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FAQ

If whooping cough is suggested as a diagnosis it is natural to ask how it can be proved or disproved.

There are now several ways, but which is best depends on where you live, because different laboratories are likely to do different tests.

The best, but most difficult way is to try to detect the causative organism (Bordetella pertussis) in the back of the nose. This usually involves passing a swab on a wire through a nostril to the back of the throat and sending it to a medical lab to culture the material. This may take 5 to 7 days.  If Bordetella pertussis or parapertussis grows this is usually taken as proof that it is whooping cough. Parapertussis also causes whooping cough. It is much less common, I would guess less than 1 in 100 cases. It may be less severe because it does not produce pertussis toxin I am told. Most blood tests look for pertussis toxin antibodies so presumably will not detect Bordetella parapertussis.

Unfortunately the organisms is delicate, killed easily by many antibiotics and has often been eliminated from the body by natural defences by the time the diagnosis is suspected. It is easiest to find it in the first 2 weeks but very unlikely after 3 weeks. But the patient has often had it for 3 weeks before whooping cough is suspected.  So it is unusual to get a positive culture in whooping cough. In other words, if a swab is negative, the patient can still have whooping cough.

A better and more modern way of detecting the organism is by detecting its unique DNA pattern by means of polymerase chain reaction (PCR). This also involves getting secretions from the back of the nose and specialist laboratory testing.  A result can be obtained in 24 to 48 hours.

The test depends on the organism being present, which it may no longer be, but since it detects minute quantities of genetic material it is more likely to be positive than culture in cases of whooping cough.

Antibody tests are done by some laboratories on blood samples taken after several weeks of illness. By looking at IgG and IgA antibodies to fimbria, pertussis toxin and filamentous haemagglutinin, it is possible to say whether it is likely the patient has had whooping cough.  It is a highly specialized test and you may have difficulty finding a lab able to do it. There are several variations on this theme. Sometimes one specimen about 2 weeks into the illness is required, sometimes two specimens some weeks apart. Some labs do less satisfactory immunological tests.  These tests are not always accurate. They sometimes say the patient has had whooping cough when they haven't, and sometimes the other way round. You need to know the reliability of a test before accepting the answer as true.

In the United Kingdom since 2002, (and now many other countries) NHS labs (via the HPA) can do anti-pertussis toxin ELISA IgG on a single sample at least 2 weeks into the illness and give a fairly reliable diagnostic result. A doctor or nurse simply has to write "pertussis antibodies" on the lab request form. It takes about 10 to 14 days to get a result back. They can also arrange PCR in special (usually hospitalised) cases Over recent years I have noticed that most patients are now able to blood tests done in most countries.
In the UK since January 2013 Oral Fluid testing can be done on 8 to 16 year olds. This age group often refuses a blood test. If a doctor suspects whooping cough, notifying the HPA will result in getting instructions to forward oral fluid to the relevant lab. It should be done after at least 2 weeks of coughing.

The bottom line is that in practice the diagnosis has often to be made on symptoms and course of the illness alone, unless blood antibody tests can be done. 

 

 

Todar's online bacteriology chapter on pertussis