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OBJECTIVE: To investigate the etiology and clinical characteristics of pertussis-like syndrome. METHODS: Thenasopharyngeal secretionscollectedfrompatientswithpertussis-likesymptominChildren's Hospital Affiliated to Soochow University from February 2016 to December 2017 were detected for pertussis DNA using PCR assays and other microbiological assessment. RESULTS: A total of 197 children were enrolled in the study,of whom 119(60.4%)patients were positive for Bordetella pertussis,and 37 cases(37.8%)were positive for other pathogens,including 14 cases(37.8%)of rhinovirus,14 cases(37.8%)of Mycoplasma pneumoniae,4 cases(10.8%)of human bocavirus,3 cases(8.1%)of parainfluenza virus and1 case(2.7%)of respiratory syncytial virus,and 1 case(2.7%)of Haemophilus influenzae. There were no significant differences in mean age,paroxysmal cough,inspiratory whoop,posttussive vomiting,paroxysmal cyanosis,or pulmonary signs between pertussis group and pertussis-like syndrome group(P>0.05). The proportion of male in pertussis group(57.1% vs. 35.3%),white blood cell counts[(18.83±11.54)×10~9/L vs.(12.46±6.01)×10~9/L)],lymphocyte counts[(10.62±8.48)×10~9/L vs.(6.54±5.13)×10~9/L)]were significantly higher than those in pertussis-like syndrome group(P<0.05). CONCLUSION: Rhinovirus and Mycoplasma pneumoniae are the main pathogens of pertussis-like syndrome. Leukocyte and lymphocyte counts can be used as an index to differentiate pertussis from pertussis-like syndrome.
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Objective: To characterize two Achromobacter xylosoxidans recovered from 2 patients diagnosed with pertussis during a Bordetella pertussis surveillance program. Methods: Nasopharyngeal swabs from 2 children under 1 year of age with clinical suspicion of pertussis were analyzed by culture and PCR. Results: Two Achromobacter xylosoxidans A8, closely related to Bordetella spp. were recovered from 2 patients diagnosed of pertussis, both carrying the ptxA gene and IS418 the pertussis toxin encoding gene. Subsequently, antibiotic susceptibility was evaluated by disk-diffusion method and by PCR. Conclusions: Although more detailed studies are needed, the present data highlight the possibility that Achromobacter xylosoxidans, closely related Bordetella pertusssis microorganisms and not covered under the vaccine umbrella, might also result in cases of whooping cough. Thereby further surveillance is necessary to determine the extension and relevance of their pathogenic role in order to discriminate their real public health implication.
ABSTRACT
OBJECTIVE@#To characterize two Achromobacter xylosoxidans recovered from 2 patients diagnosed with pertussis during a Bordetella pertussis surveillance program.@*METHODS@#Nasopharyngeal swabs from 2 children under 1 year of age with clinical suspicion of pertussis were analyzed by culture and PCR.@*RESULTS@#Two Achromobacter xylosoxidans A8, closely related to Bordetella spp. were recovered from 2 patients diagnosed of pertussis, both carrying the ptxA gene and IS418 the pertussis toxin encoding gene. Subsequently, antibiotic susceptibility was evaluated by disk-diffusion method and by PCR.@*CONCLUSIONS@#Although more detailed studies are needed, the present data highlight the possibility that Achromobacter xylosoxidans, closely related Bordetella pertusssis microorganisms and not covered under the vaccine umbrella, might also result in cases of whooping cough. Thereby further surveillance is necessary to determine the extension and relevance of their pathogenic role in order to discriminate their real public health implication.
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Objective To explore the clinical characteristics and management of children who were critically ill with severe pertussis and those who had severe pertussis-like syndrome.Methods The patients with severe pertussis and severe pertussis-like syndrome admitted to Pediatric Intensive Care Unit from Mar.2005 to Mar.2013 were involved in this study,and their clinical characteristics were collected and the experience of management was summarized.Resuits Totally 31 patients were involved in the study,15 cases were male and 16 cases were female,the median age was 2.68 months (age ranged 34 days-7 months).All the 16 cases of severe pertussis were less than 3 months,and none of them had received pertussis vaccine.Of 31 patients,16 (51.61％) cases were characterized by apnea,12 (38.70％) cases showed cyanosis,10(32.26％) cases exhibited bradycardia,8(25.80％) cases presented spasmodic cough,leukocytosis [white blood cell count (26.85 ± 12.43) × 109/L] as well as lymphocytosis [blood lymphocyte (70.10 ± 8.82)％] were observed.Complications included respiratory failure(13 cases,41.94％),pulmonary hypertension (7 cases,22.58％),circulatory dysfunction(6 cases,19.35％) and encephalopathy(5 cases,16.13％).Two cases of severe pertussis patients presenting with cardiac arrest received CPR survival due to prolonged apnea.Severe pertussis infants were more likely to present apnea,cyanosis,bradycardia and be complicated with pulmonary hypertension than those who had severe pertussis-like syndrome infants [75.00％ (12/16 cases) vs 26.70％ (4/15 cases),x2 =7.008,P=0.008;62.50％ (10/16 cases) vs 13.30％ (2/15 cases),x2 =7.634,P =0.006;50.00％ (8/16 cases) vs 13.30％(2/15 cases),x2 =4.610,P =0.032;37.50％ (6/16 cases) vs 6.67％ (1/15 cases),x2 =4.074,P =0.044].In the patients with pulmonary hypertension group,the white blood cell count,the rate of suffering from respiratory failure as well as circulatory dysfunction,the rate of using mechanical ventilation,the rate of using vasoactive drug were significantly higher than those in the normal pulmonary arterial pressure group[(47.96 ± 17.79) × 109/L vs (23.20 ± 5.29) x 109/L,t =2.278,P =0.025 ; 71.42％ (5/7 cases) vs 8.33 ％ (2/24 cases),x2 =11.943,P =0.001 ;71.42％ (5/7 cases) vs 8.33％ (2/24 cases),x2 =11.943,P =0.001 ;42.86％ (3/7 cases)vs 0 (0 case),x2 =11.020,P =0.001 ;42.86％ (3/7 cases) vs 0 (0 case),x2 =11.020,P =0.001].Pertussis-mediated pulmonary hypertension were also treated with milrinone,and all cases were cured.Conclusions Severe pertussis and severe pertussis-like syndrome in infants are characterized by high morbidity of apnea and respiratory failure.Severe pertussis tends to occur in younger unvaccinated infants(＜3 months).Severe pertussis is more likely to be combined with pulmonary hypertension.Pulmonary hypertension is the sign of disease get aggravation,and milrinone treatment may be effective.
ABSTRACT
El síndrome coqueluchoide, cuadro parecido a la tos ferina, es uno de los síndromes respiratorios bajos más comunes en la práctica pediátrica sobre todo en los últimos años. La tos ferina sigue siendo la enfermedad inmunoprevenible más antigua de la infancia que aún causa brotes importantes, principalmente en niños, pero también en adolescentes y adultos. El objetivo de esta revisión es proporcionar información a todos los médicos generales y pediatras de atención primaria y secundaria de salud sobre este problema epidemiológico y de su actual reemergencia. El control de esta enfermedad es un problema de salud tanto en países desarrollados como en vías de desarrollo. Uno de los mayores obstáculos que ha contribuido a una tardía intervención epidemiológica y tratamiento de la tos ferina en varios países del mundo, ha sido la baja sospecha clínica de esta enfermedad en los médicos y trabajadores de la salud, y el desconocimiento de la familia, en la mayoría de las veces. En el momento actual existe una reemergencia mundial de la tos ferina, situación que es necesario conocer y aceptar para un oportuno diagnóstico y tratamiento.
Pertussis-like syndrome, a clinical picture similar to whooping cough, is one of the most common lower respiratory syndromes in the pediatric practice in recent years. Whooping cough continues to be one of the oldest preventable diseases in infants, which still causes significant outbreaks mainly in children, but also in adolescents and adults. The objective of this review was to provide general physicians and pediatricians at the primary and the secondary health care levels with information about this present re-emerging epidemiological problem. The management of this disease is difficult for both the developed and the developing countries. One of the major obstacles that lead to delayed epidemiological intervention and treatment of whooping cough in several countries has been the poor clinical suspicion of the presence of the disease on the part of health workers and physicians, and the lack of knowledge within the family setting. It is required to know and to accept the re-emergence of whooping cough at present, in order to make a timely diagnosis and to apply a line of treatment.