessed on 10/12/08.
Cornish, N. (2005 January). Identifying, testing for, and treating Bordetella pertussis. CAP Today [On-line information]. Available online at http://www.cap.org. Accessed on 10/12/08.
(2007 June 12). Pertussis. CDC Travelers' Health Yellow Book. Chapter 4, Prevention of Specific Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/travel/yellowBookCh4-Pertussis.aspx through http://www.cdc.gov. Accessed on 10/12/08.
Mayo Clinic Staff (2007 December 19). Whooping Cough. Mayoclinic.com [On-line information]. Available online at http://www.mayoclinic.com/health/whooping-cough/DS00445 through http://www.mayoclinic.com. Accessed on 10/12/08.
Weinberg, G. (2006 June, Revision). Pertussis. Merck Manual Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec23/ch272/ch272g.html#sec23-ch272-ch272g-800 through http://www.merck.com. Accessed on 10/12/08.
(2005 Revised). Pertussis (Whooping Cough). The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch173/ch173l.html#sec14-ch173-ch173l-774 through http://www.merck.com. Accessed on 10/12/08.
(2006 June). Pertussis. Guide to Surveillance, Reporting and Control. Massachusetts Department of Public Health, Bureau of Communicable Disease Control [On-line information]. PDF available for download at http://www.mass.gov/Eeohhs2/docs/dph/disease_reporting/guide/pertussis.pdf through http://www.mass.gov. Accessed on 10/12/08.
Carney, H. et. al. (2008 September, Updated). Bordetella pertussis. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Bacteria/Bordetellapertussis.html# through http://www.arupconsult.com. Accessed on 10/12/08.
(2004 September). Pertussis – Laboratory Testing. Minnesota Department of Health [On-line information]. Available online at http://www.health.state.mn.us/divs/idepc/diseases/pertussis/hcp/labfacts.html through http://www.health.state.mn.us. Accessed on 10/12/08/.
Gregory, D. (2006 August 1). Pertussis: A Disease Affecting All Ages. American Family Physician [On-line information]. Available online at http://www.aafp.org/afp/20060801/420.html through http://www.aafp.org. Accessed on 10/12/08.
Centers for Disease Control and Prevention: Guide for the Control of Pertussis Outbreaks (2000; amended in 2005, 2006). Available online at http://www.cdc.gov/vaccines/pubs/pertussis-guide/guide.htm through http://www.cdc.gov. Accessed November 2008.