Clinical Presentation of Infants Hospitalised with Pertussis

Background. Despite the widespread use of pertussis vaccine; there has been a resurgence of pertussis cases in developed and developing countries. South Africa lacks data regarding clinical presentation and healthcare impact of pertussis.Objectives. To describe the clinical presentation and healthcare impact in hospitalised infants with confirmed pertussis.Methods. This was a retrospective cohort study; conducted in Bloemfontein between April 2008 and September 2012. Infants with laboratory-confirmed pertussis (group 1; N=102); were compared with infants with a negative pertussis result (group 2; N=104) and infants with a lower respiratory tract infection of unspecified aetiology (group 3; N=104). The following data were extracted from the clinical records: demographics; presenting symptoms; paediatric intensive care unit (PICU) admission; length of stay in the general ward and PICU; overall hospital stay and outcome.Results. There were no significant demographic differences between the groups. A larger percentage of infants in group 1 (n=41; 40%) required PICU admission compared with group 2 (n=37; 36%) and group 3 (n=20; 19%). The median PICU stay of group 1 was longer (11 days) compared with group 2 (6 days) and group 3 (5 days). The presence of cough and post-tussive vomiting was significantly higher in group 1 than groups 2 and 3. There was no significant difference in mortality between the groups. Conclusion. Pertussis results in significant morbidity in infants. Measures to identify and manage this vaccine-preventable disease should be considered at a national level

Ethionamide-Induced Hypothyroidism in Children

Ethionamide is a second-line anti-tuberculosis drug used in the management of drug-resistant tuberculosis. Hypothyroidism is reported to be a rare adverse effect. A retrospective descriptive study was done of all children started on treatment for multidrug-resistant tuberculosis from 2006-2009; who received ethionamide as part of their drug regimen. Information collected included age; weight; human immunodeficiency virus (HIV) status; ethionamide dose and thyroid function tests. Seven of 13 (54) children developed hypothyroidism and received thyroxine for the duration of ethionamide treatment. Thyroid function returned to normal within two months of completion of tuberculosis treatment in six of the seven children (one lost to follow-up). Ethionamide-induced hypothyroidism is more common in this small number of patients than previously reported. The results warrant further studies to confirm these findings and elucidate possible reasons