Severe Pertussis in Childhood: Update and Controversy - Systematic Review

Abstract

Objective: Through a systematic review, this essay aimed at revising the concepts of severe pertussis, updating the epidemiology, pathophysiology, clinical presentation, antibiotic therapy and auxiliary therapeutic options for symptomatology and complications.Data sources:This review considered publications from the last 30years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Google Scholar, as well as protocols of the Ministry of Health and recommendations of the Centers for Disease Control and Prevention, related to childhood pertussis (whooping cough), with emphasis on its severe form. This research was based on keywords derived from the terms “pertussis”, “azithromycin”, “antitussives”, “leukocyte reduction” in Portuguese and English. Duplicate studies and those with unavailable full-text were excluded.Data synthesis:Among 556 records found, 54 were selected for analysis. Pertussis, as a reemerging disease, has affected all age groups, evidencing the transient immunity conferred by infection and vaccination. Severe cases occur in neonates and infants, with secondary viral and bacterial complications and malignant pertussis, a longside hyperleukocytosis, respiratory failure and shock. Macrolides continue to be the chosen antibiotics, while antitussives for coughing remain without efficacy. The prompt treatment in Intensive Care Units improved the prognostic in severe cases, and transfusion was promising among procedures for leukoreduction. Conclusions: Approaching severe pertussis in childhood remains a challenge for diagnostic and therapy, as the available therapeutic options are still unsatisfactory. Strategies of prevention are expected to reduce the occurrence of severe cases, while new studies should confirm the role of auxiliary therapies.

Analysis of clinical characteristics of severe pertussis in infants and children: a retrospective study

“…An observational study showed that this strategy conferred up to 90% protection for infants under 3 months from pertussis, by the dual effect of preventing maternal infection thereby minimizing mother-to-baby transmission, and also by virtue of specific IgG antibodies from the mother crossing the placenta affording protection to baby after birth [10][11][12][13]. In Argentina the deaths of pertussis cases deceased by 87% in 2013 compared to 2011, since the country implemented the strategy of acellular pertussis vaccination in pregnancy in 2012 [14].…”

Analysis of clinical characteristics of severe pertussis in infants and children: a retrospective study

“…An observational study showed that this strategy conferred up to 90% protection for infants under 3 months from pertussis, by the dual effect of preventing maternal infection thereby minimizing mother-to-baby transmission, and also by virtue of speci c IgG antibodies from the mother crossing the placenta affording protection to baby after birth. [9,10,11,12]. In Argentina the deaths of pertussis cases deceased by 87% in 2013 compared to 2011, since the country implemented the strategy of acellular pertussis vaccination in pregnancy in 2012 [ 13].…”

Cytokine expression patterns in hospitalized children with Bordetella pertussis, Rhinovirus or co-infection

“…It uses macrophages as an intracellular niche and that the intra macrophage phase of infection could play a significant role in survival and persistence of bacteria within the host 43 – 45 . Moreover, it has been reported that expression of IP-10 in mixed infections occurred earlier than in single infection possibly promoting a faster and stronger macrophage response 4 .…”

“…Despite a high childhood vaccination rate, Bordetella pertussis (Bp) outbreaks occur periodically and Whooping cough–also known as Pertussis–remains a public health problem particularly for infants 1 – 3 and children, for whom it remains one of the most fatal infections 4 .…”