01Approach to the Critical Patient/attcp66

Immediate priorities

›Airway and breathing threats

›Cyanosis during paroxysmal coughing spells

›SpO2 < 90% during or after coughing paroxysm

›Persistent post-paroxysm desaturation

›Apnea in infants

›Complete cessation of breathing lasting >20 seconds

›Associated bradycardia requiring stimulation or intervention

›Respiratory failure

›Increasing work of breathing

›Rising PaCO2 despite supplemental oxygen

›If unable to maintain oxygenation, proceed to definitive airway management

›Mechanical ventilation for refractory hypoxia or apnea

›Avoid excessive positive pressure that may worsen pulmonary hypertension

›Circulatory threats in severe infant pertussis

›Pulmonary hypertension

›Extreme leukocytosis with lymphocytosis triggering pulmonary vascular occlusion

›WBC >40,000/μL associated with ICU admission and death in infants

›Cardiogenic shock physiology

›Right heart failure from pulmonary hypertension

›Hemodynamic instability requiring inotropic support

›If hemodynamic compromise, activate PICU and consider exchange transfusion

›Exchange blood transfusion for extreme leukocytosis with pulmonary hypertension

›Norepinephrine or dopamine for vasopressor support

›Critical decision branching

›Fulminant infant pertussis pattern

›Age <3 months with apnea, bradycardia, or cyanosis

›WBC >50,000/μL with leukemoid reaction

02History/hx83

Presenting symptoms

›Cough characterization

›Paroxysmal nature

›Repetitive vigorous coughs during a single expiration

›Inability to breathe during a coughing spell

›Duration and progression

›Cough >2 weeks duration raises clinical suspicion

›Progressive worsening after initial mild URI phase

›Nocturnal predominance

›Paroxysms frequently worse at night

›Sleep disruption common

›Classic associated symptoms

›Inspiratory whoop

›Forceful inspiration producing high-pitched whooping sound after paroxysm

›Present in approximately 50% of adolescents and adults; less reliable in infants

›Posttussive vomiting

›Vomiting or gagging immediately after coughing spell

›More prevalent in children and adolescents

›Posttussive syncope

›Present in approximately 2% of adults

›Vasovagal mechanism from intrathoracic pressure changes

Phase and timeline

›Three-phase illness pattern

›Catarrhal phase

›Duration 1-2 weeks

›Rhinorrhea, malaise, mild cough indistinguishable from viral URI

›Highly contagious during this phase

›Paroxysmal phase

›Duration 2-3 months ("100-day cough")

›Paroxysmal cough, inspiratory whoop, posttussive vomiting

›Patient appears well between episodes

›Convalescent phase

›Gradual resolution over weeks to months

›Intercurrent viral illnesses may trigger recurrence of paroxysms

›Incubation period

›7-10 days from exposure

›Longer than typical viral URIs at 1-3 days

›Useful epidemiological clue when known contact identified

Alarm features

›High-risk features requiring immediate attention

›Infant age <3 months

›Apnea with or without cyanosis

›Bradycardia during paroxysms

›Poor feeding or deceptively well appearance masking severity

›Cyanosis during or after paroxysms in any age

›Requires immediate oxygen and monitoring

›Signals severe hypoxia burden

›Absence of fever

›Fever present in only approximately 12% of adults

›Presence of high fever suggests secondary bacterial pneumonia or alternative diagnosis

Exposure and vaccination history

›Epidemiological exposure

›Known contact with confirmed pertussis case

›Household members with prolonged cough illness are most common source for infants

›Daycare, school, or community outbreak exposure

›Incubation timing

›Onset 7-10 days after known exposure supports pertussis

›Vaccination history

›DTaP series completion in children

›Primary series at 2, 4, 6, 15-18 months, and 4-6 years

›Tdap booster in adolescents and adults

›Immunity wanes within 3-5 years of acellular vaccine

›Odds of pertussis increase approximately 1.33x per year since last dose

›Maternal Tdap status

›Recommended at 27-36 weeks gestation to provide passive immunity to neonate

Risk factors

›Host risk factors

›Unvaccinated or undervaccinated status

›Single most important risk factor for acquisition

›Age extremes

›Infants <3 months: highest morbidity and mortality

›Adults ≥65 years: increased severity

›Chronic pulmonary disease

›Asthma and COPD increase risk of acquisition and severe disease

›Immunocompromised state

›Higher risk for prolonged and severe disease

›Pregnancy

›Third trimester infection: relevant for treatment timing and neonatal protection

›Obesity

›Identified risk factor for pertussis acquisition

Past medical history

›Relevant prior conditions

›Prior pertussis infection

›Does not confer lifelong immunity; reinfection possible

›May attenuate severity in subsequent episodes

›Chronic lung disease

›Asthma or COPD increases severity and risk of complications

›Immunodeficiency

›Higher risk for prolonged, severe, or atypical disease

03Physical Exam/exam52

Vital signs

›Vital sign pattern

›Temperature

›Typically afebrile; fever absent in approximately 88% of adults

›Presence of fever suggests secondary bacterial pneumonia

›Oxygen saturation

›May desaturate during paroxysmal coughing episodes

›Baseline SpO2 normal between paroxysms in mild cases

›Heart rate

›Tachycardia may occur during paroxysms

›Bradycardia during paroxysms in infants is an alarm sign

General appearance

›Between-paroxysm appearance

›Typically appears well between coughing episodes

›"Deceptively well" appearance in infants is a key diagnostic pitfall

›Severity not reflected in between-paroxysm assessment

›Observe a coughing paroxysm if present

›Staccato repetitive coughs on single expiration

›Followed by forceful inspiratory whoop

›Followed by posttussive emesis or gagging

Head, eyes, ears, nose, throat

›Cough-related physical findings

›Scleral hemorrhage

›Subconjunctival or scleral hemorrhage from Valsalva during paroxysms

›Highly suggestive when present in context of prolonged cough

›Facial plethora and petechiae

›From elevated intrathoracic pressure during paroxysmal coughing

›Rhinorrhea

04Differential Diagnosis/ddx50

Infectious causes of prolonged cough

›Bacterial respiratory infections

›Mycoplasma pneumoniae

›Prolonged cough, may have low-grade fever

›Younger adults; chest X-ray may show patchy infiltrates

›ICD-10: J15.7

›Chlamydophila pneumoniae

›Subacute cough onset, hoarseness, pharyngitis

›Often indistinguishable from pertussis clinically

›ICD-10: J16.0

›Tuberculosis

›Chronic productive cough, night sweats, weight loss, hemoptysis

›Exposure risk and endemic area travel

›ICD-10: A15.0

›Viral respiratory infections

›Viral URI with postinfectious cough

›Most common cause of prolonged cough overall

›Typically self-limited; preceding febrile illness common

›ICD-10: J06.9

›Adenovirus, parainfluenza, RSV

›Can cause prolonged cough in children

›Distinguished by fever and absence of inspiratory whoop

Non-infectious causes of prolonged cough

›Airway and reactive disease

›Asthma or cough-variant asthma

›Nocturnal cough, wheezing, response to bronchodilators

›No posttussive vomiting or inspiratory whoop

›ICD-10: J45.909

05Laboratory Tests/lt51

Microbiological confirmation

›Nasopharyngeal PCR

›Test of choice for pertussis confirmation

›Sensitivity 77-97%, specificity 88-97%

›Optimal within first 4 weeks of cough onset

›Results available in 1-2 days

›Technique

›Deep nasopharyngeal swab or aspirate required

›Anterior nasal swab is insufficient

›Dacron or nylon swab; avoid cotton or calcium alginate

›Nasopharyngeal culture

›Gold standard test

›Sensitivity 20-80%, specificity 100%

›Best yield within first 2 weeks of cough onset

›Requires special Regan-Lowe or Bordet-Gengou media

›Limitations

›Results in 7-10 days; too slow for acute clinical decisions

›Prior antibiotic therapy markedly reduces yield

›Sensitivity declines rapidly after catarrhal phase

›Serology

›Anti-pertussis toxin IgG

›Most useful 3-12 weeks after symptom onset

›Single elevated value (≥100 IU/mL) diagnostic in unvaccinated

›Not reliable if vaccinated within the past year

›Limitations

›Not useful in acute presentation

›Vaccination confounds interpretation

06Diagnostic Tests/dt55

Scoring Systems

›Pertussis clinical case definition (CDC/WHO)

›Confirmed case criteria

›Cough illness of any duration with laboratory confirmation (PCR or culture)

›Or: clinically compatible illness with epidemiological linkage to confirmed case

›Probable case criteria

›Cough ≥2 weeks with at least one of: paroxysmal cough, inspiratory whoop, posttussive vomiting

›No laboratory confirmation but no alternative diagnosis identified

›CHEST Guideline clinical criteria for pertussis (Moore et al., 2019)

›High clinical probability features

›Paroxysmal cough with posttussive vomiting

›Inspiratory whoop

›Cough duration >3 weeks without fever

›Clinical prediction

›Among adults with prolonged cough, 12-32% have pertussis

›Absence of fever is the strongest single predictor in adults

MRI

›MRI indications in pertussis

›Brain MRI for neurological complications

›Seizures or encephalopathy in infant pertussis

›Hypoxic-ischemic injury pattern from apneic episodes

›MRI findings in pertussis encephalopathy

›Diffuse cerebral edema on T2/FLAIR sequences

›Cortical or subcortical signal abnormality from hypoxic injury

›MRI not indicated in uncomplicated pertussis

›Clinical diagnosis; imaging reserved for neurological complications only

CT

›Chest CT indications

07Disposition/dispo45

Admission indications

›Mandatory admission criteria

›Infants <4 months with suspected or confirmed pertussis

›High risk for apnea, respiratory failure, and rapid deterioration

›Cardiorespiratory monitoring mandatory

›Apnea, cyanosis, or oxygen requirement

›Any episode of apnea requiring stimulation or intervention

›SpO2 <95% requiring supplemental oxygen

›Inability to tolerate oral intake

›Dehydration from posttussive vomiting

›Failure to feed in infants

›Secondary pneumonia

›Radiographic or clinical evidence of pneumonia

›Requires IV antibiotics if unable to tolerate oral therapy

›ICU admission criteria

›WBC >40,000-50,000/μL in infants

›Associated with pulmonary hypertension and fatal outcomes

›Respiratory failure requiring mechanical ventilation

›Refractory hypoxia or rising PaCO2

›Pulmonary hypertension on echocardiography

›Requires intensive hemodynamic monitoring and management

›Hemodynamic instability

›Cardiogenic or distributive shock

Discharge criteria

›Safe discharge criteria

›Tolerating oral intake without significant vomiting

›Adequate hydration and nutrition maintained

›No apnea or oxygen requirement

08Treatment/t100

Antibiotic therapy

›First-line: Azithromycin

›Adult dosing

›500 mg on day 1, then 250 mg daily on days 2-5

›Alternative adult regimen: 500 mg daily for 3 days

›Pediatric dosing (children ≥6 months)

›10 mg/kg on day 1 (maximum 500 mg), then 5 mg/kg daily on days 2-5 (maximum 250 mg)

›Alternative: 10 mg/kg/day for 3 days (maximum 500 mg/day)

›Infants <1 month

›10 mg/kg/day orally for 5 days

›Azithromycin preferred over erythromycin to avoid IHPS risk

›Infants 1-5 months

›10 mg/kg/day for 5 days

›Evidence and rationale

›Eradicates organism and reduces transmission

›Does not shorten clinical course once paroxysmal phase has begun

›Treat within 3 weeks of cough onset to reduce transmission

›Second-line: Clarithromycin

›Adult dosing

›500 mg twice daily for 7 days

›Pediatric dosing

›7.5 mg/kg/dose twice daily for 7 days (maximum 500 mg/dose)

›Contraindications

›Avoid in infants <1 month

›Caution in QT prolongation risk

›Third-line: Erythromycin

›Adult dosing

›500 mg four times daily for 14 days

›Pediatric dosing

›40-50 mg/kg/day divided four times daily for 14 days

›Limitations

›More gastrointestinal side effects; less preferred

›Risk of infantile hypertrophic pyloric stenosis (IHPS) in neonates

›Avoid erythromycin estolate due to hepatotoxicity risk

›Alternative: TMP-SMX

›Indication

›Macrolide intolerance or allergy

›Dosing

›8 mg/kg/day of TMP component divided twice daily for 14 days

›Adult: TMP 160 mg/SMX 800 mg twice daily for 14 days

›Avoid in

›Infants <2 months (risk of kernicterus)

›Pregnant individuals near term

Postexposure prophylaxis

›Indications for PEP

›High-risk household contacts

›Infants <12 months

›Pregnant individuals in third trimester

›Immunocompromised contacts

›Close contacts of high-risk individuals

›Same antibiotic regimens as treatment

›Azithromycin preferred for PEP

›Initiate within 21 days of last exposure to be effective

Supportive care

›Respiratory support

›Supplemental oxygen for SpO2 <95%

›Nasal cannula or face mask titrated to SpO2 ≥95%

›High-flow nasal cannula for refractory hypoxia

›Minimize cough triggers

›Calm environment; avoid suction or stimulation that provokes paroxysms

›Small, frequent feeds to reduce coughing triggers

›Hydration and nutrition

›Oral rehydration if tolerated

›Small frequent feeds in infants to reduce posttussive vomiting

›IV fluid resuscitation for dehydration when oral intake inadequate

›Nasogastric feeds

›If oral intake insufficient in hospitalized infants

Ineffective treatments (avoid)

›Agents without proven benefit

›Corticosteroids

›No benefit demonstrated for symptom control or course shortening

›Cochrane review 2014 found no evidence of benefit

›Bronchodilators (salbutamol/albuterol)

›No proven benefit in pertussis

›Do not reduce cough frequency or severity

›Antihistamines (diphenhydramine)

›No benefit for cough suppression in pertussis

›Pertussis immune globulin

›No proven benefit for clinical management

›Cough suppressants

›Ineffective; cough is toxin-mediated, not from ongoing bacterial infection

Severe and fulminant pertussis management

›ICU-level interventions

›Mechanical ventilation

›For refractory hypoxia or apnea requiring ventilatory support

›Avoid high positive pressure that worsens pulmonary hypertension

›Exchange blood transfusion

›Consideration for WBC >50,000-100,000/μL with pulmonary hypertension

›Reduces leukocyte-mediated pulmonary vascular occlusion

›Inotropic support

›Dopamine or dobutamine for right heart failure

›Norepinephrine for vasodilatory shock

›Pulmonary hypertension management

›Inhaled nitric oxide in refractory cases

›ECMO considered in extreme refractory cases

Vaccination

›Opportunistic vaccination

›Tdap for all patients ≥11 years who have not received it

›Single dose replacing one Td booster

›Regardless of interval since prior Td

›Pregnancy

›Tdap at 27-36 weeks gestation each pregnancy

›Provides passive antibody transfer to neonate

›Cocooning strategy

›All close contacts of newborns vaccinated with Tdap if not already

›Reduces infant exposure to pertussis in early weeks of life

09Special Populations/sp70

Pregnancy

›Maternal pertussis considerations

›Antibiotic treatment modifications

›Azithromycin is the preferred antibiotic in pregnancy

›Safe in all trimesters

›Treatment duration for pregnant individuals

›Treat up to 6 weeks after cough onset (versus 3 weeks in general population)

›Rationale: neonatal protection if near term at delivery

›TMP-SMX avoidance

›Avoid near term due to risk of neonatal kernicterus

›Avoid in first trimester for theoretical folate antagonism risk

›Neonatal protection strategy

›Maternal Tdap vaccination

›Administered at 27-36 weeks gestation in each pregnancy

›Provides passive maternal antibody transfer to fetus

›Protects neonate in first weeks before primary vaccination begins

›Cocooning

›All household contacts and caregivers vaccinated before infant born

›Particularly important for unvaccinated grandparents and close contacts

›Fetal and neonatal risks

›Maternal infection near term

›Risk of neonatal pertussis transmitted at delivery

›Neonates may present with apnea rather than classic whooping cough

›Prematurity risk

›Severe maternal paroxysmal coughing may trigger preterm labor (rare)

Geriatric

›Age-related clinical differences

›Atypical presentation common

›Inspiratory whoop often absent in older adults

›Prolonged dry cough may be sole manifestation

›Misattributed to COPD exacerbation, GERD, or ACE inhibitor cough

›Complications more frequent

›Rib fractures from paroxysmal coughing in osteoporotic patients

›Urinary incontinence: approximately one-third of females ≥50 years

›Syncope (~2%) with fall risk in elderly

›Drug considerations

›Azithromycin cautions

›QT prolongation risk in patients on other QT-prolonging medications

›Clarithromycin similarly prolongs QT; monitor ECG if risk factors present

›Renal function adjustment

›TMP-SMX dose reduction required if eGFR <30 mL/min/1.73m2

›Drug interactions

›Azithromycin interactions with warfarin and digoxin; monitor levels

›Vaccination in elderly

›Tdap single dose if not previously received

›Adults ≥65 years often have not received Tdap

›CDC ACIP recommends Tdap for all adults once if not previously given

Pediatrics

›Infant-specific management (age <3 months)

›Hospitalization mandatory

›All infants <3-4 months with suspected pertussis require admission

›Risk of apnea, respiratory failure, and rapid deterioration

›Antibiotic choice

›Azithromycin first-line for all ages

›Erythromycin avoided in neonates due to IHPS risk

›TMP-SMX avoided in infants <2 months (kernicterus risk)

›CBC monitoring

›Serial WBC in hospitalized infants

›WBC >40,000/μL with lymphocytosis requires ICU consultation

›Prematurity

›Premature infants at higher risk for severe disease

›Lower gestational age correlates with higher risk of apnea and ICU admission

›Impaired immune response from immature immunological system

›DTaP initiation

›Not delayed for prematurity; begin at 2 months chronological age

›Do not adjust for corrected gestational age

›Adolescent considerations

›Waning vaccine immunity

›DTaP series completed in childhood; immunity wanes by adolescence

›Tdap booster at age 11-12 years is routine recommendation

›School and sports participation

›Excluded from school/sports until 5 days of antibiotics completed

›Can transmit to unvaccinated infants in household

10Background/b81

Epidemiology

›Global incidence

›Pertussis cases worldwide

›WHO estimates 24.1 million cases annually with 160,700 deaths

›Predominantly in low-vaccination-coverage countries

›Resurgence in high-income countries

›Cyclical epidemics every 3-5 years despite high vaccination coverage

›Driven by waning acellular vaccine immunity and unvaccinated individuals

›United States incidence

›~15,000-50,000 reported cases annually; true incidence estimated much higher

›Approximately 85% of cases occur in adolescents and adults

›Age distribution and mortality

›Infant morbidity and mortality

›Highest morbidity and mortality in infants <3 months

›Case fatality rate in neonates approximately 1% in high-income countries

›Lower mortality with rapid recognition and ICU support

›Adult burden

›Adults are primary reservoir and transmission source for infants

›Among adults with cough >2 weeks, 12-32% have pertussis

›Transmission dynamics

›Attack rate

›Highly contagious: secondary attack rate 70-100% in susceptible household contacts

›Transmission by respiratory droplets within 1-2 meters

›Contagious period

›Most contagious during catarrhal phase and early paroxysmal phase

›Remains contagious up to 21 days from cough onset if untreated

Pathophysiology

›Organism characteristics

›Bordetella pertussis

›Gram-negative coccobacillus

›Exclusively human pathogen; no animal reservoir

›Strict aerobe; fastidious growth requirements

›Virulence factors

›Pertussis toxin: primary virulence factor; causes lymphocytosis and beta-islet cell sensitization

›Filamentous hemagglutinin: adhesin mediating respiratory epithelial attachment

›Pertactin: outer membrane protein; adhesin and immune evasion factor

›Adenylate cyclase toxin: impairs neutrophil and macrophage function

›Tracheal cytotoxin: causes ciliary dysfunction and epithelial cell death

›Disease mechanism

›Mucosal colonization and toxin production

›Organism colonizes ciliated respiratory epithelium

›Toxins impair mucociliary clearance leading to mucus accumulation

›Paroxysmal cough results from mucus accumulation in airways

›Leukocytosis mechanism

›Pertussis toxin inhibits lymphocyte trafficking from lymph nodes

›Causes marked peripheral lymphocytosis not from proliferation but from redistribution

›Pulmonary hypertension mechanism in fulminant disease

›Extreme lymphocytosis causes leukocyte plugging of pulmonary microvasculature

›Pulmonary vascular resistance rises leading to right heart failure

›Exchange transfusion aims to reduce leukocyte burden acutely

›Vaccine immunity and waning

›Acellular pertussis vaccines (aP)

›Target pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae

›Immunity wanes significantly within 3-5 years of last dose

›Shorter-duration protection than whole-cell pertussis vaccines

›Natural immunity

›Prior infection does not confer lifelong immunity

›Reinfection possible; subsequent episodes typically less severe

Therapeutic Considerations

›Antibiotic treatment rationale

›Primary goal: reduction of transmission

›Antibiotics eradicate organism from nasopharynx within 3-5 days

›Does not shorten clinical cough once paroxysmal phase established

›Most beneficial within first 3 weeks of cough onset

›Treatment after 3 weeks

›Generally not recommended for symptom relief as cough is toxin-mediated

›Exception: pregnant individuals near term treated up to 6 weeks after onset

›Macrolide selection

›Azithromycin favored due to shorter duration and fewer GI side effects

›Superior adherence compared to erythromycin 14-day course

›Class B evidence supporting azithromycin as first-line (CDC guidelines)

›Fluoroquinolones

›In vitro activity against Bordetella pertussis

›No clinical data to support use; not recommended

›Vaccine prevention as therapeutic strategy

›Maternal immunization

›Most effective individual-level intervention to prevent infant pertussis

›Tdap at 27-36 weeks provides passive antibody transfer

›Cocooning

›Ensures all household contacts immune before infant birth

›Complements maternal vaccination

›Evidence base

›CDC ACIP 2018 recommendations for pertussis, tetanus, and diphtheria prevention

›Cochrane review 2007 supports macrolide antibiotics for reduction of transmission

11Patient Discharge Instructions/pdi42

copy discharge instructions

›About your illness

›You have been diagnosed with pertussis (whooping cough), a bacterial respiratory infection

›Caused by Bordetella pertussis bacteria

›Spreads through respiratory droplets from coughing

›What to expect

›Coughing spells may last 2-3 months even with proper treatment

›Antibiotics reduce your ability to spread the infection but do not stop the cough

›You are contagious until you have completed 5 days of antibiotics

›Medications

›Antibiotic prescription

›Take the full course of antibiotics as prescribed

›Do not stop early even if feeling better

›Symptom management

›No proven cough suppressant works for pertussis cough

›Avoid triggers that provoke coughing spells (cold air, smoke, exercise)

›Small frequent meals may reduce posttussive vomiting

›Isolation requirements

›Stay home from work, school, and daycare

›Until 5 days of antibiotics are completed

›If untreated, remain isolated for 21 days from start of cough

›Protect vulnerable contacts

›Avoid contact with infants <12 months until no longer contagious

›Inform household members and close contacts to seek evaluation and prophylaxis

›Follow-up care

›Primary care follow-up within 1-2 weeks

›To reassess cough trajectory and review test results

›Ensure household contacts have received antibiotic prophylaxis and vaccination

12References/r52

Guidelines and key sources

›Cornia PB, Lipsky BA

›Pertussis Infection in Adults

›Journal of the American Medical Association, 2026

›Primary evidence source for clinical presentation, treatment, and complications

›Moore A, Harnden A, Grant CC, Patel S, Irwin RS

›Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report

›Chest, 2019

›Clinical criteria for pertussis diagnosis and probability assessment

›Kline JM, Smith EA, Zavala A

›Pertussis: Common Questions and Answers

›American Family Physician, 2021

›Comprehensive clinical overview including epidemiology and management

›Liang JL, Tiwari T, Moro P, et al

›Prevention of Pertussis, Tetanus, and Diphtheria With Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

›MMWR Recommendations and Reports, 2018

›Authoritative vaccine schedule and cocooning strategy recommendations

›Wang K, Bettiol S, Thompson MJ, et al

›Symptomatic Treatment of the Cough in Whooping Cough

›Cochrane Database of Systematic Reviews, 2014

›Evidence basis for ineffectiveness of corticosteroids, bronchodilators, antihistamines

›Altunaiji S, Kukuruzovic R, Curtis N, Massie J

›Antibiotics for Whooping Cough (Pertussis)

›Cochrane Database of Systematic Reviews, 2007

›Evidence for macrolide antibiotics in reducing transmission

›Miller JM, Binnicker MJ, Campbell S, et al

›Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update (IDSA/ASM)

›Clinical Infectious Diseases, 2024

Evidence & Review