An Observational Study of Severe Pertussis in 100 Infants ≤120 Days of Age

Cherry, James D.; Wendorf, Kristen; Bregman, Brooke; Lehman, Deborah; Nieves, Delma; Bradley, John S.; Mason, Wilbert H.; Sande-Lopez, Linette M.; Lopez, Merrick; Federman, Myke; Chen, Tempe; Blumberg, Dean A.; Johnston, Samantha; Schwenk, Hayden T; Weintrub, Peggy Sue; Quinn, Kevin K.; Winter, Kathleen; Harriman, Kathleen

doi:10.1097/inf.0000000000001710

Cited by 34 publications

(30 citation statements)

References 31 publications

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“…A resurgence of pertussis across age groups has occurred in several countries in recent years, specifically in unimmunized (0–8 weeks) or partially immunized (2–6 months) infants [ 43 – 45 ]. Neonates also have significantly higher rates of complications and death compared with other age groups, which is in line with previous reports [ 44 – 47 ]. During 1980–2016, in countries such as Australia, Belgium, Brazil, Portugal, the UK and the US where high coverage levels of pertussis vaccination have been reported, a rise in the incidence of pertussis has been observed [ 37 , 46 , 48 – 51 ].…”

Section: Discussionsupporting

confidence: 92%

Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries

et al. 2019

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Pertussis is an under-recognized cause of neonatal morbidity and mortality. To review information on the epidemiology and disease burden of neonatal pertussis in South and Southeast Asian countries, a systematic literature review of three bibliographic databases was undertaken. Peer-reviewed original studies on neonatal pertussis epidemiology and burden published since 2000, with a geographical scope limited to South and Southeast Asian countries, were included. Data were systematically extracted based on parameters defined a priori. Our findings show that the burden of neonatal pertussis and its complications is substantial. An increase in the number of pertussis cases has been noted since early 2000, ranging from 61 to 92.9% in infants 0–3 months old. The most common symptoms an infant is likely to present with are cough with or without paroxysms, cyanosis, apnea, tachypnea, difficulty in breathing and leukocytosis. In addition, it can lead to hospitalization (length of stay: 5–7 days), complications (e.g., pneumonia, seizures) and mortality ranging from 5.6 to 14.7%. Other observations indicate that diagnosis is challenging because of non-specific clinical symptoms. Specifically, for obstetricians and gynecologists, the information available for making informed decisions on the prevention of neonatal pertussis is unreliable. Maternal immunization against pertussis during late stages of pregnancy has proven to be efficacious and well tolerated. A high burden of neonatal pertussis, as well as its complications, is observed in South and Southeast Asian countries. There is a need to intensify efforts to protect this vulnerable population with maternal vaccination. Funding : GlaxoSmithKline Biologicals SA Plain Language Summary : Plain language summary available for this article. Please see Fig. 1 and the following link: https://doi.org/10.6084/m9.figshare.7951187 .

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Section: Discussionsupporting

confidence: 92%

Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries

et al. 2019

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“…Provisional criteria for ET therapy in patients with leukocytosis (lymphocytosis subtype) have been recently suggested. [ 11 ] As summarized in Table 1 , the survival rate of pertussis patients with hyperleukocytosis is significantly higher when ET therapy is used; however, this therapy has not yet been used in a pertussis patient in China.…”

Section: Discussionmentioning

confidence: 99%

Fatal malignant pertussis with hyperleukocytosis in a Chinese infant

Tian

Wang²,

Deng³

2018

Medicine

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Rationale:Pertussis has re-emerged on a global scale and is an ongoing public health problem, even in countries with high rates of vaccination. Hyperleukocytosis [white blood cell (WBC) count >100 × 109/L] is a rare complication that strongly predicts mortality in cases of severe pertussis.Patient concerns:We report a case of severe pertussis in an infant who initially presented with persistent cyanotic cough, tachypnea, and grunting. The infant's condition deteriorated rapidly, and she was transferred to the pediatric intensive care unit (PICU) during her third hour of hospitalization. On the third hospital day, her WBC count had increased to 101.85 × 109/L with a lymphocyte count of 36.76 × 109/L, and her hemoglobin level had fallen to 6.9 g/dL. Bone marrow examination found no evidence of tumor cells. Her initial echocardiogram showed no abnormal findings; however, a subsequent echocardiogram 10 days later revealed pulmonary hypertension.Diagnoses:The patient was diagnosed with severe pneumonia, which was confirmed to be pertussis based on a persistent cough in the infant's mother and the polymerase chain reaction and culture of the infant's nasopharyngeal secretions being positive for Bordetella pertussis.Interventions:The infant was treated with supportive care, early macrolide antibiotics, and broad-spectrum antibiotics before being transferred to the PICU for further management, including continuous venovenous hemodiafiltration.Outcomes:Unfortunately, the infant died as a result of pulmonary hypertension and multiorgan failure.Lessons:Exchange transfusion should be considered in all infants who present with severe pertussis with hyperleukocytosis. This guideline is supported by the findings of a comprehensive literature review, which is included in this article, as well as newly published criteria for exchange transfusion therapy. Finally, we hope that adults in China will be vaccinated against B. pertussis in order to prevent the infection of infants within their households.

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“…Studies have shown that plasma exchange and leukapheresis can reduce leukocyte count and signi cantly improve fatal hypoxemia and pulmonary hypertension [23,24]. Some researchers have used carbon monoxide and sildena l to dilate pulmonary blood vessels and reduce pulmonary hypertension; some e cacy was observed [25].…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical characteristics of pertussis in 184 infants and children: a retrospective study

Wang

Zhang

et al. 2020

Preprint

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Backgroud: The incidence of pertussis shows an increasing trend in recent years, but some clinicians often lack sufficient understanding of the clinical characteristics and risk factors for severe pertussis, and more effective measures should be taken to reduce the incidence and mortality of pertussis in young infants. Methods: A retrospective study was conducted, and 184 infants and children with pertussis who had been hospitalized in the Department of Pediatrics of Beijing Ditan Hospital affiliated with Capital Medical University from January 2016 to December 2017 were included in the study. Clinical data of the patients were collected and the clinical characteristics were statistically analyzed. Results: Among the 184 patients, 41.85% were infants < 3 months of age, and 65.22% were not vaccinated against pertussis. There were 22 critically ill children, among whom 4 died, and compared with moderate cases, they had a higher proportion of children younger than 3 months of age and infants not vaccinated against pertussis (63.64% vs. 38.89% and 100% vs. 60.49%, respectively); a higher proportion of children with pulmonary consolidation (77.27% vs. 1.85%); higher leukocyte count(× 109/L , 35.80 ± 20.53 vs 19.41 ± 8.59); and a higher proportion of children with severe hyperleukocytosis (18.18% vs. 0%, respectively) (P<0.05). Conclusions: 1. Infants aged < 3 months who were not vaccinated for pertussis tended to be infected with pertussis and had severe pertussis. Adjusting the immunization strategy to vaccinate pregnant women to produce protective effects for the infants should be considered. 2. Severe pneumonia and hyperleukocytosis are the main mechanisms underlying severe pertussis and the key points of prevention and diagnosis of severe pertussis.

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An Observational Study of Severe Pertussis in 100 Infants ≤120 Days of Age

Cited by 34 publications

References 31 publications

Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries

Neonatal Pertussis, an Under-Recognized Health Burden and Rationale for Maternal Immunization: A Systematic Review of South and South-East Asian Countries

Fatal malignant pertussis with hyperleukocytosis in a Chinese infant

Analysis of clinical characteristics of pertussis in 184 infants and children: a retrospective study

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