RESUMEN
Objectives: Aresurgence of pertussis or whooping cough has been observed worldwide despite broad vaccination coverage. Pertussis like illness [PLI] refers to a clinical syndrome compatible with pertussis infection but lacking laboratory confirmation or an epidemiological link to a confirmed case. Our study aimed to estimate the contribution of Bordetella pertussis infection and identifying predictors of its diagnosis in a cohort of children with PLI
Methods: Demographic and clinical information were retrospectively collected from the medical records of children < 13 years old and hospitalized for PLI in two pediatric units in Oman from 1 January 2012 to 31 December 2013. The laboratory data of all cases were reviewed and confirmed cases of pertussis were identified, analyzed, and compared with non-confirmed cases
Results: A total of 131 patients were enrolled in this study. The majority [95.4% [125/131]] were infants. Only 54.1% [71/131] of admitted children with PLI were tested for pertussis. The incidence of pertussis infection among the tested group was 16.9% [12/71] with a 95% confidence interval 8.2?25.6. Severe illness occurred in 56.4% [74/131] of patients, and six were confirmed to have pertussis. Pediatric intensive care unit admission was required for one confirmed case of pertussis and eight cases from the PLI group [three were negative for pertussis, and five were not tested]. Receiver operator characteristic curve analysis revealed that a white blood cell count >/= 23.5 × 10[9]/L had 96.6% specificity and lymphocytes >/= 17 × 10[9]/L had 98.3% specificity
Conclusions: Taking into consideration that the number tested for pertussis was limited, the incidence of pertussis was 16.9% [12 out of 71 patients]. Lymphocytosis can be used as a reliable predictor for the diagnosis of pertussis especially in the absence of specific confirmatory tests or until their results are available
RESUMEN
The introduction of measles vaccination programs and broad coverage worldwide has meant this infection a rare encounter for pediatricians. In Oman, with almost 100% measles vaccination coverage for children, this infection disappeared from the list of fever and rash differential diagnoses. Encephalitis is a well-known complication of measles infection and sometimes can be the only manifestation especially in adults. We report a seven-year-old Syrian immigrant who was admitted to the Royal Hospital, Muscat, with acute encephalitis secondary to wild measles infection. Although she had a classical presentation of measle infection, the diagnosis was missed in the private and regional hospital she attended before getting referred to Royal Hospital. She was later identified to be exposed to an outbreak of the infection in an unvaccinated population. Magnetic resonance imaging showed high signal intensity of both basal ganglia suggestive of measles encephalitis. The diagnosis was confirmed by detection of measles virus from her urine and blood, and a throat swab. The isolated measles virus was D8 serotype, which was prevalent in Syria around the same time. The child was treated with steroids and vitamin A. She achieved full recovery despite her severe presentation. A high degree of suspicion for measles infection should be maintained in unvaccinated children with a compatible presentation of the infection or its complications. There might be a role for steroid use in cases of acute measles encephalitis