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Five Month old girl with Persistent Cough A five month old girl was brought to a pediatricians office because of coughing for one week. The coughing is more at night. There was no fever, vomiting, diarrhea, rashes, or runny nose. She had been healthy previously. Her birth history was normal and she is developing normally. The father and uncle has asthma. Her immunization is complete for her age. The father is smoker although he said he smokes outside. The physical examination was normal. Because of the strong family history of asthma and there was no fever, the pediatrician diagnosed that the coughing is from asthma. Albuterol nebulizer was prescribed. A week later the infant was seen again for follow up and there was no significant changed. The albuterol was continued and nebulized pulmicort (a steroid) was added. Several days later, the baby was brought to an emergency room because of blood in the phlegm after coughing. There was no fever. Her oxygen saturation was normal. The ER physician did test of pertussis. Chest x-ray was interpreted as normal. The following day, the ER doctor called the pediatrician of the baby and reported that the baby’s pertussis test was positive. Because of the age of the baby, under 6 months old, she was put in the hospital for treatment and observation. Diagnosis: Whooping cough or pertussis [Comment: The mother, who was also coughing was tested positive to pertussis. The sibling, about 4 years old, was negative for pertussis. There are some cases of pertussis in their community. The important lesson in this patient is: if an infant is coughing longer than 2 weeks, whooping cough or pertussis should be considered even though the immunization is complete. Pertussis is a potentially a serious condition in infant younger than 6 months old.] Leo Leonidas, MD, FAAP
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