Bordetella Pertussis Infection in Patients With Cancer

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Bortadella pertussis is a gram-negative pleomorphic coccobacilli known to cause whooping cough, a respiratory tract infection characterized by paroxysmal cough. B pertussis is transmitted via large droplets produced during coughing, sneezing, or talking that deposit on mucosal surfaces of susceptible individuals.

The recommended antimicrobial therapy for the treatment or chemoprophylaxis of pertussis in immunocompromised or immunocompetent patients is a macrolide, such as azithromycin, clarithromycin, or erythromycin. An alternative option is trimethoprim/sulfamethoxazole. In patients who are allergic or intolerant to these agents, doxycycline or levofloxacin can be used.

According to 2 case reports illustrated in the journal Cancer Control, 1 patient with metastatic ovarian cancer receiving myelosuppressive therapy presented with a productive cough and shortness of breath, while the other patient with chronic lymphocytic leukemia (CLL), who had undergone hematopoietic stem cell transplantation, reported a nonproductive cough, sore throat, and fatigue. Diagnoses for both patients were made by PCR testing via a nasopharyngeal swab with pneumonia associated with B pertussis.

Both patients were successfully treated with a 5-day to 7-day course of oral azithromycin 250 mg daily. The patient with ovarian cancer reported improvement in symptoms within 3 weeks, while the patient with chronic lymphocytic leukemia had complete resolution of his symptoms 2 weeks after antibiotic therapy.

Bordetella Pertussis Infection in Patients With Cancer
Bordetella Pertussis Infection in Patients With Cancer

Summary: We illustrate 2 cases of pneumonia associated with Bordetella pertussis infection in 72-year-old and 61-year-old patients with cancer receiving myelosuppressive therapy after hematopoietic stem cell transplantation. Bacterial infections are a significant cause of morbidity and mortality in patients with cancer, and those receiving hematopoietic stem cell transplant, solid organ transplant, or myelosuppressive therapy are at increased risk. The infection was detected and the 2 patients had good outcomes following azithromycin treatment. Pertussis, also known as whooping cough, is a contagious respiratory illness that has become a public health challenge due to decreased immunity of the pertussis vaccine. Therefore, it is critical to recognize pertussis early in the course of the disease.


The lung is one of the most frequently involved organs in a variety of complications in the immunocompromised host.1 Among the pulmonary complications that occur in persons who are immunocompromised, infection is the most common and is associated with high rates of morbidity and mortality.1 The most commonly encountered type of infection is bacterial in origin.2 Before the development of vaccines, Bordetella pertussis infection was a significant threat among immunocompetent hosts.3 Bordetella vaccination has significantly reduced the number of infections, but immunity appears to be short lived.4 In addition, a large portion of the population remains susceptible to infection from B pertussis.5 We present 2 cases of B pertussis infection that led to pneumonia in patients with cancer. The medical staff members at our institution were up to date on their vaccinations, and no secondary cases of pertussis were reported.


Case 1

A woman aged 72 years with metastatic ovarian cancer who was receiving chemotherapy with intrathecal methotrexate, gemcitabine, and carboplatin presented with a 12-day history of productive cough with yellow sputum and shortness of breath associated with the coughing spells. She had tried a cough suppressant with minimal relief. She denied fever, chills, sweats, hemoptysis, ill contacts, and recent travel.

Her vital signs were within normal limits, and findings on physical examination were significant for crackles heard throughout the lung fields. Her white blood cell count was 4,910/μL with a normal differential. The patient denied receiving pneumocystis prophylaxis in the past and tested negative for Pneumocystis jiroveci.

The result from a nasopharyngeal swab sent for a respiratory viral polymerase chain reaction (PCR) panel was positive for B pertussis. PCR testing was negative for adenovirus, Chlamydia pneumoniae, coronavirus, metapneumovirus, rhinovirus, enterovirus, influenza types A and B, Mycoplasma, parainfluenza virus types 1 to 4, and respiratory syncytial virus. Computed tomography (CT) of the chest showed dependent areas of subpleural consolidation and patchy, ground-glass opacities (Figure 1).

(To view a larger version of Figure 1, click here.)

She was discharged home with a 5-day course of oral azithromycin (250 mg daily). Repeat PCR testing 1 week later was negative for B pertussis. She reported improvement of her symptoms 3 weeks later. 

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