Pathology and Pathogenesis of Fatal<i>Bordetella pertussis</i>Infection in Infants

Paddock, Christopher D.; Sanden, Gary N.; Cherry, James D.; Gal, Anthony A.; Langston, Claire; Tatti, Kathleen M.; Wu, Kuan-Hung; Goldsmith, Cynthia S.; Greer, Patricia W.; Montague, Jeltley L.; Eliason, Mark T.; Holman, Robert C.; Guarner, Jeannette; Shieh, Wun‐Ju; Zaki, Sherif R.

doi:10.1086/589753

Cited by 276 publications

(231 citation statements)

References 39 publications

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“…Of note, IHC staining for B. pertussis was negative in all specimens. In none of the 15 cases were there typical findings of fatal pertussis (pulmonary hemorrhage, septal edema, necrotizing bronchopneumonia, and leukocyte aggregates in septal and pleural veins and lymphatics) [5].…”

Section: Resultsmentioning

confidence: 97%

“…Although all but one of the 15 cases had some evidence of respiratory tract infection, in none was it typical of fatal B. pertussis infection, i.e., in none of the infants was there evidence of a descending lower respiratory tract infection dominated by necrotizing bronchiolitis, fibrinous edema, or prominent angiolymphatic collections of leukocytes [5]. Rather, the histopathological findings were most consistent with a mild viral infection.…”

Section: Discussionmentioning

confidence: 94%

“…Tissue samples were stained at the CDC by using hematoxylin and eosin and by an immunoalkaline phosphate technique with a monoclonal antibody which reacts to lipooligosaccharide A of B. pertussis (IHC staining) [5].…”

Section: Methodsmentioning

confidence: 99%

“…The PCR results were positive for B. pertussis in 12 (5.1%) of the case subjects and from 5.3% of control subjects. In a more recent study, we studied the pathology of fatal infant pertussis using immunohistochemistry and molecular techniques [5].…”

Section: Introductionmentioning

confidence: 99%

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The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

et al. 2011

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Background In a previous controlled study, we investigated the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants (sudden infant death syndrome, SIDS). In this present study, we investigated further the respiratory pathology in a subset of infants in the original study. Methods Originally, there were 234 infants with SIDS and, of these, 12 had either a nasopharyngeal swab (NPS) or a tracheal swab specimen (TS) that was positive for B. pertussis by polymerase chain reaction (PCR). Here, tissue specimens from eight infants who were originally PCRpositive were compared with tissue specimens from seven infants in whom the original PCR studies were negative. Results The histopathologic diagnoses were as follows: 14 of 15 had pulmonary edema and the remaining case had early diffuse alveolar damage. Although 14 of 15 cases had some histologic or clinical evidence suggesting respiratory tract infection, the features were more consistent with a viral etiology, and in none were the findings typical of respiratory disease attributable to B. pertussis. ConclusionsThe findings in this present investigation do not support a direct role of B. pertussis at the site of infection (ciliated epithelium) in the causation of SIDS. The clinical aspects of this study were carried out in the 1990s when pertussis was widespread in Germany. Therefore, the original finding of some PCR-positive cases is not surprising. The possibility that B. pertussis infection could still be a factor in some SIDS cases, e.g., by a systemic release of toxins, cannot be definitely ruled out.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

et al. 2011

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“…Another contributing factor to hyperinflation and air leaks could have been bronchiolar obstruction. In a recent study by Paddock et al, 18 histopathologic examination of 14 infants with fatal pertussis revealed necrotizing bronchiolitis with luminal occlusion…”

Section: Discussionmentioning

confidence: 94%

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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Gram‐negative rods

2015

Practical Medical Microbiology for Clinicians

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Pathology and Pathogenesis of FatalBordetella pertussisInfection in Infants

Abstract: Pertussis should be suspected in any infant death associated with marked leukocytosis, bronchopneumonia, or refractory pulmonary hypertension, particularly in children aged Show more

Cited by 276 publications

References 39 publications

The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

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

Gram‐negative rods

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