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Objective To analyze the clinical characteristics and laboratory indexes of pneumonia complicated with pertussis syndrome in Suzhou area in order to provide the basis for rational treatment.Methods Children who had been hospitalized at Department of Respiratory,Children's Hospital of Soochow University during January 2012 to October 2016 were enrotled and diagnosed as pneumonia complicated with pertussis syndrome.A total of 236 cases were enrolled.Multiple pathogen detection and clinical information were collected in all patients.The subjects were divided into 28 days-＜ 3 months group,3-＜ 6 months old group,6-＜ 12 months old group and ≥ 12 months old group.The clinical data of children in each age group were retrospectively analyzed.Results Pneumonia complicated with pertussis syndrome was easy to occur within 6 months of infants,with the highest incidence in the 3-＜ 6 months group,there was a significant difference among the different age groups (x2 =231.870,P ＜ 0.05) [28 d-＜ 3 months group:5.3％ (102/1 910 cases),3-＜6 months group:5.7％ (76/1 341 cases),6-＜ 12 months group:2.0％ (36/1 762 cases),≥12 months group:0.4％ (22/5 304 cases)].The patients could become sick all the year round,with the highest incidence in summer[2.6％ (72/2 740 cases)in spring,3.7％ (96/2 611 cases)in summer,2.1％ (56/2 749 cases) in autumn,and 0.48％ (12/2 487 cases)in winter],and there were significant differences among the different seasons (x2 =62.380,P ＜0.001).Clinical symptoms were paroxysmal spasmodic cough,33.0％ (78/236 cases) of the performance with wheezing,mainly in the older than 3 months group.The incidence of fever was positively correlated with age(x2 =12.938,P ＜ 0.05).Peripheral white blood cell count and lymphocyte percentage increased,and the 3-＜ 6 months old group increased markedly.White blood cell count as high as (19.01 ± 11.99) × 109/L,the highest percentage of lymphocytes was up to 0.80,platelets were significantly increased in more than 80％ of children.The incidence of C-reactive protein (CRP) was negatively correlated with age,28 days-＜ 3 months group more prone to have high CRP.Pulmonary inflammatory pathology showed multiple pulmonary involvement by chest radiography,and it was more likely to occur in 28 d-＜ 3 months group.Viruses,bacteria and mycoplasma pneumoniae (MP) could cause pneumonia associated with pertussis syndrome,and mixed infection occurred in 56 cases.The top three pathogens were rhinovirus,MP and Streptococcus pneumoniae,and mixed infection was more prone to occur in 28 d-＜ 3 months group.Conclusion Pneumonia complicated with pertussis syndrome is easy to occur within 6 months of infants,with the highest incidence in summer.Viruses,bacteria and MP all could cause pneumonia associated with pertussis syndrome,and mixed infection could occur in some cases.The top three pathogens are rhinovirus,MP and Streptococcus pneumoniae.
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Objective To observe the clinical characteristics of infants with pertussis syndrome and the influence of gastroesophageal reflux (GER) on pertussis syndrome in small infants, and provide experience for improving curative effect. Methods ① The clinical data of 807 infants with pertussis syndrome treated at Wuhan Children's Hospital from January 2015 to June 2017 were retrospectively analyzed, in which their clinical characteristics including symptoms, signs and related physical and chemical examinations were summarized. ② Prospective randomized controlled trials were performed at the Children's Hospital of Wuhan from June 2017 to June 2018, there were 120 infants with ages < 6 months diagnosed as pertussis syndrome and simultaneously accompanied by gastric volvulus (GV) and GER, and they were randomly divided into a study group and a control group according to the date sequence of definite diagnosis, 60 cases in each group. The control group was given conventional medical treatment, while in the study group, additionally the infants received massage to restore gastric proper position and anti-reflux therapy. The clinical efficacies of two groups were observed. Results ① Retrospective analysis showed that clinically, pertussis syndrome commonly occurred in infants of ages < 6 months, accounting for 88.30% (713 cases); all cases had spastic cough, and 60.00% (484 cases) infants' coughing was severer at night. In laboratory examinations, 83.27% (672 cases) of the infants had elevated platelets (PLT), 25.03% (202 cases) had abnormal myocardial zymograms, and 70.38% (568 cases) had elevated white blood cells (WBC). In the pathogen examination, only were pathogens found in 34.8% infants, mainly single pathogen infection, accounting for 86.12%. Chest radiographs suggested 71.50% of infants with pneumonia, and 73.00% of infants with GER, among which 77.92% of infants were accompanied by GV. ② The prospective study showed that in the treatment of infants with pertussis syndrome accompanied by GV and GER, manual massage should be used timely to correct GV and simultaneously anti-reflux therapy should be given, in the aspects of time required to improve cough symptoms (days: 5.36±1.40 vs. 6.59±1.56, P < 0.01) and shortening of the hospital stay (days: 6.50±1.41 vs. 8.09±1.63, P < 0.01) in the study group were superior to those in the control group; the case of respiratory failure in the study group was lower than that in the control group [2 cases vs. 8 cases, P < 0.05]. Conclusions In pertussis syndrome, lymphocytes occupy the main proportion of WBC elevation that is an important differential criterion between pertussis syndrome and infantile pneumonia with gastric volvulus and gastroesophageal reflux. PLT elevation in pertussis syndrome suggests that attention should be paid to the elevation as that might be related to the disease prognosis. It is necessary to further investigate whether the positive pathogen discovered in the course of pertussis syndrome is a pathogenic one, and attention should also be paid to the medical examination of GV and GER in the small infants with pertussis syndrome, since early proper intervention to correct GV and GER can significantly improve their clinical efficacies.
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Objective To investigate the etiology and clinical manifestations of patients with suspected pertussis under 2 years old.Methods A total of 90 patients under 2 years old with suspected pertussis were collected prospectively from July 2015 to June 2016.Nasopharyngeal secretions and clinical data were obtained.Bordetella pertussis was detected by polymerase chain reaction (PCR).Patients were classified into pertussis group if the PCR was positive,or pertussis syndrome group if negative.Other 13 respiratory viruses and atypical pathogens were also detected,and bacterial culture was performed.Pathogens and clinical manifestations were compared between groups.For normal distributed data,continuous variables between groups were compared using two-sample t-test,while categorical variables between groups were compared using chi-square test.Results A total of 90 suspected cases were included,including 46 males and 44 females.Age ranged from 33 days to 18 months,and the median age was 3 months.Thirty-five cases (38.9％) were positive for Bordetella pertussis PCR (the pertussis group),the age ranged from 34 days to 13 months,the median age was 2 months.Fifty-five cases (61.1 ％) were negative (the pertussis syndrome group),with the age ranging from 33 days to 18 months,and the median age was 4 months.In pertussis group,there was a higher percentage of hospitalization history in 1 month before onset than that of the pertussis syndrome group,and the difference was statistically significant (x2=4.496,P＜0.05).Patients in pertussis group were more likely to have cyanosis and cough at night (x2=4.234 and 10.960,both P＜0.05),and the course of pertussis was longer than that in pertussis syndrome (t=3.402,P＜0.05).The length of hospital stay before pertussis onset in pertussis group was longer than that in the pertussis syndrome group (P＜0.05).The mean white blood count in pertussis group was (22.00±9.42) × 109/L,and that in pertussis syndrome group was (16.31±8.10) × 109/L,and the difference between the two groups was statistically significant (t=3.049,P＜0.05).In pertussis group and pertussis syndrome group,influenza virus A was detected in 22 and 44 cases,respectively;rhinovirus in 16 and 25 cases,respectively;parainfluenza virus in 5 and 12 cases,respectively;respiratory syncytial viruses in 3 and 6 cases,respectively.Conclusions Patient who presents with cyanosis,cough at night and high white blood cell count is more likely to have pertussis.Influenza viruses A,humanrhinovirus and human parainfluenza viruses are common pathogens to be found in patients with suspected pertussis under 2 years of age.
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Objective To investigate the effects of vitamin K1 in the adjuvant treatment of spasmodic cough in pertussis syndrome children,and its impacts on length of hospital stay.Methods 87 pertussis syndrome children were randomly divided into two groups,among which 41 cases in the control group were treated with the therapies such as anti -infection,respiratory support,antispasmodic,expectorant et al,while 46 cases in the treatment group were treated additionally with vitamin K1 on the basis of the control group.Then compared the duration and hospital stay of the two groups with spasmodic cough.Results The disappeared time of spasmodic cough in the treatment group was (7.22 ±1.33)d and hospital stay was (9.52 ±1.84)d,which in the control group were (15.51 ±2.73)d,(18.71 ± 3.30)d respectively,and there were statistically significant differences(t =-18.310,-16.269,all P <0.01).In the treatment group,the total effective rate was 93.5%,there were 18 cases with markedly effective,25 cases with effective and 3 cases with ineffective.Correspondingly,there were 7 cases markedly effective,23 cases effective, 11 cases ineffective,and total efficiency rate was only 73.1% in the control group,the difference was statistically significant(χ2 =4.285,P <0.05 ).Conclusion Vitamin K1 to alleviate spasmodic cough in children has a significant effect,which can reduce the duration of the cough time and hospital stay in pertussis syndrome children, and also can improve the clinical effect.