Wave of Pertussis Cases Raises Questions About Diagnoses, Testing

Robert Gould, MD, a hospitalist in suburban Seattle, knows that his HM colleagues don’t immediately think of pertussis as a diagnosis. But as an epidemic of whooping cough rolls through Washington state, he urges they keep the disease in mind.

"I’m thinking about it more," says Dr. Gould, a hospitalist at Swedish/Edmonds Hospital in Edmonds, Wash., who has treated one patient who tested positive for the illness. "One thing I think about is if someone comes in with a primary respiratory issue and they have underlying COPD and they’re having a cough. Do you test for it? Do you consider it? It’s just so hard, because do you test everyone who comes in with one week of cough?"

The topic is timely. The Washington State Department of Health reports that through May 26, the state reported 1,947 cases of whooping cough, up from just 154 cases for the same time period last year.

Dr. Gould says the outbreak of pertussis brings up an interesting question for hospitalists. HM physicians don’t want to order unnecessary tests—particularly in light of recent initiatives to combat the practice—but not testing can leave a person vulnerable to the disease’s progression. When suspicions are high that whooping cough is the diagnosis, one solution is simply to order one of the most common therapies: azithromycin. That eliminates the testing cost, which can run up to several hundred dollars, while giving the patient a medication not greatly associated with Clostridium difficile or other negative outcomes, Dr. Gould says.

"Thinking about it is the biggest thing," he adds.

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