When should an adult with a spasmodic upper-respiratory infection be swabbed for pertussis? — CONNIE KELLY, FNP, Franklin, N.Y.

In adults and older children, pertussis is rarely fatal but can cause considerable morbidity, particularly in those with underlying medical conditions. Infants are at greatest risk of a fatal outcome, and early recognition and treatment of pertussis in adults and adolescents may be helpful in limiting transmission. Clinical diagnosis is difficult because pertussis can present similar to the common cold, bronchitis, and continuing post-viral cough. Signs and symptoms of pertussis include a cough of longer than 14 days, paroxysmal cough, an inspiratory whoop, or post-tussis emesis. I have a lower threshold for testing for adults who have contact with infants or high-risk underlying medical conditions. Close contacts of a person with pertussis during the contagious period should receive antibiotic prophylaxis. — JoAnn Deasy, PA-C, MPH (149-1)