Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

Abstract

Cough syncope, also called "tussive syncope", is a well-recognized syndrome for about 70 years, in which loss of consciousness usually occurs immediately after a violent cough or prolonged bouts of violent coughing, lasting for seconds with rapid restoration of full consciousness. Its precise pathophysiologic mechanism is not fully understood and remains a matter of debate. Although pertussis is a frequent cause of prolonged cough in adults, still its burden in this age group is under-appreciated and under-diagnosed worldwide. This is well reflected by the fact that despite cough syncope is definitely not rare, until yet only six cases of cough syncope related to pertussis have been reported in the medical literature, one of them by us. We describe additional three adults with recurrent cough syncope due to pertussis who were diagnosed during a period of 3 months which completely resolved by treatment with azithromycin. Diagnosing four cases of cough syncope in adults due to pertussis during a short period in one Department of Internal Medicine, while only five cases were reported from the rest of the world, reflects the great lack of awareness on adult pertussis worldwide. Our four cases indicate that physicians should be much more aware of pertussis as a cause of cough and cough syncope in adults in order to terminate the attacks of cough and cough syncope and its serious complications by adequate antibiotic treatment, as happened with our four patients.

Comment on ‘Cough syncope as a cause of motor vehicle crash: fatal distraction?’

“…Regarding prevalence, we agree that cough syncope can be described as 'rare' 12 or 'uncommon', 8,13 but the literature also uses 'very rare', 9 'rare/infrequent', 14 'may not be uncommon', 15 'frequently overlooked' 14 and 'definitely not rare'. 3 Although cough syncope is a well-recognised disorder with several hundred cases reported in the literature, no study has looked at the rates, so significant uncertainty remains as to its frequency. 16 In summary, our view is that the diagnostic criteria recommended by Guo et al 1 are not supported by the literature.…”