Clinical Findings in <i>Bordetella pertussis</i> Infections: Results of a Prospective Multicenter Surveillance Study

Heininger, Ulrich; Klich, Kerstin; Stehr, K.; Cherry, James D.

doi:10.1542/peds.100.6.e10

Cited by 123 publications

(81 citation statements)

References 18 publications

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“…27 Among microorganisms, a prominent role for B pertussis might be suspected for several reasons, as follows. 1) B pertussis infections in infancy are frequently associated with apneic spells, 16 which are occasionally lifethreatening 28 and if leading to death may be reported as SIDS. 29 2) Epidemiologic evidence indicates that SIDS is associated with B pertussis infection.…”

Section: Discussionmentioning

confidence: 99%

“…This is not surprising, because apnea is a common complication of pertussis among young infants. 16,17 In an attempt to assess how frequently SIDS is caused by Bordetella pertussis infections, we have been obtaining postmortem nasopharyngeal specimens (NPSs) since December 1990, in collaboration with several German institutes of legal medicine (ILMs). In our initial studies, we failed to culture B pertussis from infants with sudden unexpected deaths.…”

Section: Introductionmentioning

confidence: 99%

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A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

Heininger¹,

Kleemann

Cherry

2004

Pediatrics

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ABSTRACT.Objective. This was a prospective, controlled, multicenter study to investigate the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants.Design. Between 1995 and 1997, all infants who died at 7 to 365 days of age and for whom autopsies were performed in 1 of 8 participating institutes of legal medicine were enrolled. During a standardized autopsy, nasopharyngeal specimens (NPSs) and tracheal specimens were obtained for polymerase chain reaction (PCR) assays to detect B pertussis. The oligonucleotide primers PTp1 and PTp2, which specifically amplify a 191-base pair DNA fragment of the pertussis toxin operon of B pertussis, were used. Two control subjects (matched according to residence, age, gender, and nationality) were enrolled for each case subject, via a network of pediatricians in private practice, and NPSs were obtained from those infants. Parents of case subjects and control subjects were asked to provide specific information on respiratory illnesses of the child, contact with a known case of pertussis, or close contact with a person with a cough illness during the 4 weeks before death or enrollment, as well as the child's pertussis immunization status. The pathologists performing the autopsies were unaware of the PCR results.Results. Enrolled were 254 infants (66% male) with sudden unexpected deaths and 441 matched control subjects. Autopsies according to protocol were performed for 234 of the case subjects (92%); a diagnosis of sudden infant death syndrome (SIDS) was made for 76%. For the remaining subjects, causes of death were respiratory or other infections (14%), congenital anomalies or organ failures (4%), aspiration (2%), or accidents or traumatic events (4%). PCR results were positive for B pertussis for 12 case subjects (5.1%) (all with SIDS or respiratory infections) and 5.3% of control subjects. Of the 12 case subjects with positive PCR results, 10 (83%) were male. Questionnaires had been returned by the parents of 5 of the 12 infants. Three had experienced a respiratory illness (all with cough), beginning 7, 14, and 19 days before death. None had a known contact with a case of pertussis. Four of 15 control infants (27%) with positive PCR findings for B pertussis had a cough illness, indicating possible pertussis, and 2 of those 4 developed typical symptoms (whooping). Background information was received from 116 parents (46%) of case subjects and from parents of all control subjects. Upper respiratory tract infections within 4 weeks before death were reported for 53% of case subjects and 38% of control subjects. Also, fewer case subjects (33%) than control subjects (68%) had received age-adequate numbers of pertussis vaccine doses.Conclusions. The concept of infection as a factor in SIDS is supported by a number of observations, including the seasonal distribution of the occurrence of SIDS; the high incidence of concurrent upper respiratory tract infections among infants dying as a result of SIDS; the peak age at 3 to 4 months; nicotin...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

Heininger¹,

Kleemann

Cherry

2004

Pediatrics

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“…6 Pneumonia, apnea, and episodic cyanosis are the most common complications of pertussis. 7 However, the most severe cases can involve respiratory failure, ARDS, pulmonary hypertension, and death. Severe leukocytosis may be a predictor of pulmonary hypertension and mortality in pertussis infection.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

Mata

Sarnaik

2013

Pediatrics

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Pertussis is an illness that causes significant morbidity and mortality, especially in infants younger than 3 months old. In the most severe cases, it can cause pneumonia, respiratory failure, acute respiratory distress syndrome, pulmonary hypertension, and death. There are reports of using rescue extracorporeal membrane oxygenation (ECMO) as a rescue therapy. However, the mortality of ECMO with pertussis is higher than with other causes of pediatric respiratory failure. We report here the case of a 2-month-old boy with severe respiratory failure and pulmonary hypertension who satisfied ECMO criteria but was successfully treated with repeated bronchoscopy with instillation of N-acetylcysteine. Our patient' s respiratory failure was refractory to multiple therapies that have shown benefit in pediatric hypoxemic respiratory failure, including open lung strategies, prone positioning, intratracheal surfactant, and inhaled nitric oxide. Although pulmonary hypertension is a key factor in most cases of fatal pertussis, the adverse effects of hyperinflation and air leaks were more important in this patient' s clinical course. Because bronchiolar obstruction from inflammatory, mucous, and airway epithelial debris can be seen in severe pertussis, a regimen of repeated therapeutic bronchoscopy was initiated, and thick, inspissated secretions were retrieved. The patient' s airway obstruction gradually resolved, and he eventually recovered with minimal sequelae. Pediatrics 2013;132:e1418-e1423

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“…The disease not only occurs in unimmunized children and in infants too young to be immunized but also in adolescents and adults with waning immunity [3,4]. Complications such as encephalopathy may affect patients at any age [5,6]. Although most countries have implemented pertussis component vaccines in their immunization programs for children, booster doses in adolescence are recommended only in a few countries [2].…”

Section: Introductionmentioning

confidence: 99%

The Role of Bordetella Infections in Patients with Acute Exacerbation of Chronic Bronchitis

et al. 2005

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Background: Acute exacerbations of chronic bronchitis (AECB) are associated with a variety of viral and bacterial infectious agents, some of which are potentially preventable by immunization. Bordetella pertussis, which causes whooping cough, has not been studied in this context. We aimed to assess the role of Bordetella infections in patients with AECB. Patients and Methods: Patients with AECB, who presented to participating private practices in Basel, Switzerland, between October 2000 and June 2002, were evaluated by a standardized questionnaire, nasopharyngeal swabs for culture (Bordetella spp.), and PCR (Bordetella spp. and selected other respiratory pathogens) and paired blood samples for serologic diagnosis of Bordetella infection. Results: A total of 26 patients (34-86 years of age) were recruited. All culture and PCR samples were negative. Serology revealed Bordetella infection in eight (31%) patients. Duration of cough was shorter in patients with Bordetella infection compared to those without Bordetella infection (mean 15 days vs 41 days, p = 0.04). Cough ≥ 21 days duration was present in three (43%) of seven patients with evidence of Bordetella infection compared to 17 (94%) of 18 controls (p = 0.012). Progression to convalescence from initial to follow-up visit after 4-6 weeks was comparable between both groups. Conclusion: Bordetella infections appear to play a significant role in AECB and preventive measurements such as immunization with acellular pertussis vaccines should be considered. Extended investigations are necessary to confirm our preliminary and provocative findings.

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Clinical Findings in Bordetella pertussis Infections: Results of a Prospective Multicenter Surveillance Study

Cited by 123 publications

References 18 publications

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

Bronchoscopy With N-Acetylcysteine Lavage in Severe Respiratory Failure From Pertussis Infection

The Role of Bordetella Infections in Patients with Acute Exacerbation of Chronic Bronchitis

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