Analysis of clinical characteristics in 857 patients with pediatric pertussis in Xi'an / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the clinical characteristics in children with pertussis,and to provide a scientific basis for treatment of pertussis.Methods Retrospective analysis of general data,symptoms,signs,auxiliary examinations,treatment and prognosis was performed on the patients with pediatric pertussis in Xi'an from January 2015 to December 2016;the epidemiological data were analyzed by using descriptive approach.Results In a total of 857 patients with pertussis,there were 469 males and 388 females (the gender ratio of 1.21 ∶ 1.00),183 cases (21.3％) from the urban areas and 674 cases (78.7％) from the rural areas.The cases were reported throughout the year,indicating 2 peak times of onset:355 cases (41.5％) from July to September and 218 cases (25.4％) from February to April.And 473 cases (55.2％) were younger than 6 months;479 cases (55.9％) were inoculated with diphtheria,tetanus and pertussis combined vaccine(DTP) vaccine;492 cases (57.4％) were exposed to their family members who coughed at that time.Cough was the main symptom,and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases (97.5 ％),facial suffusion in 806 cases (94.0％),peri-oral cyanosis in 308 cases (35.9％),asthma in 269 cases (31.4％),crow-like echo in 248 cases (28.9％),and apnea in 46 cases (5.4％);pulmonary moist rale was found by check-up in 761 cases (88.8％),and fever was observed in 159 cases (18.5％).The increased proportion of the peripheral blood lymphocytes was found in 702 cases (81.9％),the increased total count of leukocytes in 505 cases (58.9％),the increased procalcitonin(PCT) in 36 cases (4.2％) and the elevated level of high sensitivity C reactive protein(hsCRP) in 17 cases (2.0％);pneumonia was suggested by chest radiography in 673 cases (78.5％);in the blood-gas analysis,hypoxemia was suggested in 50 cases (5.8％) and respiratory failure in 9 cases (1.1％).In the 857 patients with pertussis,59 cases (6.9％) were with severe-type pertussis.At 1 week of the treatment,no spasmodic cough was reported in 515 cases (60.1％) and obviously relieved spasmodic cough in 198 cases (23.1％),and no deaths occurred.Conclusions The cases of pertussis occur throughout the year in Xi'an,predominately from July to September and February to April.A higher incidence is reported in the rural areas,compared with the urban areas,particularly in those younger than 6 months with incomplete DTP vaccination,who usually have severe conditions.In many cases,those with pediatric pertussis are infected by family members;most of them have spasmodic cough with good prognosis,without typical clinical signs.