ABSTRACT
Objective:To study the clinical features of children with pertussis and the risk factors of severe pertussis.Methods:A retrospective analysis was performed based on clinical data and laboratory examination results of hospitalized children with pertussis who admitted to the intensive care unit, respiratory department, and emergency general department at Hunan Children′s Hospital from January 2019 to March 2020.According to the age, the patients were divided into age ≤3 months group( n=58)and age >3 months group( n=64). According to sputum culture, 63 cases were divided into negative sputum culture group and 59 cases were positive sputum culture group.The patients were also divided into vaccinated group( n=19)and unvaccinated group( n=103). Severe disease was seen in 28 cases, and the other 94 cases had the modest disease.The clinical characteristics between two groups were compared, and the risk factors of severe pertussis pneumonia were analyzed. Results:The hospitalization days in age ≤3 months group was higher than that in age >3 months group.It was also found that shortness of breath, apnea, cyanosis after coughing, heart rate decline were more common in age ≤3 months group than those in age >3 months group( P<0.05). The incidences of respiratory failure and heart failure in positive sputum culture group were higher than those in negative sputum culture group.Clinical characteristics such as hospitalization days, hospitalization expenses, peak white blood cell count, peak lymphocyte count, and incidence of bacterial infection were higher in severe pertussis group than those in non-severe pertussis group( P<0.05). Four patients were treated with exchange blood transfusion, and one patient died.Logistic regression analysis revealed that fever, wheezing, cyanosis after coughing and white blood cell count>20×10 9/L were risk factors for severe pertussis.White blood cell count of 20×10 9/L and lymphocyte count of 14×10 9/L had the highest sensitivity and specificity in predicting severe pertussis(0.71, 0.78; 0.54, 0.79). Conclusion:The younger the children are, the more likely they have shortness of breath, apnea, cyanosis, heart rate falls, and the longer the hospital stay.Bacterial infection will aggravate pertussis.Patients with fever, wheezing, cyanosis after coughing, and white blood cell count>20×10 9/L are more likely to develop severe pertussis.The white blood cell count >20×10 9/L and the lymphocyte count >14×10 9/L are associated with severe pertussis.
ABSTRACT
Pertussis is a highly contagious respiratory disease.Although widespread vaccination has greatly reduced the incidence of pertussis, there was a " recurrence of pertussis" in the past 30 years, and pertussis outbreaks occurred in some areas.Infants who have not been vaccinated or have not completed the full course of immunization suffer from more severe pertussis infections.Because of the atypical symptoms of young infants, missed diagnosis and misdiagnosis often occur, and pertussis cannot be diagnosed and treated in time.As a result, they can easily develop into severe pertussis or even die.In this article, recently published research on severe pertussis are summarized, so as to provide guidance for the clinical diagnosis, treatment, prevention and basic scientific research of severe pertussis.
ABSTRACT
Pertussis is an acute highly contagious respiratory disease,which is associated with high rate of hospitalization and death in infants and young children.The pathogenesis of severe pertussis has not been elucidated,and there has not been a consistent universal definition in severe pertussis.This article summarizes the present clinical definitions of severe pertussis related diagnosis,and the risk factors for death from pertussis.This text could benefit the clinical practice and the further researches,and to contribute to establish a regulation of the diagnosis and treatment of severe pertussis early.
ABSTRACT
Pertussis is an acute highly contagious respiratory disease, which is associated with high rate of hospitalization and death in infants and young children.The pathogenesis of severe pertussis has not been elucidated, and there has not been a consistent universal definition in severe pertussis.This article summarizes the present clinical de-finitions of severe pertussis related diagnosis, and the risk factors for death from pertussis.This text could benefit the clinical practice and the further researches, and to contribute to establish a regulation of the diagnosis and treatment of severe pertussis early.
ABSTRACT
Objective To investigate the efficacy and safety of leukoreduction therapy in severe per-tussis in infants. Methods Therapeutic processes of 3 cases of severe pertussis in PICU of Shanghai Children′s Medical Center were retrospectively studied from October 2017 to May 2018. We reviewed the related literatures and summarized the time and effectiveness of leukoreduction therapy in severe pertussis. Results All 3 cases had leukocytosis,respiratory faliure,pulmonary hypertension and right heart failure. One case had multiple organ failure before undergoing exchange transfusion therapy and eventually died. Two cases that had pulmonary hypertension during the period of WBC′s rising accepted leukopheresis therapy before multiple organ failure,and eventually survived. We reviewed the foreign literatures which was almost case reports,leukoreduction therapy might improve the prognosis of severe pertussis in infants,but the time of using it had no conclusion. Conclusion This is the first report of leukoreduction therapy for the severe per-tussis in infants in China. It provides a new method for the treatment of severe pertussis in infants. It is worth looking forward to use this method combined with continuous renal replacement therapy and extracorporeal membrane oxygenation technology. In the future,multicenter clinical research should be done to explore the effectiveness and safety of leukoreduction therapy in the severe pertussis in infants.
ABSTRACT
La coqueluche grave es una variante clínica de la infección por Bordetella pertussis, que cursa con leucocitosis extrema, neumonía, insuficiencia respiratoria grave e hipertensión pulmonar, y acarrea una alta mortalidad. La hipertensión pulmonar es el evento crucial que desencadena el colapso cardiovascular, resistente al tratamiento y, en ella, participan la toxina pertussis y la leucostasia pulmonar. La remoción de la masa leucocitaria mediante exanguinotransfusión se plantea como una opción terapéutica. Presentamos el caso clínico de un paciente de 6 meses de edad con diagnóstico de coqueluche grave, que fue sometido a exanguinotransfusión de una volemia como medida de rescate cuando ya tenía hipoxemia resistente e hipertensión pulmonar. Se observó una reducción de la concentración de glóbulos blancos del 47% y una mejora en los parámetros de oxigenación que persistió durante 48 horas, momento a partir del cual el paciente evolucionó en forma tórpida con falla multiorgánica y murió.(AU)
Severe pertussis is a clinical variant of Bordetella pertussis infection that is accompanied by extreme leukocytosis, pneumonia, severe respiratory failure and pulmonary hypertension, and this condition carries a high mortality. Pulmonary hypertension is the crucial event that triggers refractory cardiovascular collapse, and pertussis toxin and pulmonary leukostasis are involved. Removal of leukocyte mass by exchange transfusion is proposed as a therapeutic option. We present a 6-month-old patient with diagnosis of severe pertussis, who underwent a single volume exchange blood transfusion as a rescue measure when the refractory hypoxemia and pulmonary hypertension were already present. We observed a reduction in the white blood cell count of 47%, and an improvement in oxygenation parameters that persisted for 48 hours, after which time the patient evolved into a torpid form with multiorgan failure and death.(AU)