Objective. To study the features of the clinic and serological diagnosis of pertussis in adults. Patients and methods. The study included patients admitted to Infectious diseases clinical hospital No 1 in 2018 with prolonged cough syndrome. Clinical methods were used for monitoring adult patients with pertussis. Information about the course of the disease is recorded in the "case histories" and clinical observation cards. To verify whooping cough, blood was examined to detect anti-pertussis antibodies of class IgM, IgG, IgA using an enzyme-linked immunosorbent assay (RIDASCRЕЕN, R-Bioрharm AG). Results. In total, 52 patients were included in the study, among which pertussis was verified in 57.7–6.8% of patients. Using the generally accepted classification in 26.6–8.0% of patients, pertussis proceeded in a mild form, in 66.7–8.6% in moderate and in 6.7–4.5% in severe form. The presented clinical characteristics of pertussis in adults debunk the myth of the supposedly mild course of the disease in this population. A description of the severe course of whooping cough in an elderly patient is presented. A feature of the formation of post-infectious immunity in adults is, along with the development of IgG class antibodies starting from the 3rd week of the disease, the rapid accumulation of IgA class antibodies in the absence of IgM class antibodies. Conclusion. A detailed description of the clinical symptoms of pertussis in adults will improve the doctors' awareness of the clinical verification of pertussis. The effectiveness and prospects of using the enzyme-linked immunosorbent assay for the diagnosis of pertussis in adults with a single study, starting from the 3rd week from the onset of the disease, are proved. Key words: ELISA, whooping cough, clinical forms, serological diagnosis, severity of course
В статье представлен анализ клинико-диагностических особенностей коклюша у детей старшего возраста. Удельный вес данной возрастной группы среди госпитализированных составлял 11,3±2,7–13,3±2,7% с преобладанием привитых против этой инфекции больных. У 93,6±3,6% пациентов заболевание протекало в среднетяжелой форме с типичным симптомокомплексом. Для верификации клинического диагноза был использован метод полимеразной цепной реакции (ПЦР) и серологический метод – иммуноферментный анализ (ИФА). Эффективность метода ПЦР составляла 87,8%. Особая диагностическая ценность метода ИФА определялась возможностью подтвердить диагноз коклюша у привитых детей и в поздние сроки болезни, что ранее представляло большие трудности. Основным серологическим критерием служило выявление ассоциации высокого уровня продукции иммуноглобулинов IgG и IgA.
The article presents the analysis of clinical and immunological features of the combined course of pertussis and respiratory chlamydia in children. The study of the prodromal period and spasmodic cough symptoms showed that concomitant chlamydial infection did not significantly affect the severity of pertussis: 63.2% of patients had mild degree and 36.8% — moderate severity of the disease. However, in this case, the disease was delayed. Bronchitis and in some cases obstructive bronchitis was observed mainly in children under 1 year.The study of the lymphocytes subpopulation found that the content of NK cells decreased only in 10.5% of children, T helpers — in 21.1%, the ratio of CD4+ /CD8+ — in 26.3%. The function of cytokine network was characterized by more active production of such proinflammatory cytokines as IFN and TNF than their production during pertussis monoinfection. The levels of production of IL-8 and IL-6 were similar in all the studied groups. The production of IL-4 by lymphocytes in children with whooping cough in combination with chlamydial infection was weaker then in patients with pertussis monoinfection or in healthy children. These features are considered as immunological predictors of long reconvalescence in patients with association of pertussis and respiratory chlamydia.
Aim. To study the clinical course, diagnosis of pertussis in pregnant women. Materials and methods. Under observation were 25 pregnant women with whooping cough. The age structure was dominated by patients from 6 to 35 years old, amounting to 64%. At the time of hospitalization in 2 (8%) patients the gestation period corresponded to the first trimester, in 7 (28%) II, in 9 (36%) III. In 7 (28%) patients, the diagnosis of whooping cough was made during childbirth. The following methods were used to verify pertussis: bacteriological, PCR and serological (ELISA). Results and discussion. Clinical analysis showed that pregnant women with pertussis who came to the hospital were admitted to hospital mainly in the late stages of the disease (at 45 week in 68.6% of cases). Pertussis infection in all cases was typical: in moderate form 96%, mild at 4%. In 64% of patients, whooping cough accompanied by other respiratory diseases, which were the main cause of development of bronchitis. The use of ELISA allowed to confirm the clinical diagnosis in 91.7% of patients. Conclusion. The course of whooping cough in pregnant women is characterized by a typical symptom complex. To improve the verification of the diagnosis, it is advisable to use modern laboratory tests (PCR, ELISA).
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