ABSTRACT
Pertussis is a vaccine-preventable disease with an incidence that has been trending upwards in the United States over the last two decades. This is evident by an increase in the incidence from 10,100 cases in 1974 to a peak of >48,000 cases noted in the last decade. Pertussis disease severity ranges from mild to severe, with resultant complications capable of causing significant morbidity and mortality. We report a case of pertussis in a 5-week-old female infant who presented with fever, paroxysms of cough, apnea, and seizures leading to cardiopulmonary arrest. Cardiopulmonary resuscitation lasted 11 minutes before the return of spontaneous circulation. She was transferred to our tertiary facility and admitted to the pediatric intensive care unit. Complete blood count revealed significant leukocytosis, chest X-ray revealed bilateral pulmonary edema with pleural effusion, and echocardiogram demonstrated pulmonary hypertension. Bordetella pertussis infection was confirmed on respiratory polymerase chain reaction. She was treated with antibiotics, ventilatory management, and other supportive care. She was discharged on room air after a hospital course of 7 weeks with care coordination between her primary care provider, pulmonologist, and neurologist. Despite the positive outcome in this case, it is important to note that managing severe pertussis involves multidisciplinary care, and the morbidity and cost implications can be mitigated on a population scale through vaccine optimization strategies.
ABSTRACT
BACKGROUND: There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM). AIM: To investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes. METHODS: We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with vs without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block. RESULTS: Crude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% vs 35.6%; P < 0.0001). After propensity matching, in-hospital mortality (11.1% vs 11.9%; P < 0.0001), stroke (2.3% vs 3.0%; P < 0.0001), acute heart failure (4.6% vs 6.5%; P = 0.001), cardiogenic shock (1.5% vs 1.9%; P < 0.0001), septic shock (7.2% vs 9.6%; P < 0.0001), and atrioventricular block (1.5% vs 2.4%; P < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age. CONCLUSION: There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.
