Background Recent reports of pertussis epidemiology from Asia,Africa and South America have been limited, but the WorldHealth Organization estimates indicate that these regions havethe highest disease burden. Difficulty in estimating the prevalenceof pertussis is due to lack of access to diagnostic methods,misdiagnoses, under-reporting, and different countries' reportingcriteria. A syndrome characterized by severe episodes of coughingresembling whooping cough (pertussis) has also been defined aspertussis-like syndrome.Objective To report eleven cases of pertussis or pertussis-likesyndrome in the pediatric ward of Hasan Sadikin Hospital.Methods This retrospective study was conducted by reviewingmedical records from 2008-2010. Characteristics of 11 pertussislikesyndrome patients were documented including age, gender,history of pertussis immunization, clinical manifestations,laboratory findings, initial diagnosis, treatment and clinicalresponse. Isolation of Bordetella pertussis using Bordet-Gengouagar was also noted. Pertussis diagnoses were grouped based ontwo classifications: probable and confirmed.Results Eleven patients were diagnosed with pertussis-likesyndrome, including 5 boys and 6 girls. Most subjects were lessthan 6 months of age. Only one subject had received previouspertussis immunization. Dyspnea, paroxysmal cough, and feverwere the most common symptoms. All were initially diagnosedto have had severe bacterial pneumonia, and later changed toprobable pertussis. Three subjects exhibited post-tussive vomitingand cyanosis, while none had apneic symptoms. All B. pertussisisolations yielded negative results. Ampicillin or cephalosporinwas initially administered. Patients receiving subsequentclarithromycin showed good clinical responses.Conclusion All infants were likely considered to have pertussis,as most had no pertussis immunizations. However, B. pertussisisolation was unsuccessful in all cases. As such, diagnoses couldnot be confirmed. [Paediatr In don es. 2012;5 2: 28-31].
Latar belakang.Demam neutropenia merupakan penyulit yang sering terjadi pada anak dengan penyakit keganasan sehingga menyebabkan morbiditas dan mortalitas yang tinggi. Sebagian besar demam neutropenia disebabkan oleh bakteri, sehingga perlu diberikan terapi empiris dengan antibiotik spektrum luas. Pemberian antibiotik bukan tidak berbahaya, karena itu diperlukan penanda bahwa demam yang terjadi disebabkan oleh bakteri. Procalcitonin(PCT) merupakan penanda terjadinya respons inflamasi tubuh yang disebabkan oleh bakteri. Tujuan.Untuk mengetahui nilai diagnostik PCT sebagai penanda infeksi bakteri pada anak keganasan dengan demam neutropenia. Metode.Penelitian potong lintang dilakukan sejak bulan Januari sampai Agustus 2011 di Rumah Sakit Dr. Hasan Sadikin Bandung, pada 49 pasien usia 1−13 tahun dengan demam neutropenia pada berbagai kasus keganasan. Sediaan darah untuk pemeriksaan biakan dan kadar PCT dilakukan pada saat pasien masuk rumah sakit atau pertama kali demam dan hari ke-5 untuk pemeriksaan PCT kedua. Penelitian kami telah disetujui oleh Komite Etik RS Dr. Hasan Sadikin Bandung. Analisis statistik menggunakanchi-square,Mann Whitney, uji t, dan korelasirankSpearman.Hasil.Dari 49 subjek penelitian ditemukan 18 (37%) dengan hasil biakan bakteri positif dan 31 (69%) tidak ditemukan bakteri. Pada pasien dengan hasil biakan bakteri positif ditemukan perbedaan bermakna dibanding dengan hasil biakan negatif dalam jumlah leukosit (p=0,020), absolute neutrophyl count(ANC)(p=0,020), dan kadar PCT (p=0,021) pada pemeriksaan awal. Demikian pula pemeriksaan pada hari ke-5 terdapat perbedaan bermakna dalam jumlah leukosit (p=0,003), ANC (p=0,002), dan kadar PCT (p<0,001). Pada kelompok biakan darah positif jumlah leukosit, ANC, dan kadar PCT pada pemeriksaan awal dibandingkan dengan pemeriksaan hari ke-5 tidak menunjukkan perbedaan yang bermakna. Terdapat korelasi negatif antara PCT dan ANC (rs-0,598; p=0,001). Kadar PCT >0,84 ng/mL memiliki sensitivitas 77,8%; spesifisitas 87,1%; dan akurasi 83,7% dalam mendeteksi kemungkinan infeksi bakteri pada pasien demam neutropenia.Kesimpulan.Procalcitoninmempunyai nilai diagnostik yang baik untuk memprediksi bakteremia pada demam neutropenia.
Background Recent reports of pertussis epidemiology from Asia,
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