Whooping Cough (Pertussis) Tests

Also Known As:
Pertussis Tests

Formal Name:
Bordetella pertussis Culture
PCR
Antibodies (IgA
IgG
IgM)

This article was on. March 25, 2021

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At a Glance

Why Get Tested?

To detect and diagnose infection with Bordetella pertussis, which causes pertussis, also known as whooping cough

When To Get Tested?

When you have ongoing spasms or fits of coughing (paroxysms) that your healthcare practitioner suspects are due to whooping cough (pertussis)
When you have symptoms of a cold and have been exposed to someone with whooping cough

Sample Required?

A nasopharyngeal (NP) swab or a nasal aspirate
Occasionally, a blood sample drawn from a vein in your arm

Test Preparation Needed?

None

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Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Pertussis, commonly called whooping cough, is a respiratory infection caused by the bacteria Bordetella pertussis. These bacteria are highly contagious and are passed from person to person through coughing and sneezing and close contact. Whooping cough tests are performed to detect and diagnose infection with B. pertussis.

The time between infection with the bacteria and developing signs and symptoms (incubation period) varies from a few days to up to three weeks. B. pertussis typically causes a prolonged, three-stage infection:

Catarrhal Stage: This is the first stage of the disease, which usually lasts about one to two weeks. Symptoms may resemble a mild cold, with runny nose, low-grade fever and an occasional cough. Infants may develop apnea (a pause in breathing) during this stage and may be more prone to choking. Individuals are highly contagious during this time.
Paroxysmal Stage: This is the second stage of infection, which may last for one to two weeks or persist for a couple of months, and is characterized by severe bouts of coughing. Coughing is frequently followed by a ‘whoop’ sound and patients may feel exhausted and/or vomit after these coughing fits.
Convalescent Stage: During the third stage, the frequency and severity of the coughing starts to lessen and decreases over the next two to three weeks.

Whooping cough can sometimes lead to complications requiring hospitalization, particularly for infants, and may include apnea (61%) or pneumonia (23%), or much less frequently convulsions (1%), brain disease or damage (encephalopathy) (about 0.3%) or death (1%).

Whooping cough used to be very common in the United States, affecting about 200,000 people during outbreaks that would occur every few years. Since the introduction of a whooping cough vaccine and widespread vaccination of infants, this number has drastically decreased. For details on the whooping cough vaccine, see the Centers for Disease Control and Prevention (CDC)’s Pertussis: Summary of Vaccine Recommendations.

Importantly, prior infection or receipt of the complete vaccination series for whooping cough do not prevent you from becoming infected as they do not provide lifetime immunity or protection from re-infection. Fully vaccinated individuals who are infected with B. pertussis may develop a less severe infection, with persistent coughing but without the classic paroxysmal cough.

Periodic outbreaks of whooping cough in unvaccinated infants, in adolescents, and in adults still occur in the United States. According to the CDC, 10,000 to 40,000 cases of whooping cough are reported each year. Over 48,000 cases of whooping cough were reported in 2012, the most recent peak year, and many more likely went unreported.

Diagnostic tests for whooping cough

Because the initial symptoms of whooping cough, especially during the catarrhal stage, are frequently indistinguishable from those of a common cold or of other respiratory illnesses, such as bronchitis, influenza (flu), or in children, respiratory syncytial virus (RSV), diagnostic testing is necessary to help identify the infection.

There are a few test methods that may be used to detect whooping cough, and the type of testing your healthcare practitioner orders is largely dependent on how long you have had symptoms.

Bacterial culture – if the B. pertussis bacteria are present in your sample, this test will grow them on an agar plate. It may take up to 7 days for the bacteria to grow; however, the bacteria may be less likely to grow if you have been treated with certain antibiotics before the sample was collected. Culture testing is most useful in the first 2 weeks after symptom onset. If necessary, bacteria that grow in culture may be used for susceptibility testing to identify the optimal antibiotic to use.
Polymerase chain reaction (PCR) – this test detects genetic material (e.g., DNA) from the bacteria. The test can be completed within a couple of hours. PCR can detect genetic material from the bacteria from the time of initial symptom onset to approximately 3-4 weeks later.
Blood test for antibodies (i.e., IgA, IgG, IgM) to pertussis (serology) – these tests detect antibodies produced by the body’s immune system in response to B. pertussis. Antibody testing is not the preferred test because it is an indirect method to identify the infection. This type of testing is most useful in patients with more than 3-4 weeks of symptoms. According to the CDC, serology can be used from 2 to 8 weeks after the cough starts, and in some cases may be helpful up to 12 weeks after onset.

How is the sample collected for testing?

Proper collection of the appropriate samples is essential for accurate whooping cough test results.

For bacterial culture or testing by PCR, a nasopharyngeal (NP) swab or nasal aspirate is collected. For tests to detect antibodies to the bacteria, a blood sample is needed.

The nasopharyngeal swab is collected by having you tip your head back and then a swab (like a long Q-tip with a small head) is gently inserted through 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, cause your eyes to tear, and provoke a coughing spell.
For a nasal aspirate, a syringe is used to insert a small amount of sterile saline into the nasal passage 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.

Common Questions

How are they used?

Whooping cough tests are used to detect and diagnose a B. pertussis infection. Importantly, early diagnosis and treatment may lessen the severity of symptoms and help limit spread of the disease.

When are they ordered?

Whooping cough tests may be ordered when you have signs and symptoms that suggest a pertussis infection. Your healthcare practitioner may have a strong suspicion that you have whooping cough if:

You have the classic “whoop,”
You have cold symptoms and have been in close contact with someone who has been diagnosed with whooping cough
There is a known whooping cough outbreak in the community

Testing should not be performed on close contacts who do not have symptoms.

What does the test result mean?

PCR test:

A positive PCR test means that genetic material (i.e., DNA) from B. pertussis was detected in your specimen, indicating that you have been infected. However, the PCR test may also be positive with other Bordetella species.
A negative PCR test means that it is less likely that you have whooping cough but does not rule it out. If there are very few bacteria present in the sample, they may not be detected by PCR.

Culture:

A positive culture is diagnostic for whooping cough.
Similar to PCR, a negative culture does not rule out whooping cough. Culture results are dependent on proper specimen collection and transport, how long you have had symptoms prior to collection, and whether there was any prior antibiotic treatment before the sample was collected.

Both culture and PCR tests are less likely to be positive as the illness progresses.

With blood testing, pertussis IgG antibodies will be present in those who have been vaccinated or have had a past infection. IgM and IgA antibodies may indicate recent vaccination or infection and will only be present for a short period of time (2-3 months). Blood testing is not typically recommended for the diagnosis of active whooping cough and is most useful after approximately 3-4 weeks of symptoms.

How is a whooping cough treated?

Whooping cough is treated with antibiotics, which will help to resolve the infection and help stop spread of the disease. Close contacts of people diagnosed with whooping cough may also be treated to prevent spread of the infection.

When is the pertussis vaccine given?

Three different formulations of the pertussis vaccine are available, typically in combination with the tetanus and diphtheria vaccines (DPT). The vaccination is given to infants as a series of shots. Children who have not completed the series of vaccinations are at a higher risk of becoming infected. Even some people who have been vaccinated may still be infected by B. pertussis, but they tend to have a less severe illness.

Pregnant women are advised to be re-vaccinated to prevent transmission of pertussis to their newborns. Grandparents and other caretakers who will be spending time with a newborn are also advised to be re-vaccinated.

Why is my travel history important to my healthcare practitioner?

International travelers should be aware that many resource-limited countries do not have widespread vaccination programs for whooping cough. Infants who have not completed their series of vaccinations and people who have not had a recent booster vaccine may be at an increased risk of contracting whooping cough.

Can a throat swab be used instead of a nasopharyngeal sample from my nose?

A throat swab is not acceptable. During a pertussis infection, the bacteria are found in the back of the nose, not in the throat or the front portion of the nose.

Can whooping cough testing be done in my healthcare practitioner's office?

No. There is no simple, rapid diagnostic test for whooping cough. It requires specialized equipment and is typically performed in clinical laboratories. Not every laboratory performs this testing and samples may need to be sent to a public health laboratory.

Why did my doctor report my child's whooping cough?

Healthcare practitioners are required to report whooping cough to state health departments. Outbreaks are tracked and interventions, such as vaccination and appropriate prophylactic antibiotic treatment, may be provided to help limit the outbreak.

My doctor said I have Bordetella parapertussis. Is this the same as whooping cough?

B. parapertussis are bacteria that can infect humans in the same manner as B. pertussis, but the infection usually causes a milder respiratory illness. Culture methods and PCR tests can detect and distinguish B. parapertussis from B. pertussis, and both are commonly tested for since the signs and symptoms may be similar in people with either infection. Blood tests may not detect antibodies to B. parapertussis and there is no vaccine to prevent B. parapertussis infection.

Is there anything else I should know?

Direct fluorescent antibody (DFA) is a testing method that is no longer recommended or routinely available in clinical laboratories to detect whooping cough. This method is less specific and less sensitive than either the culture or PCR methods.

View Sources

Sources Used in Current Review

Couturier, M. et. al. (2019 June, Updated). Bordetella pertussis – Whooping Cough. ARUP Consult. Available online at https://arupconsult.com/content/bordetella-pertussis. Accessed December 2019.

Bocka, J. et. al. (2019 May 2, Updated). Pertussis. Medscape Pediatrics: General Medicine. Available online at https://emedicine.medscape.com/article/967268-overview. Accessed December 2019.

Kaneshiro, N. et. al. (2017 September 5, Updated). Pertussis. MedlinePlus Medical Encyclopedia. Available online at https://medlineplus.gov/ency/article/001561.htm. Accessed December 2019.

(© 1995-2019). Bordetella pertussis and Bordetella parapertussis, Molecular Detection, PCR. Mayo Clinic Laboratories. Available online at https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/80910. Accessed December 2019.

(2018 October 1). Most Pertussis Cases in Infants Tied to Unvaccinated Mother. Medscape Medical News. Available online at https://www.medscape.com/viewarticle/902739. Accessed December 2019.

(2019 March 13). Genetic Shifts in Bordetella May Explain Surge in Pertussis. Medscape Medical News. Available online at https://www.medscape.com/viewarticle/910355. Accessed December 2019.

(2017 August 7, Reviewed). Pertussis (Whooping Cough), Laboratory Information. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/pertussis/lab.html. Accessed December 2019.

(2017 August 7, Reviewed). Pertussis (Whooping Cough) Diagnosis Confirmation. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html. Accessed December 2019.

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.

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. 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. 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. 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. 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. 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. 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. 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#. 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. Accessed on 10/12/08/.

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(August 26, 2010) Centers for Disease Control and Prevention. Pertussis. Available online at http://www.cdc.gov/pertussis/. 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. 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. 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. 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. 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. Accessed November 2011.

(August 31, 2015) Centers for Disease Control and Prevention. Pertussis. Available online at http://www.cdc.gov/pertussis/. Accessed October 2015.

(August 31, 2015) Centers for Disease Control and Prevention. Pertussis, Diagnosis Confirmation. Available online at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html. Accessed October 2015.

(May 19, 2015) Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases, Chp 10, Pertussis. Available online at http://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.html. Accessed October 2015.

(February 2015) Mayo Medical Laboratories. Hot Topic: Bordetella pertussis and Bordetella parapertussis. Available online at http://www.mayomedicallaboratories.com/articles/hot-topic/2015/02-15-pertussis/. Accessed October 2015.

(August 31, 2015) Centers for Disease Control and Prevention. Pertussis, Laboratory Information. Available online at http://www.cdc.gov/pertussis/lab.html. Accessed October 2015.

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