Pertussis in infants: an underestimated disease

Abstract

BackgroundThe clinical diagnosis of pertussis is not easy in early infancy since clinical manifestations can overlap with several different diseases. Many cases are often misclassified and underdiagnosed. We conducted a retrospective study on infants to assess how often physicians suspected pertussis and the actual frequency of Bordetella pertussis infections.MethodsWe analyzed all infants with age ≤90 days hospitalized from March 2011 until September 2013 for acute respiratory symptoms tested with a Real Time Polymerase Chain Reaction able to detect Bordetella pertussis and with a Real Time Polymerase Chain Reaction for a multipanel respiratory virus. Therefore, we compared patients with pertussis positive aspirate, patients with respiratory virus positive aspirate and patients with negative aspirate to identify symptoms or clinical findings predictive of pertussis.ResultsOut of 215 patients analyzed, 53 were positive for pertussis (24.7 %), 119 were positive for respiratory virus (55.3 %) and 43 had a negative aspirate (20 %). Pertussis was suspected in 22 patients at admission and 16 of them were confirmed by laboratory tests, while 37 infants with different admission diagnosis resulted positive for pertussis. The sensitivity of clinical diagnosis was 30.2 % and the specificity 96.3 %. Infants with pertussis had more often paroxysmal cough, absence of fever and a higher absolute lymphocyte count than infants without pertussis.ConclusionsPertussis is a serious disease in infants and it is often unrecognized; some features should help pediatricians to suspect pertussis, but clinical suspicion has a low sensitivity. We suggest a systematic use of Real Time Polymerase Chain Reaction to support the clinical suspicion of pertussis in patients with less than 3 months of age hospitalized with acute respiratory symptoms.

Immunisation status of children presenting to the emergency department: Linkage of a longitudinal birth cohort with national immunisation data

“…We are careful not to over-interpret this finding, but this could reflect a higher tendency to test, and therefore diagnose, children who are not immunised to rule out respiratory pathogens, with a focus on pertussis. 18 Our study found no difference in immunisation status for children who were diagnosed in ED with an infectious disease compared to children who had other diagnoses. Although it is plausible that immunised children would present less often with infectious disease to ED (especially VPDs), given the low rate of VPDs in the community and the descriptive nature of this proof-of-concept linkage study, the power to find such a difference was likely too low.…”

“…We found that one in five children diagnosed with confirmed RSV were not immunised. We are careful not to over‐interpret this finding, but this could reflect a higher tendency to test, and therefore diagnose, children who are not immunised to rule out respiratory pathogens, with a focus on pertussis …”

Severe pertussis infection in infants less than 6 months of age: Clinical manifestations and molecular characterization

“…A recent retrospective analysis by Vittucci et al 17 analyzed the presence of pertussis among 215 infants observed over a 3-years period and hospitalized for any acute respiratory symptoms. Even without any specific selective clinical criteria for pertussis, the authors found 24.7% of positivity to pertussis.…”

Pertussis in Children: Problems in Indonesia

“…For older children and also including parents and other household members should performed measurement of IgG-anti-PT. The culture and PCR recommended to be performed in vaccinated children, adolescents and adults with less than two weeks of coughing, PCR and the measurement of IgG-anti-PT in adolescents and adults with coughing of less than three weeks, and only the measurement is laboratory-confirmed: a case that meets the clinical case definition and is laboratory-confirmed [18].…”