Pertussis predictors in hospitalized infants with acute lower respiratory tract infection
DOI:
https://doi.org/10.31053/1853.0605.v70.n2.20233Keywords:
pertussis, RSV, acute respiratory infection, lymphocytesAbstract
Background. Pertussis, or whooping cough, caused by Bordetella pertussis (BP) is a re-emerging problem in our environment. Although generally considered that the disease is relatively easy to identify infections respiratory syncytial virus (RSV) can present with similar symptoms in infants remains difficult discrimination.
Objective. Compare clinical symptoms at admission and complementary studies in infants hospitalized with acute respiratory infection (ARI) and RSV by BP to establish markers that enable their early clinical prediction.
Materials and methods. Observational, analytical, case-crossover cross comparing younger than 6 months hospitalized with suspected IRA and pertussis (2007-2012) in which BP identified (PCR and culture) and / or VRS (immunofluorescence in nasal secretions). Coinfections were excluded. Bivariate analysis was comparaperformed by calculating OR with 95% CI. Were considered significant at p <0.05. The variables studied were age, sex, hits cough, cyanosis, vomiting, apnea, wheezing and CBC with differential.
Results. We included 174 infants, 72 (41%) BP and 102 (59%) VRS. Age 2 ± 1 months (range :1-6). In both groups was documented cough and wheeze (OR: 1.2 (0.9 to 1.5) p: 0.1 and OR = 0.9 (0.8 to 1.06) p: 0.2, respectively ). Cyanosis (87% vs. 6%, OR: 14.8 p <0.01), apnea (38% vs. 3%, OR: 13.4 p <0.01) and vomiting (26% vs. 5% , OR: 3.4 p <0.01) were more frequent in infants with BP. The absolute lymphocyte count was significantly higher in children with BP (9387 ± 6317 vs. 5127 ± 2766, p <0.01). By ROC curve was identified at 9000 cells / ml as the best point to differentiate VSR BP (AUC = 0.73, 95% CI :0,64-0, 81).
Conclusions. In infants under 6 months with IRA income presence of apnea, cyanosis and lymphocytosis allowing predict significantly differentiate between pertussis those with RSV infections.
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Sangorrin A, Trenchs V, Curcoy A, García J. Tos ferina, una entidad persistente. Enferm Infecc Microbiol Clin 2010; 28:206-7
Gentile A. Infección por Bordetella pertussis. Arch Argent Pediatr 2010; 108:78-81
Gilberg S, Njamkepo E, Parent du Chaˆ telet I, Partouche H, Gueirard P, Ghasarossian C, Schlumberger M, and Guiso N. Evidence of Bordetella pertussis Infection in Adults Presenting with Persistent Cough in a French Area with Very High Whole-Cell Vaccine Coverage. The Journal of Infectious Diseases 2002;186:415–8
Donoso A, León J, Ramírez M, Carrasco J. Coqueluche en niños menores de seis meses de vida. Rev Chil Pediatr 2001;72-6
Gentile A, Man C, Mistchenko A, Romanin V ,Salvay MC. Brote de Bordetella pertussis en un hospital pediátrico. Rev Hosp Niños Buenos Aires 2005; 47(214):211-6.
Sistema Nacional de Vigilancia Epidemiológica, Boletines de Vigilancia Epidemiológica. Dirección Nacional de Epidemiologia. Ministerio de Salud y Acción Social. Años 2003-2006.
Sistema Nacional de Vigilancia Epidemiológica, Boletines de Vigilancia Epidemiológica. Dirección Nacional de Epidemiologia. Ministerio de Salud y Acción Social. Año 2012.
de Greeff S C., Mooi F R, Westerhof A, Verbakel J M M, Peeters M F, Heuvelman C J, et al. Pertussis disease burden in the household: How to protect young infants. Clin Infect Dis 2010; 50 (10): 1339-45 9. Long S. Tos ferina (Bordetella pertusis y parapertusis). En: Behrman R, Kliegman R, Jenson B, Nelson A. Tratado de Pediatria, editorial Elsevier España, 18ºed;2009: pp1178-1182.
Raymond J, Armengaud B, Gendrel D. Pertussis in young infants: apnoea and intra-familial infection. Clin Microbiol Infect. 2007; 13:172-5
Donoso A y cols. Coqueluche grave. Estado del arte. Rev Chil Infectol 2012; 29 (3): 290-306.
Von Konog CH et al. A serologic study of organism posibly associated with pertussislike coughing. Pediatr Infect Dis J 1998;17:645-49.
Centers for Disease Control and prevention guide lines for de controls of pertussis outbreak. Atlanta. 2009.
Cosnes-Lambe C, Raymond J, Chalumeau M, Pons-Catalano C, Moulin F, Suremain N, Reglier- Poupet H, Lebon P, Poyart C, Gendrel D. Pertussis and respiratory syncytial virus infections, Eur J Pediatr 2008;167:1017–1019.
Guinto-Ocampo H, Bennett J, Attia M. Predicting Pertussis in Infants. Pediatric Emerg 2008; 24:16-20.
Wood N, McIntyre P. Pertussis: review of epidemiology, diagnosis, managment and prevention. Pediatric Respiratory Reviews 2008; 9:201-12
Tozi A, Celentano L, Ciofi M, Salmaso S. Diagnosis and managment of pertussis. CMAJ, 2005;172(4):509-15.
Van der Zee A. J infect Dis 1996;174:89-96. 19. Heininger U, Klich K, Stehr K and Cherry J. Clinical Findings in Bordetella Pertussis Infections: Result of a Prospective Multicenter Surveillance Study. Pediatrics 1997;100(6); e10. (www.pediatrics.org/cgi/content/full/100/6/e10).
Piedimonte G. Pathophysiological mechanisms for the respiratory syncytial virus-reactive airway disease link Respiratory Research 2002, 3(Suppl 1):S21-S25.
Mattoo S, Cherry JD. Molecular pathogenesis, epidemiology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies. Clin Microbiol Rev. 2005 Apr;18(2):326-82.
Marcone DN, Ellis A, Videla C, Ekstrom J, Ricarte C, Carballal G, Vidaurreta SM, Echavarría M. Viral Etiology of Acute Respiratory Infections in Hospitalized and Outpatient Children in Buenos Aires, Argentina. Pediatr Infect Dis J. 2013march; 3(32):105-110.
Boletín Integrado de Vigilancia N° 130. SE 30. Secretaría de Promoción y programas sanitarios. Ministerio de Salud de la Nación. Julio 2012.
Quian J, Cerisola A, RÜttimann R. Infecciones por Bordetella pertussis en niños menores de un año hospitalizados y sus contactos del hogar. Arch Pediatr Urug 2006; 77:229-36 25. Ministerio de Salud Pública. Presidencia de la Nación. Fundamentos de la vacunación en embarazadas con vacuna Tripla Bacteriana Acelular (dTpa) Argentina 2012.
Pinto L, Paulo M. Pitrez P, Luisi F, Piccoli de Mello P, Gerhardt M, Ferlini R, Cardoso Barbosa D, Daros I, Jones M, Stein R and Marostica P. Azithromycin Therapy in Hospitalized Infants with Acute Bronchiolitis is Not Associated with Better Clinical Outcomes: A Randomized,Double-Blinded, and Placebo-Controlled Clinical Trial. J Pediatr 2012:1-5
Raymond J, Armengaud B, Gendrel D. Pertussis in young infants: apnoea and intra-familial infection. Clin Microbiol Infect. 2007; 13:172-5
Centers for Disease Control and prevention guide lines for de controls of pertussis outbreak. Atlanta. 2009.
Orecchini A. Resistencia a macrólidos de Streptococus pneumoniae en Hospital de Niños Santísima Trinidad de Córdoba. Libro de resúmenes de las Jornadas de Pediatría de la Sociedad Argentina de Pediatría 2012.
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