Bronchiolitis vs Pertussis
Bronchiolitis and Pertussis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Bronchiolitis vs Pertussis at a glance
- Bronchiolitis: Viral lower respiratory tract infection of infants causing wheeze, hypoxia, and dehydration.
- Pertussis: Bordetella pertussis respiratory infection with paroxysmal cough and inspiratory whoop.
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Side-by-side comparison
| Feature | Bronchiolitis | Pertussis |
|---|---|---|
| At a glance | Viral lower respiratory tract infection of infants causing wheeze, hypoxia, and dehydration. | Bordetella pertussis respiratory infection with paroxysmal cough and inspiratory whoop. |
| Classic presentation | 1-3 days of URI symptoms (rhinorrhea, cough, low-grade fever); Progression to lower respiratory tract: tachypnea, wheeze, cough, increased work of breathing; Poor feeding, dehydration; Apnea (especially in infants <2 months or preterm); Symptoms peak day 3-5, resolve over 1-2 weeks; Tachypnea, nasal flaring, retractions (subcostal,… | Paroxysmal coughing fits with inspiratory whoop and post-tussive emesis lasting >2 weeks in a child or adolescent. Apnea (not cough) in young infant.; Catarrhal phase (1-2 weeks): mild URI symptoms — rhinorrhea, low-grade fever, mild cough; most contagious period; Paroxysmal phase (2-8 weeks): sudden severe coughing fits ending with… |
| Workup / key labs | Clinical diagnosis — routine viral testing NOT recommended in typical cases (does not change management); RSV testing may help with cohorting, public health surveillance, or when palivizumab prophylaxis decisions affected; Pulse oximetry to assess hypoxia; Consider CBC, BMP, and blood cultures only if febrile neonate (<28 days), toxic… | CDC clinical case definition: cough ≥2 weeks with paroxysms, inspiratory whoop, OR post-tussive emesis without other apparent cause. Laboratory confirmation: positive culture, PCR, or seroconversion.; Nasopharyngeal swab/aspirate for B. pertussis PCR (highest sensitivity in first 3-4 weeks of cough); Bacterial culture on Bordet-Gengou… |
| Imaging | Chest radiograph NOT routinely recommended (AAP 2014) — risk of overdiagnosis of pneumonia and unnecessary antibiotics; Obtain CXR if focal exam findings, severe disease, fails to improve, or alternative diagnosis suspected — findings: hyperinflation, peribronchial thickening, atelectasis | Chest radiograph: often normal or shows perihilar infiltrate ('shaggy heart border'); rules out pneumonia and other complications |
| First-line treatment | Supportive care — cornerstone:; Suction nasal secretions (gentle bulb suction before feeds; deep suction NOT recommended); Hydration: oral/NG feeds if tolerated; IV fluids if severe respiratory distress or unable to feed; Supplemental oxygen for SpO2 <90% (AAP 2014; lowered threshold avoids unnecessary admission); Antipyretics for… | Antibiotic treatment primarily REDUCES TRANSMISSION; clinical benefit greatest if started in catarrhal or early paroxysmal phase; Macrolide first-line:; Azithromycin: infants <1 month 10 mg/kg/day × 5 days; older children/adults 500 mg day 1 then 250 mg days 2-5; Clarithromycin or erythromycin alternatives (avoid erythromycin in infants… |
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